Rhode Island Medicaid covers home care through three options: RIte@Home shared living, self-directed Personal Choice, and Medicaid assisted living, for adults who need long-term care. These Rhode Island Medicaid HCBS waivers are not standalone waivers: the state folded its former 1915(c) HCBS waivers into a statewide Section 1115 Comprehensive Demonstration, and the home- and community-based (HCBS) waiver services continue under it as part of the state's Medicaid long-term services and supports (LTSS) program.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf
If you are helping a parent or spouse stay in their own home, a shared-living home, or an assisted living residence instead of moving to a nursing facility, this is how Rhode Island Medicaid can help pay for that care.
In This Guide
- What Rhode Island Medicaid HCBS Waivers Are
- The Three Home and Community Programs
- Who Qualifies for Rhode Island Medicaid HCBS Waivers
- What These Programs Cover
- How to Apply in Rhode Island
What Rhode Island Medicaid HCBS Waivers Are
Home- and community-based services (HCBS) is the Medicaid umbrella for long-term care delivered outside an institution: in your own home, in someone else's home, or in an assisted living residence, rather than in a nursing facility. The federal tool built for this is a Section 1915(c) HCBS waiver, which serves people at home or in the community who would otherwise need the level of care provided in a hospital, a nursing facility, or an intermediate care facility for people with intellectual disabilities.U.S. Government Publishing Office. (n.d.). 42 CFR 441.302 — State assurances (eCFR, current). ecfr.gov. Retrieved Oct 3, 2026, from https://www.ecfr.gov/current/title-42/section-441.302
Rhode Island's setup has one wrinkle worth understanding up front. The state used to run its own separate 1915(c) HCBS waivers, but it consolidated them under its statewide Section 1115 demonstration, known as the Rhode Island Comprehensive Demonstration. Home- and community-based waiver services continue to be offered under that 1115 demonstration as part of the state's managed long-term services and supports (LTSS) program.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf For a family, the practical effect is the same as a traditional waiver: Medicaid pays for community-based care for people who meet the clinical and financial rules. You just apply through the state's Medicaid LTSS process rather than to a standalone waiver.
The Three Home and Community Programs
Rhode Island offers three main ways to receive Medicaid LTSS at home or in the community, and which one fits depends on where a person wants to live and how much they want to direct their own care.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf
| Program | Where care happens | Who it tends to fit | Self-directed? |
|---|---|---|---|
| RIte@Home (LTSS Shared Living) | A caregiver's home, in a home-like setting | Someone who needs considerable daily help but cannot safely live alone | No |
| Personal Choice | The person's own home | Someone who wants to stay home and manage their own budget and caregivers | Yes |
| Medicaid assisted living | An assisted living residence | Someone who needs on-site personal care around the clock | No |
RIte@Home is Rhode Island's LTSS Shared Living option. It is for people who want services in a home-like setting but cannot live alone because they need considerable help with activities of daily living (ADLs) such as eating, dressing, and toileting, along with homemaker services, meals, and transportation.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf
Personal Choice is the self-directed option. It is designed for people who want to keep living in their own home while managing their own service budget and hiring and directing their own caregivers.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf If having control over who provides the care matters to your family, this is the option built around that.
Medicaid assisted living covers care delivered in an assisted living residence, including on-site 24-hour personal care assistance and the supports that come with it. It fits a person who needs a residential setting with staff available at all hours rather than care that comes and goes from an outside agency.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf
Who Qualifies for Rhode Island Medicaid HCBS Waivers
To receive Medicaid LTSS at home or in the community, an applicant has to clear two separate tests: a clinical level-of-care test and a financial test. You have to meet both.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf
The clinical test (level of care)
Rhode Island sorts long-term-care need into levels, and the level you are assessed at determines what Medicaid will pay for. People who have the "highest" or "high" level of need can receive Medicaid LTSS in the home or community setting. Only those with the "highest" level of need qualify for Medicaid coverage in a nursing home.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf In practice, the community programs reach people at a "high" level of need who might not yet qualify for nursing-home coverage, which is part of what lets Rhode Island support people at home before an institutional move becomes the only option.
The financial test
In 2026, for LTSS eligibility, Rhode Island sets a countable-resource (asset) limit of $4,000 and, for elders 65 and older and Medicare-eligible adults aged 19 to 64, an income standard of countable income up to 300% of the federal SSI rate.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf That $4,000 limit is the one for the LTSS pathways most applicants use, the special-income/HCBS and medically needy groups; the LTSS-SSI group has a $2,000 limit, and ACA expansion adults are exempt from the resource test.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf Not every asset counts toward it, either: Rhode Island follows the SSI resource rules, which exclude one vehicle used as the primary source of transportation regardless of value, and household goods and personal effects.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
The home exclusion has conditions. Your primary residence and its land are excluded when the home equity is at or below the limit ($752,000 in 2026) and you, your spouse, or a dependent lives there; if you are receiving care elsewhere, you must give a written statement that you intend to return, at application and again at each eligibility renewal. If a spouse, or a child who is under 21 or blind or permanently and totally disabled, lives in the home, its entire value is excluded regardless of equity and with no intent-to-return statement, and an owner whose equity is over the limit can request a hardship exemption.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
For a married applicant, $4,000 is not what the couple has to spend down to. Rhode Island makes a Community Spouse Resource Allocation (CSRA) assessment for every couple at application, whether the care sought is in a nursing facility or at home or in the community, and the share allocated to the spouse who is not receiving LTSS is protected and cannot be used to pay for the other spouse's care.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf,Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf It is worth confirming which of your assets are countable before assuming you are over the line.
