Section 218-RICR-40-00-4.3 - Client Eligibility and Financial Participation by Clients4.3.1Medicaid Home and Community Based ServicesA. To be eligible for the Program, the client must be determined, through a functional assessment, to need assistance with activities of daily living and/or to meet an institutional level of care and must meet the following criteria: 1. Medicaid eligible residents of the State who are age sixty-five (65) or older; and2. Eligible for the Rhode Island Medicaid Program as determined by the Department of Human Services. Applicants must also be assessed and determined to be in need of the assistance provided by the Program.4.3.2At Home Cost-Share Program EligibilityA. The Program group and eligibility requirements are determined by the State as follows: 1. Single adults - a single adult requesting the Program, is treated as an individual that is a group of one (1).2. All single adults must meet the following eligibility requirements:a. A Rhode Island resident;b. Sixty-five (65) years of age, or age nineteen (19) to sixty-four (64) with a medically documented diagnosis of Alzheimer's Disease or other underlying related cause of dementia;c. Ineligible for Medicaid; andd. Income does not exceed two hundred fifty percent (250%) of the FPL.3. Adults with spouses - when two (2) spouses are living together, both the person requesting the Program and the applicant's spouse are considered members of the applicants Program group (as a "couple" or group of two (2)) unless one (1) of the exceptions specified below applies: a. Living together - a couple is considered living together in any of the following circumstances: (1) Until the first (1st) day of the month following the calendar month of death or marriage separation (when a spouse dies or the couple separates); or(2) When the number of days one (1) spouse is expected to receive LTSS in an institution is fewer than thirty (30) days.b. Exceptions - adult applicants with spouses are treated as an "individual" for eligibility purposes in the following circumstance:(1) When one (1) spouse in a couple is receiving LTSS in an institution.4. All adults with spouses must meet the following eligibility requirements: a. A Rhode Island resident;b. Sixty five (65) years of age, or age nineteen (19) to sixty-four (64) with a medically documented diagnosis of Alzheimer's Disease or other underlying related cause of dementia;c. Ineligible for Medicaid; andd. Income does not exceed two hundred fifty percent (250%) of the FPL.B. Availability of services under the Program shall be dependent upon appropriation of funds by the Rhode Island General Assembly. Persons meeting the eligibility requirements of § 4.3.2(A) of this Part shall be eligible for the cost share payment portion of the Program.4.3.3Financial Participation by ClientsA. Medicaid Home and Community Based Services Program Client share of cost for those eligible for Rhode Island Medicaid Program shall be determined by the Department of Human Services.
B. At Home Cost Share Program Clients determined eligible under § 4.3 of this Part shall be assigned a cost share based on their income level and their selected services. Clients are responsible to pay their cost share directly to the vendor/service provider.
C. Income Guidelines of the At Home Cost Share Program are determined by the Office according to the Federal poverty limit (FPL). 1. Program income guidelines will be adjusted annually when new FPL guidelines are issued. The Director has the authority to adjust cost share amounts up to a maximum of the amounts cited below: a. Level One (1) (1) Individual: up to one hundred twenty-five percent (125%) FPL for individuals(2) Home Care Cost Share: four dollars and fifty cents per hour ($4.50/hour)(3) Couple: up to one hundred twenty-five percent (125%) FPL for families of two (2)(4) Adult Day Services Cost Share: seven dollars per day ($7.00/day)b. Level Two (2) (1) Individual: greater than one hundred twenty five percent (125%) and up to two hundred percent (200%) FPL for individuals(2) Home Care Cost Share: seven dollars and fifty cents per hour ($7.50/hour)(3) Couple: greater than one hundred twenty five percent (125%) and up to two hundred percent (200%) FPL for families of two (2)(4) Adult Day Services Cost Share: fifteen dollars per day ($15.00/day)c. Level Three (3) (1) Individual: greater than two hundred percent (200%) and up to two hundred fifty percent (250%) FPL for individuals(2) Home Care Cost Share: seven dollars and fifty cents per hour ($7.50/hour)(3) Couple: greater than two hundred percent (200%) and up to two hundred fifty percent (250%) FPL for families of two (2)(4) Adult Day Services Cost Share: fifteen dollars per day ($15.00/day)218 R.I. Code R. 218-RICR-40-00-4.3
Amended effective 4/5/2022