Rhode Island CSLP and At Home Cost Share: Medicaid Community Care Programs

Most families assume there are two payment options for elder care in Rhode Island: pay everything yourself, or qualify for Medicaid and get it covered. There's actually a middle layer — state programs designed for families who can't afford full private-pay rates but don't meet Medicaid's strict financial thresholds.

Community Supportive Living Program (CSLP)

The CSLP is Rhode Island's Medicaid-funded pathway to assisted living. It bridges the gap between the cost of an assisted living residence and what a Medicaid-eligible resident can afford to pay.

Here's how it works: when your parent qualifies for Medicaid LTSS with a "High" or "Highest" clinical level-of-care determination, they can choose to live in a participating assisted living residence instead of a nursing home or home care setting. Medicaid covers the service costs — personal care, medication management, and care coordination — while the state supplements room and board through Category D and Category F State Supplemental Payments.

Category D covers residents in standard assisted living settings. Category F covers residents in Alzheimer's/dementia special care units that meet the F1-M1 licensure requirements. The Category F supplement was revised under Article 13 of the FY 2020 Appropriations Act to better reflect the actual cost of dementia care, which runs 20% to 30% higher than standard assisted living.

The resident still contributes their monthly income toward the cost of care, minus a $120 personal needs allowance. This is the same patient liability calculation used for nursing home residents, except the personal needs allowance is higher for assisted living ($120 versus $75 for nursing homes).

What CSLP means practically: Your parent can live in an assisted living residence for roughly $120 per month out of pocket (plus their contribution from Social Security and pension income), rather than $5,000 to $7,000 per month in private-pay rates. The catch is the same as all Medicaid programs — they must meet the financial eligibility criteria (assets under $4,000, income under $2,982) and pass the clinical level-of-care assessment.

@Home Cost Share Program

The @Home Cost Share Program fills a different gap. It's administered by the Office of Healthy Aging and serves Rhode Island residents who need home care or adult day services but don't qualify for Medicaid. Income and assets are too high for Medicaid, but the family still can't afford full private-pay rates for the hours of care their parent needs.

The program operates on a sliding-scale basis. Your parent pays a portion of the cost based on their income, and the program subsidizes the rest. Services covered include:

• Nonmedical home care (personal care assistance, meal prep, housekeeping)
• Adult day health program attendance
• Basic home support services

This isn't Medicaid. The @Home Cost Share Program is funded through the Office of Healthy Aging's budget and has its own eligibility criteria and application process. The sliding scale means that higher-income applicants pay more, but even at the upper end of the scale, the cost is substantially below full private-pay rates.

To apply, contact The POINT at 401-462-4444 and ask specifically about the @Home Cost Share Program. They'll walk you through the income verification process (the program has no asset test) and connect you with a regional aging hub that administers the program in your parent's area.

Which Program Fits Your Situation

If your parent has assets under $4,000 and income under $2,982: Apply for full Medicaid LTSS. If they need assisted living, the CSLP pathway covers them. If they need home care, the Personal Choice Program or agency-based HCBS services are available.

If your parent has too much income or assets for Medicaid but can't sustain private-pay rates indefinitely: The @Home Cost Share Program can reduce the monthly cost of home care and adult day services while your family works on longer-term financial planning.

If your parent is spending down assets toward Medicaid eligibility: Consider starting with @Home Cost Share for immediate relief while the Medicaid application processes. This won't affect the Medicaid timeline and provides cost support during the private-pay period.

Rhode Island also allows a Medically Needy spend-down pathway for applicants whose income exceeds $2,982. Under this provision, your parent isn't automatically disqualified — they can qualify by incurring medical and care costs that reduce their countable income to the spend-down limit. This is complex but can make Medicaid accessible for families who assume they earn too much.

The Rhode Island Care Decision Guide covers both programs in detail, including the full Medicaid eligibility framework, the CSLP application process, and how to calculate whether your parent falls into the @Home Cost Share sliding scale or the Medicaid Medically Needy pathway.

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