Section 210-RICR-40-15-1.1 - Scope and ApplicabilityA. One of the principal objectives of health and human services policymakers is to support Medicaid-eligible adults with disabilities who work by enabling them to obtain or maintain the coverage they need to retain their independence and optimize their health. Toward this end, an array of State and Federal laws and Regulations have been adopted that establish special provisions for disregarding all or a portion of the earned income of adults with disabilities who work. The State also provides Medicaid coverage for an array of employment services and supports to assist beneficiaries with disabilities who are employed. In addition, the State has taken the option under Federal law to create a unique eligibility pathway - known as the Sherlock Plan - which enables working adults with disabilities who are otherwise Medicaid ineligible or unable to obtain needed employment supports to buy into the program at a low monthly cost.B. To qualify for the Medicaid special income provisions, a person must be determined to have a disability by a Federal or State government entity or appropriately designated contractual agent of the State in accordance with the standards set forth in Subchapter 05 Part 1 of this Chapter. Such entities include the U.S. Social Security Administration and the Medical Review Team (MART) and Office of Medical Review (OMR) within the Executive Office of Health and Human Services (EOHHS). Adults with disabilities who work and are seeking initial or continuing eligibility for Medicaid long-term services and supports (LTSS) may be subject to distinct "clinical/functional disability" criteria, as set forth in §1.7.1 of this Part. A beneficiary who meets these disability criteria and qualifies for these special income provisions is eligible for the full range of Medicaid covered employment services and supports.C. Employment services and supports may also be available to adults with disabilities, over age nineteen (19), who are eligible for Medicaid in accordance with the provisions of Part 30-00-1 of this Title in one (1) of the Medicaid Affordable Care Coverage (MACC) groups based on the modified adjusted gross income standard - MAGI. Although a disability determination is not required, the scope of employment services and supports available may not be as extensive as through the other eligibility pathways for working adults with disabilities. Accordingly, seeking eligibility based on a formal determination of disability is an option, as set forth in herein in the following sections.210 R.I. Code R. 210-RICR-40-15-1.1
Amended effective 10/5/2021