Section 210-RICR-50-00-6.4 - LTSS Determination of IncomeA. In accordance with Medicaid institutional rules (Subchapter 05 Part 1 of this Chapter, Medicaid Long-Term Services and Supports: Institutionally Based LTSS), an applicant for Medicaid LTSS is both a financial responsibility unit (FRU) and a Medicaid eligibility unit of one (1) for the family size involved when determining financial eligibility once the joint resources of a couple have been allocated in the community spouse allocation of resources process in accordance with § 6.5 of this Part. There is also no spouse to spouse deeming of the income in the LTSS financial eligibility determination process.B. The financial eligibility for current non-LTSS Medicaid beneficiaries is reevaluated using the LTSS Rules with information previously provided to the State by the beneficiary. As additional information from the beneficiary may be required, financial eligibility determination is not automatic unless the basis for coverage is receipt of SSI.C. Medicaid LTSS is available to applicants and beneficiaries who have countable income that does not exceed the limits established for one (1) or more of the following eligibility pathways:1. ACA expansion adults - Adults between the ages of nineteen (19) and sixty-four (64) with income up to one hundred thirty-eight percent (138%) of the FPL, including the five percent (5%) disregard, using the MAGI method as set forth in Part 30-00-5 of this Title, Medicaid MAGI Financial Eligibility Determinations and Verification. The LTSS applicant is treated as a family of one (1) for LTSS eligibility purposes, irrespective of whether he or she resides with a non-LTSS spouse and receives services at home, in a health institution or a community-based service setting.2. Elders and adults with disabilities (EAD), including: a. SSI-eligible Medicaid beneficiaries;b. Adults between the ages of nineteen (19) and sixty-four (64). Medicare eligible or enrolled with countable income up to three hundred percent (300%) of the SSI rate using the method set forth in §40-00-3.2 of this Title; andc. Elders sixty-five (65) and older. Countable income up to three hundred percent (300%) of the SSI rate based on the SSI method in §40-00-3.2 of this Title.3. LTSS medically needy adults - Adults with countable income above three hundred percent (300%) of the SSI rate up to the average private pay rate for the applicable institutional level of care may be eligible as medically needy if they meet the requirements set forth in Part 2 of this Subchapter, Medicaid Long-Term Services and Supports: Medically Needy Eligibility Pathway. For these purposes, the average monthly private pay rate for the institutional level of care is as set forth in § 2.6 of this Subchapter and is included in summary of resources limits in §40-00-3.1 .7(A)(7)(d) of this Title. Except as provided herein, countable income is determined based on the SSI method in §40-00-3.2 of this Title. D. The provisions in § 6.11 of this Part govern the treatment of income from trusts for applicants and beneficiaries of Medicaid LTSS.E. Financial eligibility for Medicaid LTSS is determined at the time of initial application and annual renewal. Applicants and beneficiaries are required to report changes to EOHHS about income and resources that may affect eligibility within ten (10) days of the date the change occurs. Failure to make a timely report is treated as non-cooperation and may result in the termination of Medicaid LTSS eligibility unless good cause for non-reporting exists.F. Distributions from long-term care insurance policies that are used to pay for longterm services and supports are not treated as income for the purposes of determining Medicaid LTSS eligibility. For these distributions to be exempt, the policy must be issued by an appropriately licensed and certified entity or under the auspices of a Qualified Long-Term Care Insurance Partnership (QLTCIP) program in this State or another State.210 R.I. Code R. 210-RICR-50-00-6.4
Adopted effective 1/20/2019
Amended effective 7/21/2021