If your income sits above the 300%-of-SSI standard, you are not automatically shut out. Rhode Island runs a medically needy pathway for LTSS, and every applicant with countable income above that standard is automatically evaluated for it. A person qualifies if their total countable income is at or below the projected cost, at the private-pay rate, of the long-term services and supports they are seeking or receiving.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf Note what that ceiling is tied to: the projected cost of the care you are actually asking Medicaid to pay for, not a flat dollar figure, so ask the state which projected cost applies to your plan of care rather than assuming a nursing-home number. Rhode Island also amended its LTSS financial-eligibility regulation (210-RICR-50-00-6) effective July 27, 2026, so confirm the current standard with the state before you plan around it.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
One more rule to plan around: Rhode Island applies a five-year (60-month) look-back to asset transfers, so gifts or transfers made in the five years before you apply can affect eligibility.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf If a transfer leads to a penalty period, you can ask the state for a hardship exemption.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf If large transfers are part of your family's recent history, talk with the state or a qualified elder-law professional before you apply.
What These Programs Cover
The home- and community-based services these Rhode Island programs provide are the everyday supports that make staying out of a nursing facility possible, and the covered list is written per program rather than as one shared menu. In Medicaid assisted living, covered services include on-site 24-hour personal care assistance, homemaker and chore services, medication management, therapeutic, social, and recreational activities, and health-related transportation.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf Under RIte@Home, the supports are hands-on help with the activities of daily living, eating, dressing, and toileting, plus homemaker services, meals, and transportation delivered in a shared-living home.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf
The mix a given person receives depends on their assessed needs and the program they enroll in. Someone in Personal Choice directs their own budget toward the supports they need most, while someone in assisted living receives care from the residence's staff. In every case, the goal of the coverage is the same: enough support to live safely in the community.
How to Apply in Rhode Island
Medicaid LTSS in Rhode Island is administered by the Rhode Island Executive Office of Health and Human Services (EOHHS) together with the Department of Human Services (DHS). You apply through the state's Medicaid LTSS application process, and you have to meet both the financial test and the clinical level-of-care test before coverage starts.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf
Here is what to expect. You submit an LTSS application, the state reviews your income and assets against the financial rules, and a clinical assessment establishes your level of need. If you qualify, you then work with the state to enroll in the delivery option that fits, RIte@Home, Personal Choice, or Medicaid assisted living. Because there are two determinations happening, it helps to gather financial documents (bank statements, proof of income, information on any recent transfers) before you start.
Federal rules put an outer limit on how long the state can take to decide. Under 42 CFR 435.912, a Medicaid eligibility determination may not exceed 90 days for applicants who apply on the basis of disability and 45 days for all other applicants, except in unusual circumstances, for example when the applicant or an examining physician delays or fails to take a required action, or there is an administrative or other emergency beyond the agency's control.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 The state must also set its own timeliness standards, running from the date of application to the date it notifies you of its decision, and tell applicants what they are.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 An applicant qualifying on age rather than disability is on the 45-day standard. If the agency does run late, it must record the reasons in your case record, and it cannot use the time limit as a waiting period or a reason to deny you, so a case that stalls is worth raising with the agency.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912
Frequently Asked Questions
Is there a waiting period or interest list for these programs?
Enrollment runs through the state's Medicaid long-term services and supports (LTSS) process: you apply, the state confirms both your financial eligibility and your clinical level of need, and then you enroll in the delivery option that fits.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf Timelines and current availability can change, so the Rhode Island Executive Office of Health and Human Services (EOHHS) is the right place to confirm where things stand for your situation before you plan around a specific date.
Do I have to move out of my own home to get help?
Not with every option. Personal Choice is the self-directed program built specifically around staying in your own home and directing your own budget and caregivers. RIte@Home and Medicaid assisted living, by contrast, deliver care in a different living arrangement, a caregiver's shared-living home or a staffed residence.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf If remaining in your own home is the priority, Personal Choice is the option designed for that.
Can I get Medicaid to pay for care at home instead of a nursing home?
Yes. That is the purpose of Rhode Island's home- and community-based services. People assessed at the "highest" or "high" level of need can receive Medicaid LTSS in the home or community, while nursing-home coverage is limited to those with the "highest" level of need.Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf So a person can qualify for home and community care at a level of need that would not yet qualify them for Medicaid in a nursing facility.
Does the five-year look-back apply to home care, or only to nursing homes?
It applies to home care too. The five-year (60-month) look-back is part of Rhode Island's financial-eligibility rules for Medicaid long-term services and supports (LTSS), and those rules govern home- and community-based coverage the same way they govern nursing-home coverage.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf So a transfer you made in the five years before applying can affect a home-care application, not just a nursing-home one, which is why it is worth getting advice before you apply if your family has made large gifts recently.
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