Rhode Island Global Consumer Choice Waiver: How the Section 1115 Waiver Shapes Your Care Options
What Makes Rhode Island's Medicaid Different
Most states run Medicaid long-term care through a patchwork of separate programs — one waiver for home care, another for assisted living, a different program for nursing homes, each with its own application process, waitlist, and eligibility criteria. Families in those states apply to multiple programs hoping one accepts them.
Rhode Island threw out that model. The state operates its entire long-term care system under a single Section 1115 Demonstration Global Consumer Choice Compact Waiver. Every form of long-term care — nursing homes, assisted living, home health aides, adult day programs, personal care, home modifications — falls under one administrative umbrella.
One application. One eligibility determination. One budget authority deciding where and how care is delivered.
How the Global Waiver Affects Your Parent's Care
The practical impact for families comes down to three things:
One application covers everything. When your parent files the DHS-2 and receives a clinical level-of-care determination, they're evaluated for the full spectrum of services — not just the one service they initially requested. The system is designed to match care intensity to clinical need, which means the state can authorize home care for someone who might have ended up in a nursing facility under a fragmented system.
The state controls the care setting. Under the waiver, EOHHS and the managed care organization determine where care is delivered based on the clinical assessment. If your parent is assessed at the "high" level of care, they're eligible only for community-based services — home care, adult day health, or assisted living. Nursing home placement under Medicaid is reserved for individuals assessed at the "highest" level of care.
Rebalancing is the policy goal. The waiver's explicit purpose is shifting care from institutions to homes and communities. Rhode Island has used the consolidated budget to fund home-care programs, caregiver payment options, and assisted living slots that wouldn't exist under traditional Medicaid. The tradeoff: the state has more latitude to deny facility placement for individuals it determines can be served safely at home.
The Two Levels of Care
The clinical assessment under the waiver produces one of two determinations that controls what services your parent can access:
Highest Level of Care: Reserved for individuals with severe physical or cognitive impairments requiring 24-hour nursing supervision or extensive assistance with multiple activities of daily living — transferring, eating, toileting, bathing. This determination opens both doors: Medicaid-funded nursing home placement or intensive home and community-based services. The family can choose.
High Level of Care: For individuals who need significant ADL assistance but don't require constant institutional-level medical supervision. This determination authorizes community-based services only — home care, adult day health, assisted living, the Personal Choice Program. Nursing home placement under Medicaid is not available at this level.
The distinction matters enormously. A parent assessed at "high" who the family believes needs nursing home care faces a difficult choice: pay privately for the nursing home, or accept the community-based services Medicaid will cover.
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How Clinical Assessments Work
The level-of-care determination starts with the GW-OMR-PM-1 medical evaluation form, completed by your parent's physician. This form documents the specific physical and cognitive limitations — which ADLs require hands-on assistance, what medical conditions complicate daily function, whether cognitive decline creates safety risks.
EOHHS or the managed care organization's nurse then conducts their own assessment, using the physician's evaluation alongside a functional review. If an applicant's condition improves or declines over time, a reassessment can change the level-of-care determination and alter which services Medicaid authorizes.
Reassessments can go both directions. A parent receiving home care whose condition deteriorates may be upgraded to "highest" and become eligible for nursing home placement. A parent in a nursing facility who stabilizes may be assessed at "high" and transitioned to community-based care.
The Programs Available Under the Waiver
The Global Waiver funds an array of services that families often don't know exist until a case manager or The POINT outlines them:
- Personal Choice Program — self-directed care where your parent (or their representative) manages a budget and hires caregivers, including family members other than spouses or legal guardians
- RIte@Home — shared living arrangements where a caregiver provides 24-hour support in their own home or the participant's home
- Home health services — skilled nursing and therapy delivered at home
- Adult day health — structured daytime programs with medical oversight
- Home modifications — accessibility adaptations funded through the waiver
- Assisted living services — the care component in certified assisted living residences (room and board remains a private-pay obligation)
What Families Need to Know
The waiver gives Rhode Island more flexibility than most states in how it delivers long-term care, but that flexibility runs in both directions. The state can authorize creative, home-based care options that keep your parent out of an institution — and it can also restrict access to nursing home placement for individuals it determines can be served in the community.
Understanding which level of care your parent qualifies for, and what services that level authorizes, is the first decision point in the entire LTSS process. Everything else — financial eligibility, spend-down, spousal protections — follows from the clinical determination.
The Rhode Island Medicaid Long-Term Care & Asset Protection Guide includes a complete map of every program available under the Global Waiver, with eligibility criteria, application steps, and the specific level-of-care requirements for each service type.
Get Your Free Rhode Island — Medicaid Long-Term Care Eligibility Checklist
Download the Rhode Island — Medicaid Long-Term Care Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.