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. This category of Medicaid is sometimes called Medicaid Expansion or “MAGI”

Income must be less than 138% of the federal poverty level which is $17,609 for a single adult (Effective March 2020). 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). 

Individuals who have been found eligible for Social Security Disability Insurance benefits receive Medicare coverage 24 months after eligibility. If the person’s income is less than 138% FPL, s/he can receive Medicaid coverage until Medicare starts. Then the individual’s continued eligibility for Medicaid would be based on eligibility under the disability 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 have a choice of enrolling in one of 3 managed care plans, Neighborhood Health Plan of RI, UnitedHealthcare, or Tufts Health Plan.

You can apply on-line 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. 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.

People needing help with the application process can call the HSRI Contact Center at 1-855-840-4774. There are also Navigators at community locations who can help with the application process. 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.

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 35 days of the date on the notice. If a hearing is requested within 15 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 RIPIN for assistance (401-270-0101).

For more information on Medical Assistance see the EOHHS website.

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