The Medicaid program provides comprehensive medical coverage to seniors (age 65+) and people with permanent disabilities. People receiving SSI benefits automatically qualify for Medical Assistance. Seniors and people with disabilities who are receiving Social Security Retirement or Disability benefits (or have other income) and have income/resources that exceed the SSI limits may still be eligible for Medical Assistance which has higher income and resource limits. In addition, people with disabilities who are waiting for a decision on eligibility for SSI or Social Security Disability Insurance benefits may be eligible for Medical Assistance. If income is less than 138% FPL, the person may be eligible for Medicaid based on income.
- 65 and older.
- People who have a severe physical and/or mental disability that has lasted or will last longer than one year or will result in death and prevents any substantial gainful employment.
- Must be a citizen or eligible immigrant. Eligible immigrants include refugees or persons granted asylum. Lawful Permanent Residents who entered the U.S. before 8/22/96 or if entered on/after 8/22/96 must be in status for at least 5 years. In addition, immigrants who were in lawful status in the U.S. before 8/22/96 and lived in RI at some time before 7/1/97 may be eligible for coverage.
Income and Resource Limits
There are two programs within the Medical Assistance Program that provide coverage for seniors and people with disabilities. The first is called “The Low Income Aged/Disabled program.” For this program, the resource limits are $4,000 for an individual and $6,000 for a couple. The home in which the individual lives and a car used to get medical treatment are not counted. The monthly income limit in 2017 is $1,025 for an individual and $1,374 for a couple.
The second program is called “Medically Needy.” The resource limits and exemptions (home, car) are the same as for the Low Income Aged/Disabled program. The monthly income limit is $903 for an individual and $947 for a couple. If the applicant has income above the Low Income Aged/Disabled limit, s/he can become eligible for Medical Assistance coverage for a six month period through the “flex test” by showing medical bills that equal the difference between income and the Medically Needy limit.
How to Apply
For seniors, a decision is made within 30 days of the date of the application. People with disabilities (who are not receiving Social Security Disabilities Benefits) need to submit medical information from their doctor. A decision on the application is made within 90 days of the date of application.
Re-certification: Renewal of eligibility for Medical Assistance is required every 12 months.
Applicants denied Medical Assistance coverage and recipients who are notified that benefits will be terminated can request a hearing within 30 days of the date of the notice. If a hearing is requested within 10 days of the notice of benefit termination or reduction, benefits can continue until a hearing decision is reached.
RI Legal Services (1-800-662-5034) or the Disability Law Center may provide assistance to families who are denied benefits, receive notice of termination or have other problems with Medical Assistance coverage. You can also contact RIREACH for assistance (855-747-3224).
For more information on Medical Assistance see the EOHHS website.