Frequently Asked Questions
What is Medicaid?
Medicaid is a program offering free or low-cost care to individuals who qualify based on income, family size and other factors.
What are the Medicaid eligibility groups?
The Rhode Island Medicaid program groups coverage types based on needs. Services covered within these coverage types are the same. Examples of coverage groups include:
RIte Care is the coverage group for parents/caretakers and their dependent children up to age 18, or 19 if enrolled in school full-time. It also includes pregnant women.
Medicaid Expansion is for adults ages 19-64 without dependent children.
Rhody Health Partners is the coverage group for adults 21-64 who have a disability, or elders with a disability who do not have Medicare or other health insurance.
What is Fee for Service (FFS)?
Fee for Service is a traditional type of insurance in which Medicaid will pay your provider directly instead of through a Health Plan (MCO). Also, Fee for Service gives you immediate access to your Medicaid benefits before your enrollment in a health plan begins. To use benefits before your health plan enrollment begins, you must use a FFS provider.
What is health plan coverage?
Most Medicaid eligible individuals are additionally covered through "managed care". This managed care is administered by Health Plans such as Neighborhood Health Plan, Tufts Health Plan, UnitedHealthCare. The Rhode Island Medicaid program pays for this health plan coverage on your behalf.
PACE (Program for All Inclusive Care for the Elderly), is another program available that enables elders to remain in their own communities for as long as possible. Individuals cannot be enrolled with a managed care plan and PACE simultaneously. PACE contracts with specific doctors, home health, and other agencies to provide your care. For more information, contact: PACE at (401) 490-6566 or 1-877-781-7223.
Finally, RIteShare is Rhode Island's Premium Assistance Program that provides help paying for an employer's health insurance plan. The State will pay all or part of the cost for employee health insurance coverage. Individuals cannot be enrolled with a managed care plan and PACE simultaneously.
What are the differences between the health plans?
All Medicaid health plans offer the same benefits. However, each health plan has its own provider network and prescription drug coverage. Before choosing a plan, you should make sure that your doctors and prescriptions are covered by that plan. Each plan may also offer some additional benefits beyond the basic Medicaid coverage. These can be found in the details for each plan.
What if I need help choosing a plan?
If you would like help finding the best health plan for you, call HealthSource RI at (855) 840-4774 and ask to speak to a Choice Counselor. They will help you find the information you need to make a good decision.
Will my health plan coverage begin immediately?
Once you have been determined eligible for Medicaid, you will be asked to select a health plan and a primary care physician. There will be a short wait for your health plan enrollment to begin. During this waiting period, you are still able to use your basic Medicaid coverage to get services. You should use your "Anchor" card until you receive a card from your health plan.
What if I need an interpreter?
The Call Center at HealthSource RI offers callers a choice between English and Spanish speaking agents and is able to assist callers in any language when needed.
