Health Care

Older woman with visiting nurse, stethoscope

The Rhode Island Executive Office of Health and Human Services (EOHHS) administers the publicly-funded Medicaid program. Medicaid is an important source of coverage for low-income families with children, pregnant women, older adults (age 65 and over) and people with disabilities and special needs who otherwise might not be able to pay for or get access to affordable health care.

Are you looking for coverage for:

How has Medicaid Health Care Changed?

Expansion of Medicaid Eligibility. Since 2014, adults between the ages of 19 and 64 who are either not eligible for or enrolled in Medicare or receiving Supplemental Security Income (SSI) have had access to Medicaid. If you are an adult in this age group and your monthly income for just you is at or below 138% of the federal poverty level a month (see chart here), you may be eligible for Medicaid affordable care coverage through a Rhody Health Partner’s plan.

How to Apply. Medicaid and HealthSource RI work together using Rhode Island’s state-of-the-art eligibility system created for health reform. This web-based system determines eligibility for most types of Medicaid and other forms of affordable coverage using a single, streamlined application. There may be instances in which you will have to fill out a longer application or complete additional forms, if you are looking for long-term care, for example. The good news is that HealthSource RI will point you in the right direction if that is what is best for you after asking just a few questions.

You can apply online at HealthyRhode.ri.gov and you will be guided step-by-step through the application process. You can still apply using a paper application, in-person or by mail, telephone, or fax, if that works better for you.
Adults seeking long-term care who are receiving Medicare or SSI must complete the DHS-2 application. You can bypass HealthSource RI and complete the DHS-2 application online by clicking here or in paper form: English, Spanish, Portuguese.

Income Standard. We use modified adjusted gross income or MAGI – when determining Medicaid eligibility for families, children, pregnant women, and adults in the Medicaid expansion group. We can use electronic matches to verify your income in most cases, so you won’t have to provide extra documentation.

Types of Coverage

The types of health services and supports Medicaid covers varies depending on age, family structure and a person's needs. For families, children and pregnant women, RIte Care and RIte Share offer full health insurance coverage through a managed care organization. Adults ages 21 and older are covered through a Rhody Health Partners (RHP) plan.

If you need long-term care, we offer programs to cover home and community-based services (your own home, assisted living or shared living arrangement, and group homes) and institutional settings like nursing homes and certain hospitals, depending on your needs. For people who are receiving Medicare and are eligible for Medicaid, there is a long-term services and support (LTSS) managed care arrangement as well. Please see our Integrated Care Initiative for more information.

Medicaid Health Plans:

Neighborhood Health Plan of Rhode Island
1-800-459-6019

Tuft Health Plan
1-866-738-4116/ TTY: 711

UnitedHealthcare Community Plan
1-800-587-5187

Medicaid Dental Plans:

UnitedHealthcare Dental/RIte Smiles
1-866-375-3257

Medicaid Dental Services (Older Children & Adults)

Eligibility

You must be a resident of Rhode Island to apply and be able to prove that you are a citizen or a legally present non-citizen who is in a status that qualifies you for publicly funded health coverage. Whether you are eligible for one of our programs depends on a variety of factors including: income, age, type of health care needs, and, for certain programs, the amount of your resources or assets.

To learn more or check whether you are eligible and how to apply, click here.