Rhode Island Medicaid goes by several names depending on who it covers — RIte Care for children and families, Rhody Health Partners for expansion adults, and RIte @ Home for long-term care at home.
But the program most people outside Rhode Island don’t know about is the Sherlock Plan — a Medicaid pathway for working adults with disabilities, available up to 250% FPL with a $10,000 asset limit.
That’s one of the most distinctive Medicaid programs in New England.
Rhode Island also has an unusually generous $4,000 countable asset limit for long-term care applicants — double the $2,000 federal minimum used by most states — and RIte Share, a premium assistance program that helps pay for employer-sponsored health insurance rather than replacing it.
Administered by the Executive Office of Health and Human Services (EOHHS), Rhode Island Medicaid serves more than 370,000 residents.
The state expanded Medicaid in 2014 and runs its own marketplace — HealthSource RI — which simultaneously determines Medicaid eligibility when you apply for coverage.
This guide covers every RI Medicaid program, 2026 income limits, the $4,000 asset limit, the 60-month look-back, and how to apply. For income limits across all states, see Medicaid income limits by state.
Rhode Island Medicaid Programs
Rhode Island runs more named Medicaid programs than most small states, each with its own branding and target population.
RIte Care is Rhode Island’s managed care program for children up to age 19 and pregnant women.
Coverage is delivered through one of three managed care organizations: Neighborhood Health Plan of Rhode Island, Tufts Health Plan, or UnitedHealthcare Community Plan of New England. RIte Care includes full medical, dental (through RIte Smiles), and behavioral health coverage.
RIte Share is Rhode Island’s premium assistance program — instead of enrolling a Medicaid-eligible family in a state plan, RIte Share pays all or part of their share of employer-sponsored health insurance premiums.
This is ideal for families where at least one adult has employer coverage available. The employer plan covers the services while RIte Share picks up the employee’s share of the premium cost.
Rhody Health Partners (Medicaid Expansion Adults) covers adults 21–64 with incomes up to 138% FPL who are not eligible for or enrolled in Medicare.
Expansion adults choose from three managed care plans or may be auto-assigned one. Rhode Island was among the first states to implement ACA expansion in 2014.
RIte @ Home / HCBS Waivers provide home and community-based services — personal care, adult day, meal delivery, home modifications — for seniors and disabled adults who need nursing-level care but want to remain at home.
This is a non-entitlement program with limited slots. Waiting lists may apply. Contact the Office of Healthy Aging at 1-401-462-4441 to begin the process.
Nursing Home / Institutional Medicaid covers care in Medicaid-certified nursing facilities and ICF/IID (Intermediate Care Facilities for Individuals with Intellectual Disabilities).
This is an entitlement program — anyone meeting the financial and functional requirements cannot be turned away due to program capacity.
The Sherlock Plan is Rhode Island’s Medicaid program specifically for working adults with disabilities.
It is named after the landmark Olmstead v. L.C. and Sherlock legal advocacy. Adults can earn up to 250% FPL and hold up to $10,000 in assets (with exemptions for items needed for employment — such as a wheelchair-accessible vehicle). This program allows people with disabilities to work without losing Medicaid coverage, which is a significant concern for many.
Regular Medicaid (Aged, Blind, and Disabled — ABD) covers low-income elderly, blind, or disabled Rhode Islanders who do not require nursing home-level care.
Income and asset limits are less strict than long-term care programs, though stricter than ACA expansion.
PACE (Program for All-Inclusive Care for the Elderly) — Rhode Island operates Neighborhood INTEGRITY, a three-way demonstration between CMS, Rhode Island, and Neighborhood Health Plan of RI.
PACE combines Medicare and Medicaid coverage into a single coordinated plan for seniors with high or highest-level care needs who wish to remain in the community. It is one of the more integrated dual-eligible programs in the state.
Income Limits — 2026
All figures are monthly gross income. The Federal Benefit Rate (FBR) is $967/month for 2026.
| Program | Single Applicant | Married (Both Applying) |
|---|---|---|
| Nursing Home / RIte @ Home (HCBS) | $2,901/mo (300% FBR) | $5,802/mo |
| Regular Medicaid (ABD) | $967/mo (100% FBR) | $1,450/mo |
| ACA Expansion Adults (Rhody Health Partners) | $1,799/mo (138% FPL) | $2,432/mo |
| Children / RIte Care | Up to $3,260/mo (250% FPL) | — |
| Pregnant Women | Up to $3,260/mo (250% FPL) | — |
| The Sherlock Plan (Working Disabled) | Up to $3,260/mo (250% FPL) | — |
Notes on Rhode Island’s Income Rules
Nursing Home / HCBS: Income above $2,901/month goes toward care costs after protecting a Personal Needs Allowance of $50/month for nursing home residents (higher for HCBS), Medicare premiums, and any applicable spousal allowance.
