Medicaid for nursing home and home care in Rhode Island

Who qualifies

You must meet two kinds of rules: a clinical test and a financial test.

The clinical test (level of care)

The state looks at how much help you need with daily life.

• Highest need: You can get Medicaid in a nursing home or at home.
• High need: You can get care at home and in the community, but not nursing home care.

A doctor fills out a medical evaluation form as part of your application.

The financial test

If your income is higher than 300% of the SSI rate, you are not shut out. Rhode Island has a "medically needy" path for adults with income above that level. Your medical and care costs are used to "spend down" your income to the state's limit. Ask DHS how this works for you.

What counts and what does not

Resources

• Counted: cash, bank accounts, stocks, bonds and other things you could turn into cash.
• Your home is not counted if you live there or plan to return, and your equity is at or below $752,000. You must state your intent to return in writing when you apply and at each renewal.
• Long-term care insurance: If you have a Rhode Island partnership long-term care policy, the state ignores resources up to the amount the policy paid. Payments from long-term care insurance policies are not counted as income.
• Gifts and transfers: The state looks back five years (60 months) from the month you apply. If you gave away money or property for less than its value, Medicaid will not pay for long-term care for a period of time. The state works out that period by dividing the value given away by the average private nursing home cost. As of April 2026 that is $12,106 a month. Other Medicaid services still continue during a penalty. You can ask for a hardship waiver.

Income

Social Security, pensions and most other income count. After you qualify, most of your income goes toward your care:

• In a nursing home, you keep $75 a month for personal needs.
• At home, you keep income up to 300% of the SSI federal payment for rent, food and bills.

If you are married

Rhode Island protects the spouse who stays at home.

If your spouse's own income is below the minimum, part of your income can go to them. You qualify on resources once what is left after your spouse's share is $4,000 or less.

What Medicaid pays for

Nursing home care

Medicaid pays the nursing home, minus the part of your income you pay toward your care.

Care at home and in the community

Rhode Island's home and community services can include:

• homemaker and certified nursing assistant (CNA) help, and personal care
• meals on wheels
• a personal emergency response button
• home changes and special medical equipment
• case management and senior companion
• respite for family caregivers
• assisted living

You can get services through a health plan, through regular Medicaid, or by directing your own care with help from a fiscal agent. If you move out of a nursing home, a one-time payment can help with a security deposit, moving costs or furniture.

How to apply, step by step

1. Call first if you want home care. The POINT (401-462-4444) or the DHS Long-Term Care office (401-574-8474) can explain your choices.
2. Fill out the application. Use the Application for Assistance (DHS-2) and the LTSS forms. These include:
   • Medical Evaluation of Applicant for Level of Care (GW-OMR-PM-1), filled out by your doctor
   • Ownership of Real Estate (MA-400)
   • Home and Community Based Waiver, Notification of Recipient Choice (CP-12)
   • Authorization forms DHS-25 and DHS-25M
   • Liens and Recovery Notice (MA-89 LR)
3. Send it in. Apply online at healthyrhode.ri.gov, or mail it to Rhode Island Department of Human Services, P.O. Box 8709, Cranston, RI 02920-8787. You can also call DHS at 1-855-697-4347.
4. Send proof. Because of the five-year look-back, DHS may ask about your accounts and property for that whole period. Keep bank statements, proof of income, deeds and any insurance or trust papers ready.

After you apply

• Report changes in income or resources within 10 days.
• Renewals: Answer every renewal letter. If you own a home you have left, restate in writing that you plan to return.
• Appeals: If you are denied or your share of cost seems wrong, ask for a hearing within 35 days of the date on your notice. Log in to healthyrhode.ri.gov and click "file an appeal," call 1-855-840-4774, or mail the form to ATTN: Appeals, State of Rhode Island, P.O. Box 8709, Cranston, RI 02920-8787. Appeal within 10 days to keep your coverage during the appeal.

Things people miss

• Too much income is not the end. Use the medically needy path.
• You may not need Medicaid at all. If your income is under 250% of the poverty level and you do not qualify for Medicaid, the Office of Healthy Aging's At HOME Cost Share program helps pay for home care and adult day care. There is no asset limit.
• Estate recovery. After you die, Rhode Island can recover Medicaid costs paid from age 55 onward from your estate. It does not do this while a spouse, a child under 21, or a blind or disabled child survives you.

Free help

• The POINT (Aging and Disability Resource Center): 401-462-4444, any time of day. Website: myoptions.ri.gov.
• DHS Long-Term Care offices: 401-574-8474 or 1-855-697-4347.

Read more about paying for a nursing home and Medicare coverage limits, or see all benefits in Rhode Island.

Phone numbers: Free help lines for Rhode Island agencies

Check what you may qualify for