Shared Living in Rhode Island: How Medicaid Pays Family Caregivers Through RIte@Home

What Shared Living Means Under Rhode Island Medicaid

Shared living in Rhode Island is a Medicaid benefit — not a housing arrangement you set up privately. It operates under the RIte@Home program within the state's 1115 Demonstration Waiver, and it works like this: an adult child or relative moves in with the care recipient (or the care recipient moves in with them) and receives a tax-free daily stipend from Medicaid for providing care.

This is one of the few Medicaid programs that directly pays a family member to be the caregiver. The stipend is based on the parent's assessed level of need — specifically the nursing facility level of care determination — and it is tax-free under IRS Notice 2014-7.

The program is administered through shared living providers in the state. Seven Hills Rhode Island is one of the larger providers coordinating these arrangements, handling the administrative infrastructure between the family caregiver, EOHHS, and the Medicaid fiscal intermediary.

Who Can Be a Paid Caregiver (and Who Can't)

The most important restriction: spouses are explicitly barred from being paid caregivers under the shared living program. This catches many families off guard. If your father has dementia and your mother is his primary caregiver, she cannot receive the stipend through this program.

However, adult children, siblings, nieces, nephews, and other relatives are eligible. Parents of adult care recipients can also serve as paid caregivers under RIte@Home guidelines.

Every caregiver must pass a national criminal background check, which includes fingerprinting managed by EOHHS and Gainwell Technologies. This is non-negotiable and applies even to family members who have been providing care informally for years.

How the Stipend Works

The daily stipend is a flat rate determined by the parent's assessed care needs — not negotiated or variable. Higher levels of assessed need produce higher daily stipends. These payments come through the shared living provider, not directly from the state to the caregiver.

The tax-free status under IRS Notice 2014-7 means the stipend does not count as taxable income for the caregiver. It also does not count as earned income for purposes like Social Security credits, which is worth understanding if the caregiver is building toward their own retirement benefits.

How to Apply

The pathway runs through the state's Managed Long-Term Services and Supports system:

1. The care recipient must qualify for Medicaid LTSS — that means meeting the financial thresholds ($4,000 countable assets for a single applicant, income at or below $2,982 per month in 2026) and the clinical threshold (nursing facility level of care at the "High" or "Highest" tier).

2. Contact The POINT (Rhode Island's Aging and Disability Resource Center) at (401) 462-4444. They screen for eligibility and connect families to shared living providers.

3. The shared living provider — such as Seven Hills Rhode Island or other participating agencies — coordinates the assessment, background checks, and caregiver agreement.

4. Once approved, the caregiver and care recipient sign a shared living agreement that specifies the care plan, living arrangement, and stipend terms.

Shared Living vs. the Personal Choice Program

Rhode Island offers another option for families who want to direct their parent's care: the Personal Choice Program, which lets the care recipient or their representative hire personal care assistants at $16 to $19 per hour through a fiscal intermediary.

The key difference: shared living is a live-in arrangement with a daily stipend, while the Personal Choice Program pays hourly for specific care hours without requiring cohabitation. Shared living makes more financial sense when the caregiver is already living with or near the parent and providing round-the-clock support. The Personal Choice Program works better when the family wants to hire specific help for defined hours.

RIte@Home excludes spouses as paid caregivers; spouses are typically excluded from being hired through Personal Choice. Both programs require background checks and fingerprinting.

The Rhode Island Dementia & Memory Care Guide maps out both programs side by side — eligibility thresholds, application sequences, provider contacts, and the financial implications of each — so families can choose the arrangement that fits their situation without navigating the EOHHS bureaucracy blind.

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