Understanding Rhode Island Medicaid Long-Term Services and Supports (LTSS): A Comprehensive FAQ

Navigating Long-Term Care in Rhode Island

For many Rhode Island seniors and their families, the goal is to remain at home for as long as possible. However, the cost of professional assistance can be a significant concern. Rhode Island’s Medicaid Long-Term Services and Supports (LTSS) program is designed to help eligible residents receive the care they need in the setting that best suits them—whether that is in their own home, a community-based setting, or a skilled nursing facility.

At In Home Wellcare, we understand that the Medicaid landscape can feel overwhelming. As a CHAP-accredited and RI DOH Licensed agency (#HCP02513), we are here to help you understand how these benefits can be used to maintain independence through high-quality in-home care.

What is Rhode Island Medicaid LTSS?

Rhode Island Medicaid LTSS is a program administered by the Department of Human Services (DHS) and the Executive Office of Health and Human Services (EOHHS). Unlike standard Medicaid, which covers basic medical visits and prescriptions, LTSS is specifically designed for individuals who require a higher level of care over an extended period.

One of the most important aspects of the Rhode Island system is that it prioritizes "home and community-based services." This means that if you qualify, you are not forced into a nursing home; instead, you can often receive care right in your own living room in towns like Providence, Warwick, or Cranston.

Who is Eligible for RI Medicaid LTSS?

Eligibility for LTSS is determined based on three primary categories: residency, financial status, and clinical need.

Residency and Age

To qualify, you must be a resident of Rhode Island. The program is generally available to seniors aged 65 and older, as well as younger adults with qualifying disabilities.

Financial Eligibility

Medicaid is a needs-based program. For 2026, a single applicant typically must have a monthly income below $2,982 and countable assets (like savings and stocks) totaling no more than $2,000. It is important to note that certain assets, such as your primary home (up to a specific equity limit) and one vehicle, are often excluded from this count. If you are married, there are "spousal impoverishment" rules that allow the healthy spouse to keep a higher amount of income and assets.

Clinical Eligibility (Level of Care)

The EOHHS Clinical Team must determine that you meet a specific "Level of Care." Rhode Island categorizes this into two main tiers:

• Highest Level of Care: Individuals who meet this criteria have the option of receiving care in a nursing facility or through home-based services.
• High Level of Care: Individuals in this category are eligible for home and community-based services but do not yet meet the requirements for a nursing home.

What Services Does LTSS Cover for In-Home Care?

If you are approved for LTSS and choose to stay at home, the program covers a wide range of supports to ensure your safety and well-being. These services include:

• Personal Care and CNA Care: Assistance with activities of daily living such as bathing, dressing, and grooming.
• Homemaker Services: Help with light housekeeping, laundry, and maintaining a safe environment.
• Respite Care: Providing temporary relief for family caregivers.
• Environmental Modifications: Minor changes to the home to improve accessibility.
• Case Management: Assistance in coordinating your various care needs.

In Home Wellcare provides these essential services across all 39 Rhode Island towns, ensuring that whether you live in Woonsocket or Westerly, you have access to professional, bilingual (English/Spanish) support. We accept Medicaid, Neighborhood Health Plan of RI, and UnitedHealthcare, making the transition to professional care seamless for LTSS beneficiaries.

How Do I Apply for LTSS in Rhode Island?

The application process can be lengthy, often taking three months or more, so it is vital to start as soon as you anticipate a need for care.

1. Gather Documentation: You will need proof of identity, residency, income, and five years of financial statements (to check for asset transfers).
2. Complete the Application: You must fill out the DHS "Application for Assistance" along with the supplemental LTSS forms. These can be found on the EOHHS website or at a local DHS office.
3. Submit the Forms: Applications can be submitted online via the HealthyRhode RI portal or mailed to the RI Department of Human Services, P.O. Box 8709, Cranston, RI 02920.
4. Clinical Assessment: Once the financial application is in process, the EOHHS Clinical Team will schedule an assessment to determine your functional level of care.

For those who need help navigating the paperwork, "The Point" (Rhode Island’s Aging and Disability Resource Center) offers free assistance at (401) 462-4444.

Getting Approved and Starting Care

Once you receive your determination letter indicating approval, you can select a provider to begin your services. It is important to choose an agency that is not only licensed but also aligned with your specific needs. In Home Wellcare is proud to be BBB A+ rated and dedicated to helping Rhode Islanders age with dignity in their own homes. Our team works closely with Medicaid health plans to ensure your care plan is followed precisely.

If you or a loved one are beginning the Medicaid LTSS journey and want to learn more about how in-home care can support your independence, we are here to help. Our bilingual staff can answer your questions and help you understand the next steps for your family.

Ready to discuss your home care options? Call In Home Wellcare today at (401) 402-0076.