Section 210-RICR-40-05-2.2 - General Provisions Eligibility CriteriaA. For the IHCC groups in this section, MN coverage is available to elders and persons with disabilities with high medical expenses who have income above the EAD income limit, but otherwise meet all of the general eligibility requirements for Medicaid set forth in § 1.9 of this Subchapter. 1. Determination process - Applicants who do not meet the income limits for Medicaid in the IHCC groups are automatically evaluated for MN coverage. Members of the MACC groups must contact an agency eligibility specialist if seeking MN coverage. The MN cases are determined for a six (6) month period beginning with the first (1st) day of the month in which the application is received. NOTE: To ensure EOHHS' continuation of eligibility for enhanced Federal funding, during the novel Coronavirus Disease (COVID-19) Federal declaration of emergency, the State will temporarily extend the six (6) month eligibility period. This extension will last at least until the end of the Federal emergency period. This extension only applies to individuals that are not also enrolled in another Minimum Essential Coverage group (MEC), as defined in 42 C.F.R. § 433.400. This extension supersedes all references to the six (6) month eligibility period for the duration of the COVID-19 Federal declaration of emergency. Effective the last day of the month following the month in which the Federal declaration of the COVID-19 public health emergency is terminated, the six (6) month eligibility period will no longer be automatically extended.2. Eligibility for Medicaid health coverage as MN is not established, however, until the applicant has presented proof of health expenses incurred and paid or that remain outstanding for the eligibility period. Any health expenses for which a beneficiary continues to be liable dating back to the retroactive period are also considered.3. Continuing eligibility - The date of eligibility is the actual day of the month the applicant incurs a health expense - not the billing date - which reduces income to the MNIL. Eligibility may be renewed on a continuing basis if the beneficiary is liable for health care expenses that exceed current income. Otherwise, a re-evaluation of eligibility, based on the cost of health costs currently being incurred is required.4. Agency responsibilities - The EOHHS must inform applicants who have income above the applicable limit for the appropriate IHCC group that MN coverage is an option and provide information about allowable health expenses for spenddown purposes and the scope and limits of obtaining coverage through this eligibility pathway. In addition, applicants must be informed of the impact of obtaining MN Medicaid health coverage for other programs, including the Supplemental Nutrition Assistance Program (SNAP) and the MPPP.5. Applicant/beneficiary responsibilities - Eligibility and renewal is contingent upon the applicant/beneficiary providing bills and receipts related to allowable health care expenses that are not paid through a third (3rd) party. Therefore, the chief responsibility of the applicant/beneficiary is to maintain and present this information, unless submitted directly by a provider, to the State agency.210 R.I. Code R. 210-RICR-40-05-2.2
Amended effective 10/5/2021
Amended effective 3/30/2022