Rhode Island Medicaid Application for Home Care: Step-by-Step LTSS Guide

Applying for Medicaid Long-Term Services and Supports (LTSS) in Rhode Island is a dual-gate process. Your parent must qualify both financially and clinically — and the application requires specific forms that most families do not know about until they are already scrambling. Here is the full process, laid out in order.

The Two Eligibility Gates

Rhode Island operates all long-term care under a single Section 1115 Demonstration Waiver (the Global Waiver), which means there is one unified application for both institutional and home-based care — not separate waiver programs to navigate.

Financial eligibility is determined by DHS:

• Gross monthly income cap: $2,982 (300% of the Federal Benefit Rate for 2026)
• Countable asset limit: $4,000 for a single applicant
• Primary home is exempt if the applicant lives there or documents intent to return (equity cap of $752,000)

Clinical eligibility is assessed by EOHHS:

• An in-home functional assessment determines whether the applicant meets "High" or "Highest" nursing facility level of care
• Must need daily assistance with at least two ADLs, daily skilled rehabilitation, or have impaired decision-making requiring frequent cueing

A dementia diagnosis alone does not automatically qualify — EOHHS must document specific functional deficits during the in-person assessment.

Required Forms and Documents

The application packet includes:

1. DHS-2 (Application for Assistance) — the main financial application, submitted to the Department of Human Services
2. GW-OMR-PM-1 (Medical Evaluation) — completed and signed by your parent's physician, documenting ADL limitations and diagnoses
3. CP-12 (Recipient Choice Form) — confirms your parent's choice to receive home-based care instead of nursing home placement
4. MA-89 LR (Liens and Recovery Notice) — discloses Medicaid's estate recovery rights; signing is listed as voluntary but refusal can trigger closer DHS scrutiny of property disclosures
5. 60 months of financial records — bank statements for every account, property deeds, tax returns, insurance policies

Submit the complete packet online through the HealthyRhode portal (healthyrhode.ri.gov) or by mail to RI Department of Human Services, P.O. Box 8709, Cranston, RI 02920-8787.

The Clinical In-Home Assessment

After DHS processes the financial side, EOHHS schedules a clinical care coordinator to visit your parent's home. This visit uses the AP 70.1 Social Worker's Evaluation to assess physical, cognitive, and behavioral needs.

As the adult child, you should attend this visit. The assessor needs to understand your parent's typical daily challenges — not just the snapshot they observe during a 45-minute visit. Bring documentation of falls, medication errors, wandering incidents, or any recent hospitalizations.

The assessor classifies your parent into one of two care levels:

• High Level of Care: Eligible for home and community-based services only (not nursing home placement)
• Highest Level of Care: Eligible for either home-based services or nursing home care — the parent chooses

Processing Timeline

DHS is legally required to process standard applications within 45 days. If a disability determination is needed, the deadline extends to 90 days. In practice, incomplete applications — especially missing financial records from the 60-month look-back — cause most delays.

What Happens After Approval

Once approved, you will receive a Notice of Decision detailing authorized care hours and monthly budget. From there, you choose a service delivery model:

• Agency-directed care through a licensed, Medicaid-enrolled home care provider
• Self-directed care through the Personal Choice Program, where your parent hires their own caregivers (including non-spouse family members) through a fiscal intermediary

If the HCBS waiver slots are full, your parent may be placed on a waiting list. However, institutional nursing home care is an entitlement — qualified applicants cannot be waitlisted for that. Waiver slots are prioritized by clinical acuity, not first-come-first-served.

If Your Parent Earns Too Much

Rhode Island is not an income cap state and does not use Miller Trusts. Instead, applicants whose income exceeds $2,982 can qualify through the Medically Needy Pathway by spending down excess income on medical and care expenses each month.

The Rhode Island Home Care Navigation Guide includes document organizers, spend-down trackers, and the complete application checklist — designed to help you submit a clean, complete packet the first time and avoid the processing delays that leave families paying private-pay rates during the wait.

See more Rhode Island guides →