MEDICAID – ADULTS AGE 19 – 64

The Medicaid Program provides comprehensive medical coverage to low-income adults age 19 – 64 who do not have children in their care.

Income must be less than 138% of the federal poverty level which is $16,643 for a single adult (Effective April 2017). There is no resource test for eligibility.

Note for people with disabilities: People with disabilities can be eligible for Medicaid through this category of coverage if income is within the limit. If income is above the income limit, a person with disabilities may be eligible for Medicaid under the disability category and can submit an application through the Department of Human Services (DHS). A person with disabilities who needs long term services and supports also needs to apply for coverage through DHS since these services are not covered benefits through this income-based category.

The individual must be a citizen or eligible immigrant. Eligible immigrants include: refugees, persons granted asylum, lawful permanent residents. Refugees and persons granted asylum are eligible immediately. Lawful permanent residents (LPR) who entered the U.S. after 8/22/96 must be in status for five years before they are eligible.

Individuals who are determined eligible for Medicaid will have a choice of enrolling in one of three managed care plans, Neighborhood Health Plan of RI, UnitedHealthcare, or Tufts Health Care (effective 6/1/17)

You can apply on-line here or by submitting a paper application which you can download here. You can also request a paper application from a DHS office or by calling: 1-855-697-4347. Eligibility will generally be determined by using data about income, citizenship, immigration status and other required information from other government agencies. Applicants may be asked to provide paper documentation if a computer data match is not possible. A paper application is also available from the Department of Human Services. People who need help applying can meet with a Navigator in their community. Call 2-1-1 to find a Navigator.

Youth who were in foster care: Youth who were in foster care & receiving Medicaid on their 18th birthday are eligible for RIte Care until they turn 26. There is no income limit for these young adults. The application is through DCYF.

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.

For more information on Medical Assistance see the EOHHS website.