210 R.I. Code R. 210-RICR-50-00-4.5

Current through December 3, 2024

Section 210-RICR-50-00-4.5 - Starting the Application Process

A. Applying for LTSS. All persons seeking initial Medicaid LTSS must apply, including existing Medicaid beneficiaries who are already covered through a non-LTSS pathway for parents/caretakers and adults eligible under the federal Affordable Care Act (ACA) expansion. Persons eligible for Community Medicaid (non-LTSS) are evaluated on a set of general, financial and functional/ clinical eligibility requirements in accordance with §40-05-1.5.2 of this Title and Rhode Island's Medicaid Section 1115 waiver. The information existing beneficiaries must provide when applying for LTSS is limited to only those eligibility factors related to clinical / functional and financial eligibility not already known to the agency.

B. Application Points. The State is committed to pursuing a "No Wrong Door" policy that offers consumers multiple application and renewal access points which all lead to the State's IES. (§40-00-2.2 of this Title).

1. On-line, Self-Service - Persons seeking initial or continuing eligibility have the option of accessing the eligibility system on-line using a consumer self-service portal through links on the EOHHS (www.eohhs.ri.gov) and DHS (www.dhs.ri.gov) websites or directly through HSRI (HealthSourceRI.com). Supplemental forms and required documentation may be uploaded directly on-line or faxed, emailed or U.S. mailed. The information applicants provide on-line is entered directly into the IES and processed electronically in real-time. The initial steps for applying on-line are as follows:

a. Account Creation. To initiate the application process, a person must create an account in the eligibility system. This can be done through the self-service portal by the applicant or with the help of an eligibility specialist or certified assister.

(1) Identity proofing. The applicant must provide personally identifiable information when creating an on-line account as a form of identify proofing. Verification of this information is automated.

b. Account matches. Once identity is verified, account matches are conducted to determine whether the applicant or members of the applicant's household have other accounts or are currently receiving benefits. The IES draws on information in an applicant's account when determining eligibility for other programs. This reduces the need for additional verification and supportive documentation in some circumstances.

2. Paper DHS-2 Applications - Paper forms may be completed on-site with assistance from LTSS eligibility specialists and/or submitted at various agencies, as indicated in § 4.5(D) of this Part below. Applications may also be mailed or faxed to the address identified on the DHS-2. Irrespective of point of receipt, all applications and supplemental forms are indexed scanned into the IES through the EOHHS central mail management system and assigned for review according to the type of assistance requested.

C. Application Packet. The application packet contains the several forms requesting the information necessary to determine whether a person is eligible for Medicaid LTSS. There are two types of forms required for Medicaid LTSS eligibility, however applying:

1. General Application Form - The DHS' "Application of Assistance", known as the "DHS-2", is the principal application form a person must complete when applying for Medicaid LTSS. The paper version of the DHS-2 is available on-line at: at one of the DHS offices listed here. Community agencies and LTSS providers may also be able to provide copies of the DHS-2. The DHS-2 is used for LTSS and as the basis for determining eligibility for: Supplemental Nutrition Assistance Program (SNAP), Child Care Assistance Program (CCAP), Community Medicaid for elders and adults with disabilities (EAD) who are seeking long-term care, the Sherlock Plan for persons with disabilities who work (SP), the State-funded optional supplemental security program (SSP) and the RI Works Program.

2. Supplemental Forms - All applicants for LTSS must also complete additional forms that provide the information necessary to review the application and/or determine various eligibility factors.

LTSS Required Supplemental Forms
Name of Form	Used in:	Details	Applicant sends to:
DHS-2 Cover Sheet	Application	Identifies LTSS applicants and type of services requesting	Agency with DHS-2
CP-12 Applicant Choice	General Eligibility	Applicant must attest that information about types of LTSS (institutional and HCBS) has been provided	Agency with DHS-2
Clinical/functional evaluation by Health Care Provider, GW OMR PM 1 and supporting documentation	Clinical/functional eligibility	Form for health care provider to complete	Principal Health Care Provider (physician, NF, assisted living residence). Agency sends upon request and follows-up if no response by time of application review.
Consent Form, DHS-25M-CL Provider	Clinical/functional eligibility	Supplemental form for health provider which authorizes release of health care information. Two copies included in the application packet to be sent to health care provider and/or community agency Provider	Health Care Provider
Authorization to Obtain or Release Confidential Information, DHS-25 (New consolidated form that incorporates DHS-91)	General/financial eligibility	Release for non-medical confidential information	Agency with DHS-2

3. Limits on Application Information - As the DHS-2 is an integrated application that is used across health and human services programs, applicants must answer questions that are sorted by program. Applicants are responsible for answering only those questions pertaining to eligibility for the programs for which they are applying:

a. On the paper application, the relevant questions are marked with the acronym associated with the specific programs for which the applicant is applying. "KB" means Katie Beckett, "LTSS" means long-term services and supports

b. Applicants using the electronic version of the DHS-2 may identify the programs for which they are applying upfront. The IES then automatically sorts the questions they must answer by their program(s) of choice.

D. Application Assistance. DHS and EOHHS eligibility specialists provide application assistance in completing all necessary forms, obtaining and submitting required documentation, and responding to inquiries or requests for information. Assistance is also available through:

1. The Division of Developmental Disabilities in the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) for adults with developmental/intellectual disabilities seeking Medicaid. The division also provides specialized assistance and case management services to beneficiaries.

2. The Division of Elderly Affairs (DEA) of the DHS is an additional source of application services for persons seeking LTSS in the home and community-based setting. These services are provided through community agencies under contract with DEA which also provide needs assessments to applicants and case management services to beneficiaries.

3. Community-based certified assisters including State Health Insurance Assistance Program (SHIP) counselors working through local Senior Centers and THE POINT, the State's Aging and Disabled Resource Center (ADRC).

E. Applicant Rights. The State is responsible for upholding the following rights of Medicaid LTSS applicants:

1. Authorized Representatives - Applicants may designate someone to serve as an authorized representative to help or act on their behalf in dealing with agency eligibility and LTSS specialists.

2. Translation Services - An interpreter or translator is available to assist in the application process, upon request.

3. Protection of Privacy -- All information applicants provide is kept confidential unless the agency is otherwise authorized to share with other State and federal agencies for the purposes of verification and enrollment.

4. Appeals - The agency accepts appeals and holds hearings on actions related to eligibility decisions in accordance with Part 10-05-2 of this Title.

5. Non-discrimination - Applicants are treated in a manner that is free from discrimination based on race, color, national origin, sex, gender identity or sexual orientation, age or disability.

6. Non-LTSS Medicaid Beneficiaries - Existing Medicaid beneficiaries who are seeking to expand their coverage to include LTSS may initiate the application process by requesting a change in coverage through their on-line account or by contacting DHS eligibility specialists.

210 R.I. Code R. 210-RICR-50-00-4.5