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As a Medicare beneficiary, where you live – meaning your state of residence – can have a significant impact on the care that you receive and how you pay for that care during your “golden years.” This page explains how Rhode Island’s regulations and policies are likely to affect your bottom line.
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Rhode Island, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
MSP asset limits: The asset limits for QMB, SLMB and QI are $7,860 if single and $11,800.
Medicare covers a great number services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits. Medicare can also leave its beneficiaries with large cost sharing obligations. Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for Medicare cost sharing and services only Medicaid covers if they’re enrolled in Medicaid for the aged, blind and disabled (ABD).
Medicaid for the aged, blind and disabled doesn’t ordinarily cover Long Term Services and Supports (LTSS). Those services usually require a separate application and interview process (and have different income limits).
Income eligibility: The income limit is $1,063 a month if single and $1,437 a month if married.
In Rhode Island, applicants who satisfy Medicaid’s more restrictive asset limit receive full Medicaid benefits (in addition to QMB).
Asset limits: The asset limit is $4,000 if single and $6,000 if married.
In Rhode Island, applicants whose incomes are too high to qualify for Medicaid for the aged, blind and disabled can enroll in the Medicaid spend-down. This program allows enrollees to subtract medical expenses from their income that is counted toward the Medicaid income limit.
Rhode Island usually approves spend-down benefits in 6 month increments – with additional coverage requiring new medical expenses to be submitted.
Income eligibility: The income limit is $1,063 a month if single and $1,437 a month if married.
Asset limits: The asset limit is $4,000 if single and $6,000 if married.
Medicare beneficiaries increasingly rely on long-term services and supports (LTSS) – or long-term care – which is mostly not covered by Medicare. In fact, 20 percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015. Medicaid fills this gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
This income limit does not mean nursing home enrollees can keep all their income up to this limit. Instead, enrollees must pay nearly their entire income toward their care, other than a small personal needs allowance and money for health insurance and Medicare premiums.
When only one spouse needs Medicaid, the income limit for single applicants is used – and usually only income from the applying spouse is counted.
Assets limits: The asset limit is $4,000 if single and $8,000 if married (and both spouses are applying). If only one spouse needs Medicaid, the other spouse can keep up to $128,640.
Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car. Applicants are also not allowed to have more than $595,000 in home equity.
Every state’s Medicaid program covers some community-based long-term care services, which are provided in an enrollee’s home, adult day care center, assisted living facility, or another “community” setting. Medicaid programs that pay for this care are called Home and Community-Based Services (HCBS) waivers. These programs vary from state to state in terms of services and intensity of care offered, and may have waiting lists.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
When only one spouse needs Medicaid, the income limit for single applicants is used – and only income from the applying spouse is counted.
Assets limits: The asset limit is $4,000 if single and $8,000 if married (and both spouses need care). If only one spouse has Medicaid, the other spouse can keep up to $128,640.
HCBS recipients can’t have more than $595,000 in home equity.
Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. When this occurs, only the applying spouse’s income is counted. With other Medicaid benefits, the income of both spouses is counted – regardless of who applies.
Spousal impoverishment rules allow spouses of Medicaid LTSS recipients (i.e. the non-applying spouse) to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income, along with resource and housing allowances. These rules apply when one spouse receives Medicaid coverage for LTSS, and the other spouse doesn’t have Medicaid.
These community spouses are allowed to keep:
States have to limit eligibility for Medicaid long-term care to enrollees who don’t have significant home equity. In 2020, states set a home equity limit based on a federal minimum of $595,000 and maximum of $893,000.
Rhode Island has chosen to use the most restrictive limit on home equity – meaning applicants with more than $595,000 in home equity are not eligible for LTSS programs.
Because long-term care is expensive, individuals can have an incentive to give away or transfer assets to make themselves eligible for Medicaid LTSS. To curb these asset transfers, federal law requires states to have a penalty period for Medicaid nursing home applicants who give away or transfer assets for less than their value. States can also have a penalty period for community-based LTSS. Medicaid will not pay for LTSS during this period.
Rhode Island has chosen to have an asset transfer penalty for both nursing home care and HCBS. This penalty is based on a 60-month lookback period during which time asset transfers and gifts are not allowed. The penalty is calculated by dividing the value of asset transfers and gifts by the monthly cost of nursing home care (which is $9,961 in Rhode Island in 2020).
A state’s Medicaid agency is required to recover what it paid for LTSS and related medical costs received beginning at age 55. States can choose to also pursue estate recovery for costs that are unrelated to LTSS.
Rhode Island has chosen only to recover from the estates of enrollees in this age range who receive LTSS.
When Medicaid coverage was administered by a Managed Care Organization (MCO) (i.e., a private insurer with whom the state has contracted to administer Medicaid benefits), the state will attempt to recover what it paid the insurer. That means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received.
Rhode Island may grant an exemption to estate recovery if recovering from an estate would cause hardship to a person inheriting from it.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid may attempt to recover MSP benefits it paid through that date.
Free volunteer Medicare counseling is available by contacting the Senior Health Insurance Program (SHIP) at 888-884-8721. This program is offered by the Rhode Island Office of Healthy Aging.
The SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. Counselors may also be able to provide referrals for home care agencies or long-term care services. This website has more information about the services SHIP offers.
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. Use this search feature from the National Academy of Elder Law Attorneys (NAELA) to find an elder attorney near you.
Rhode Island’s Medicaid program is overseen by the Rhode Island Department of Human Services. You can apply for Medicaid ABD or an MSP using this website, and can also find more information there about applying for long-term care in Rhode Island.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked on Medicare and Medicaid related client projects.
