218 R.I. Code R. 218-RICR-40-00-4.4

Current through December 3, 2024

Section 218-RICR-40-00-4.4 - Program Eligibility and Duration of Eligibility

4.4.1Program Eligibility

A. The Office and its contracted case management agencies shall utilize the Office approved assessment form described in Rules, Regulations, and Standards for Certification of Case Management Agencies, Part 5 of this Subchapter. This form shall include, but shall not be limited to:

1. Pertinent demographic information;

2. Residence;

3. Date of birth;

4. Marital status;

5. Annual income for the previous calendar year, including amount and source of income (such income must be supplied for applicant and spouse when applicant is married);

6. Information on participation in other home and community-based programs;

7. Social security number;

8. All other data essential for the determination of eligibility and the maintenance of client statistics;

9. Certification through signature of the applicant that permission is granted to the Office to verify any and all information supplied on the application form as well as certification through signature that the applicant will supply to the Office, upon request, written documentation of all information included on the application form.

B. Such application form shall be made available to the Office's contracted case management agencies. The Office may verify eligibility information in one (1) or more of the following ways:

1. Review and certification of eligibility by trained staff for each assessment filed with the Office or its contracted case management agencies;

2. Computer cross checks with available data banks;

3. Home-based assessment to obtain documentation for age, residence, functional status, and previous year's annual income or income for the ninety (90) days prior to application for services;

4. Confirmation of Medicaid eligibility by the Rhode Island Department of Human Services (specific to Medicaid LTSS);

5. Physician confirmation of diagnosis and functional need for services;

C. The following documentation shall be accepted as verification of age, residence, and income under the Program:

1. Age: One (1) of the following:

a. Rhode Island driver's license or identification card;

b. Birth certificate; or

c. Any other official local, State, or Federal document which indicates verified date of birth.

2. Residence: One (1) of the following:

a. Rhode Island drivers license or identification card; or

b. Any other official document which indicates permanent residence, (i.e. utility bill, tax return, etc.).

3. Income, Disregards and Medical Expenses: A combination of the following is sufficient to document all income, income disregards and medical expenses included in the definition of such under the Program:

a. Previous calendar year federal income tax return;

b. Employment income: W-2 form, pay stubs with year to date total, letter from employer indicating length of employment and wages in previous calendar year;

c. TDI/Worker's Compensation: an award letter or copies of checks;

d. Unemployment benefits: a stamped, unemployment book or copies of checks;

e. Alimony or Support: a court decree or other documentation;

f. Pension Benefits (Social Security, Veterans' Benefits, SSI, etc.): an award letter or, after determining date of initial award, copy of most recent award letter or written verification from income source;

g. Interest Income: savings statements, passbook, letter from savings institution, W-1099 or W-9 interest form;

h. Rental Income: rent receipts, lease agreement;

i. Self-Employment Income: all receipts, bills, invoices, and other documents establishing income and expenses of operations;

j. Any listing or verification from an agency or organization for one (1) of the above shall constitute acceptable documentation of income and allowable medical expense as defined in §§ 4.1.5(A)(8) and (15) of this Part.

4.4.2Duration of Eligibility

A. Clients whose eligibility has been established as described in § 4.4.1 of this Part shall remain eligible for a period of one (1) year, or until the following, whichever occurs first:

1. The client moves out of Rhode Island and is no longer a full-time resident; or

2. The client is no longer in need of the services of this Program; or

3. The Office conducts a reassessment of eligibility and determines the client to be ineligible.

218 R.I. Code R. 218-RICR-40-00-4.4

Amended effective 4/5/2022