Healthcare For Older Adults

Medicaid for older adults – people age 65 and older – offered by the Rhode Island Executive Office of Health and Human Services (EOHHS) takes many forms including:

  • Comprehensive health coverage for services like doctor visits, prescriptions, and hospital stays
  • Help paying Medicare premiums
  • Long-term services and supports (LTSS) in a nursing home, assisted living or shared living residence or at home

We also offer many other health services and supports to older adults who do not qualify for Medicaid.

Health Coverage

Eligible Older Adults without Medicare: Comprehensive Medicaid health coverage for low income older adults (age 65 and older) who DO NOT have Medicare or other health insurance coverage is available through Rhody Health Partners.  

Eligible Older Adults with Medicare:  Medicaid health coverage is available for older adults (age 65 and older) who DO HAVE Medicare and are eligible for Medicaid through the EOHHS Integrated Care Initiative (ICI).  Enrollment is voluntary and includes all the Medicaid covered services you need. Your Medicare coverage, Medicare Part D prescription drug coverage and, if you have one, Medicare Advantage Plan WILL NOT change if you enroll. Eligible older adults have a choice of enrolling through one of the following service delivery options:

  • Neighborhood INTEGRITY is a health and drug plan for Rhode Islanders eligible for both Medicaid and Medicare. Whether you are caring for yourself or a loved one, we can help you with even the most complex choices. We will explain your benefits, help coordinate your care and make sure you understand what you need to be well.
  • Program for All Inclusive Care for the Elderly or PACE is an integrated care option for older adults who qualify for Medicaid Long Term Care and have  a 'high' or 'highest' level of care need. Individuals must be 55 years or older to enroll.

Eligibility
There are three eligibility pathways to Medicaid for low income, uninsured older adults. Your income, resources and health needs will determine if you are eligible and what type Medicaid benefits you are eligible to receive. Once you have been determined eligible, you will receive a letter offering you the choice of enrolling in a Rhody Health Care Plan or a Connect Care Choice primary care practice. Older adults also receive dental care.

Medicare Premium Assistance is available for low income older adults who DO HAVE Medicare coverage through the Medicare Premium Payment Program (MPPP).

The MPPP helps older adults (age 65 and older) and adults with disabilities pay all or some of the costs of Medicare Part A and Part B premiums, deductibles and co-payments. Medicare Part A is hospital insurance coverage and Medicare Part B is for physician services, durable medical equipment and outpatient services.

Am I Eligible for the MPPP?
A person’s income and resources determine eligibility and which type of Medicare premium assistance is available.

Medicaid LTSS Preventive Services are for older adults (age 65 and older) enrolled in Medicaid who do not meet the criteria for full Medicaid long term services and supports. You may qualify for a limited range of “Preventive LTSS" if they meet certain clinic requirements.

Long-Term Services and Supports (LTSS)

Long-term care services and supports (LTSS) are for people with chronic illnesses and/or disabilities who can not care for themselves all of the time.  Medicaid LTSS covers both medical care and non-medical living supports that assist with normal daily tasks like eating, dressing and using the bathroom. LTSS is available in a person's  home and in community settings like assisted living as well as in health facilities like nursing homes.

Eligibility for Medicaid LTSS
Medicaid LTSS is for older adults (age 65 and older) who meet: (1) financial requirements related to income, resources (like cash) and assets (home ownership) and (2) clinical requirements related to health care needs. We determine the functional/clinical “level of care” need for eligibility. In addition, your resources (cash, savings, etc.) must be under $4,000.  If your monthly income is over $878, you may pay a share of the cost for your long term care.  See Long-Term Services and supports for more information about the types of Medicaid LTSS available and the settings in which they are covered.

What are my LTSS service delivery options?

If you meet the clinical and financial criteria for Medicaid long-term services and supports, the following are some options you may have:

  • Managed long-term services and supports. Neighborhood INTEGRITY or PACE
  • Fee-for-service. You can get your LTSS through a fee-for-service system. Under this system, you choose agency or provider who delivers the service(s).
  • Self-direction. You and/or your family can purchase home and community-based services on your own through a self-direction service delivery system. Under this option, you will work with EOHHS staff to develop a budget for the services in your authorized plan of care. We will then connect you to an agency – a “fiscal intermediary --that will help you pay for needed services.

Am I eligible for LTSS Cost-Share Program?

The Office of Healthy Aging’s (OHA) At Home cost-share program is an option for people who do not qualify for Medicaid and need help to remain at home. This program offers provider delivered in-home care services and/or adult day services for individuals 65 years or older who require considerable assistance leaving their homes and those age 19-64 with home and community-based services and supports (who have a diagnosis of Alzheimer’s or a related dementia and who meet program eligibility). The OHA program serves people who are not financially eligible for Medicaid long-term services and supports (LTSS) but have income at or below 250% of the Federal Poverty Level (FPL). Participants in this program are responsible for paying a share of the costs for the services they receive. The amount of the cost-share varies by income. See the OHA's At Home Cost-Share Program for more information.

Prescription Drug Assistance

You may be able to get help paying for part of the cost of some prescription drugs. There are several programs that can help:

  • Medicare Part D Prescription Coverage – 1-800-Medicare (1-800-633-4227) or The POINT at 401-462-4444
  • Partnership for Prescription Assistance – 1-888-477-2669
  • Veterans Administration – Helps veterans pay for prescriptions. Providence VA Medical Center at 401-273-7100.

Call The POINT at 401-462-4444 or 401-462-0740 TTY for information and referrals.