Health Insurance for Families and Pregnant Women

Health Insurance for Families and Pregnant Women

Pregnant women, children and parents with lower-incomes may be eligible for comprehensive medical and dental coverage through the Medicaid RIte Care/RIte Share program. If income is above the Medicaid limit, low-cost coverage may be purchased through HealthSource RI (HSRI). Since the income limits for RIte Care are higher for children than the income limits for parents, some families may have children enrolled in RIte Care while the parent purchases coverage through HSRI.

Medicaid coverage is provided through RIte Care or RIte Share, depending on whether a parent has access to health insurance coverage through their job. For dental coverage, children are enrolled in RIte Smiles, a managed care program. Adults use their Medicaid card to access dental care.

RIte Care: Recipients enroll in one of 3 managed care plans: Neighborhood Health Plan of Rhode Island, United Health Care of New England or Tufts Health Plan. There is no cost for enrollment. If a parent does not want to enroll in their employer’s coverage, she will not be eligible for Medicaid, but her children will still be eligible for RIte Care.

RIte Share: Pregnant women and families in which an individual can enroll in health insurance at their job are required to enroll in that coverage if the state determines that the insurance meets certain standards. The state pays the employee’s share of the cost (minus a required co-payment if income is above 150% FPL). Recipients also receive a Medicaid card to cover costs and services not provided through the employer’s plan (e.g., transportation, interpreter services).

Who Qualifies?

• Children/young adults under age 19 living in a family with income less than 266% FPL. All children/young adults are eligible regardless of immigration status – including children who are undocumented and DACA. Children and young adults participating in DCYF foster care, kindship or guardian programs are eligible with no income limits.
• Parents with income less than 141% FPL. The parent must be a citizen or eligible immigrant. Eligible immigrant includes refugee, granted asylum and lawful permanent resident (LPR). An adult LPR must be in status for 5 years before he/she is eligible for RIte Care/RIte Share. There is no waiting period for refugees and asylees. Lawfully present immigrants who are not eligible for RIte Care/RIte Share can purchase coverage through HealthSource RI.

• Pregnant women with income less than 258% FPL. All pregnant women are eligible for RIte Care/RIte Share regardless of immigration status (including women who are “undocumented”).

Income/Resource Limits

There is no resource test for RIte Care/RIte Share. Income must be within the applicable limit for a child, parent or pregnant women. For families with income below 141% FPL, parents and children may all be RIte Care/RIte Share eligible. If income is above 141% FPL and below 266% FPL, children may be eligible for RIte Care and parents may be eligible for federal tax credits to help them purchase coverage through HealthSource RI. Parents with income below 175% FPL whose children are enrolled in RIte Care/RIte Share can also receive a state payment to help pay for insurance. Payment is based on income and family size, visit our HealthSource RI Guide Page.

How to Apply

You can apply online at healthyrhode.ri.gov or by submitting a paper application which you can download at https://tinyurl.com/RI-DHS-2-2018. You can also request a paper application from a DHS office or by calling: 1-855-697-4347.

The online system will check income, citizenship, immigration status and other required information by accessing other government databases. The website is secure and all information is maintained confidentially. If the information cannot be checked this way, applicants will be asked to provide paper documentation.

HealthSource RI will determine eligibility for each family member applying for health insurance coverage. If all members are eligible for RIte Care they will choose a RIte Care plan. If children are eligible and parents are not (family income is between 141% and 266% FPL), the parent will enroll the children in a RIte Care plan and select a commercial plan to purchase through HealthSource RI.

*Families and pregnant women can enroll in RIte Care/RIte Share at any time. Eligibility is based on current monthly income. There is a limited period to enroll in a commercial plan through HSRI, usually November – January. People can enroll outside of this open enrollment period under certain circumstances including: loss of job-based health insurance, a significant change in income, moving to a new state.

People needing help with the application process can call the HSRI Contact Center at 1-855-840-4774. People who want to meet with a helper to complete the application can meet with a Navigator in their community. There are bilingual navigators and navigators also have access to a language line for translation. Click here to find a Navigator or call 2-1-1.

A decision on a RIte Care/RIte Share application should be made within 30 days and the applicant receives written notification.

Families need to recertify for RIte Care/RIte Share on a yearly basis. The state must send a written notice of intent to stop or change benefits at least 10 days before the change.

Families and pregnant women denied RIte Care/RIte Share or notified that benefits will stop can request a hearing within 35 days of the date on the notice.

RI Legal Services (1-800-662-5034) may provide assistance to families who are denied benefits, receive notice of termination or have other problems with RIte Care/RIte Share. You can also contact RIPIN for assistance (401-270-0101).

Annual Income Guidelines (Feb 2024)

Monthly Income Guidelines RIte Care/RIte Share (Jan 2024)