Rhode Island Medicaid Long Term Care Eligibility
Rhode Island Long Term Care
See “Further Reading” at the end of this page.
1. Residency and Citizenship – the applicant must be a resident of Rhode Island and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.
3. Income Limitations – (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.)
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Under Rhode Island law, the transfer of assets to certain recipients will not trigger a period of ineligibility. A home can be transferred to (A) one’s spouse or permanently blind or disabled child (B) into a trust for other disabled dependents (C) a child under age 21 (D) a sibling who has lived in the home for at least a year before the applicant’s institutionalization and holds equity interest in the home (D) a child who has taken care of the applicant for at least two years, thus delaying the need to move into a nursing home.
Exempt Assets for an applicant in Rhode Island include:
i. $4,000 or less in cash/non-exempt assets if single. If married, the asset limit is raised to $6,000.
ii. One home and adjoining land is exempt (equity limit $560,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified if in use. If not in use, the fair market value of up to $4,500 is excluded.
iv. Irrevocable burial trust of up to $1,500 per individual. Burial spaces, no amount specified.
v. Household furnishings, furniture, clothing, jewelry, antiques, boats, and other personal effects are exempt up to $5,000 per household.
vi. Value of life insurance if face value is below $4,000 per individual.
vii. Non-resident property essential to self support (i.e. rental property) if monthly revenue is below income limitations.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $119,220. If the community spouse’s assets do not equal the minimum of $23,844, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $1,966.25. The maximum amount of income that can be retained is $2,980.50 varying by case, depending on unique living expenses.
Rhode Island long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
Rhode Island Medicaid public policy rules and regulation manual: http://www.dhs.ri.gov/Portals/0/Uploads/Documents/Public/Policy/Medicaid_Rules_and_Regulations.pdf
Rhode Island consumer information for long term care services and support: http://www.eohhs.ri.gov/Consumer/ConsumerInformation/Healthcare/LongTermServicesandSupports.aspx