Section 210-RICR-40-00-1.8 - Medicaid BenefitsA. The benefits that members of the IHCC groups receive are dictated by the Medicaid State Plan and the State's Section 1115 demonstration waiver. Medicaid benefits include health care services and supports or, if a beneficiary has third party coverage such as Medicare, wrap-around coverage and/or financial assistance in paying premiums, co-pays, and cost-sharing. 1. Premium Assistance/and Financial Help - Dual Medicare and Medicaid beneficiaries, including those participating in the MPPP may receive full Medicaid health coverage and/or financial help paying for Medicare. The scope of benefits dual eligible beneficiaries receive depends on their income and resources. Premium assistance is also available for some Community Medicaid beneficiaries who have access to employer-sponsored insurance through the RIte Share Premium Assistance Program as set forth in Medicaid Code of Administrative Rules, Overview of the Affordable Care Coverage Groups.2. Health Care Services and Supports - The scope of services and supports beneficiaries receive varies as follows: a. Community Medicaid. Beneficiaries eligible for health coverage receive the full scope of primary care essential benefits - including acute, subacute and rehabilitative services - as well as thirty (30) days of LTSS and, based on need, a limited set of LTSS preventive services. Subchapter 10 Part 1 of this Chapter identifies the scope of covered services available through the managed care and fee-for-service delivery options for IHCC group beneficiaries eligible for full Medicaid benefits. Note: (1) The Medicaid benefits MPPP participants are eligible to receive may be limited to premium payment assistance only, depending on the basis of eligibility. See §05-1.6.1 of this Chapter. (2) For the scope of services covered under the Sherlock Plan, see Subchapter 15 Part 1 of this Chapter. b. Medicaid LTSS. Medicaid LTSS includes health supports, personal care, and social services in an institutional or home and community-based setting. The scope of Medicaid LTSS a beneficiary receives is based on need -- health status and functional ability -- and personal health preferences and goals. Persons eligible for Medicaid LTSS also receive the full scope of primary care essential benefits authorized under the Medicaid State Plan. To be eligible for Medicaid LTSS, a person must meet a specific set of financial and clinical criteria that do not apply to applicants seeking coverage through other Medicaid eligibility pathways.3. Integrated Care -- The State's Integrated Care Initiative (ICI) provides IHCC group members who have Medicare and other forms of third-party coverage who qualify for LTSS in accordance with the provisions set forth in the Medicaid Code of Administrative Rules, Overview of Medicaid and SSI-Related Coverage Groups, to obtain the coordinated services they need across the care continuum through a single plan. Subchapter 10 Part 1 of this Chapter covers these options and the process for plan selection and enrollment.4. Retroactive Eligibility - Up to three (3) months of Medicaid retroactive coverage is available for certain IHCC group beneficiaries. To qualify, the State must determine that a person would have met the applicable eligibility criteria for his or her coverage group if the application was submitted during the retroactive period. The State provides reimbursement to providers only for Medicaid covered services, however. The provisions in Subchapter 5 Part 3 of this Chapter explain the process for obtaining retroactive coverage in greater detail.210 R.I. Code R. 210-RICR-40-00-1.8