If income exceeds $2,901, a Qualified Income Trust (QIT) can redirect the excess to restore eligibility.
Community Spouse Allowance: When one spouse enters a nursing facility or HCBS, the other may keep income up to $2,643.75/month as a base Minimum Monthly Maintenance Needs Allowance (MMMNA).
If housing and utility costs exceed $793.13/month, this can be increased up to a maximum of $4,066.50/month (effective July 1, 2025 – June 30, 2026).
VA Aid & Attendance: Rhode Island does not count the VA Aid & Attendance Allowance (amounts above the Basic VA Pension) as income for Medicaid purposes.
This is a meaningful exemption for veterans receiving this benefit.
Pregnant Women: Coverage extends 12 months postpartum regardless of income changes after delivery.
Additionally, women who lose RIte Care 60 days postpartum (as their income rises above the eligibility threshold) qualify for Extended Family Planning — two years of gynecological check-ups and contraceptive services at no cost.
Sherlock Plan Income: Up to 250% FPL ($3,260/month for a single adult in 2026). Income must come from employment.
The Sherlock Plan also disregards assets needed to maintain employment — including a wheelchair-accessible vehicle and certain health savings accounts — from the $10,000 asset limit.
Federal Poverty Level Reference — 2026
| Household Size | 100% FPL | 138% FPL | 250% FPL |
|---|---|---|---|
| 1 | $1,304/mo | $1,799/mo | $3,260/mo |
| 2 | $1,762/mo | $2,432/mo | $4,406/mo |
| 3 | $2,221/mo | $3,064/mo | $5,552/mo |
| 4 | $2,679/mo | $3,697/mo | $6,698/mo |
Use the FPL Calculator to find the exact threshold for your household size.
Rhode Island’s Asset Limits — More Generous Than Most States
Rhode Island’s asset limit for long-term care Medicaid is $4,000 (single) — double the $2,000 federal minimum used by most states including Pennsylvania and Oregon.
This is a meaningful difference for applicants who have modest savings. Rhode Island’s ABD Regular Medicaid uses the same $4,000 limit.
| Situation | Countable Asset Limit |
|---|---|
| Single applicant (LTC / Nursing Home) | $4,000 |
| Married, both applying (LTC) | $6,000 |
| Married, one applying — applicant | $4,000 |
| Married, one applying — community spouse | Up to $157,920 (CSRA) |
| ABD Regular Medicaid (single) | $4,000 |
| ABD Regular Medicaid (couple) | $6,000 |
| Sherlock Plan | $10,000 |
Community Spouse Resource Allowance (CSRA): The non-applicant spouse may keep up to 50% of the couple’s total countable assets, with a maximum of $157,920.
If the non-applicant’s share falls below $32,532, they may keep up to 100% of assets up to that minimum floor.
Home equity limit: The primary home is exempt while the applicant or spouse resides there or intends to return. Rhode Island’s home equity cap is $730,000.
Exempt Assets (Not Counted)
- Primary home (within the $730,000 cap)
- One vehicle of any value
- Household goods and personal effects
- Irrevocable Funeral Trusts (IFTs)
- Medicaid Compliant Annuities
- Life insurance with face value $1,500 or less
- Employment-related items under the Sherlock Plan (wheelchair-accessible vehicles, certain HSA funds)
No asset test applies to ACA expansion adults, children, pregnant women, or RIte Share enrollees.
Rhode Island’s 60-Month Look-Back Period
Rhode Island enforces a 60-month (5-year) look-back for Nursing Home Medicaid and RIte @ Home HCBS Waivers.
When you apply, EOHHS reviews all financial transfers within the 5 years before your application date. Transfers below fair market value — gifts to family, below-market property sales, or certain trust transfers — trigger a penalty period of ineligibility.
The penalty period is calculated by dividing the transferred value by the average monthly nursing home cost in Rhode Island.
Importantly, the look-back applies to transfers made by either spouse — not just the applicant. A non-applicant spouse who gave assets away within 5 years of the applicant’s application can also generate a penalty.
Transfers that do not trigger a penalty:
- Transfers to a spouse
- Transfers to a blind or disabled child
- Transfers of the home to a caregiver child who lived there for at least 2 years before institutionalization and whose care delayed nursing home placement
- Transfers to a sibling with an equity interest in the home who lived there at least 1 year before institutionalization
No look-back applies to ABD Regular Medicaid, ACA expansion adults, or the Sherlock Plan.
Consult a Certified Medicaid Planner before making any asset transfer if long-term care Medicaid may be needed within 5 years.
Medical and Functional Requirements
To qualify for Nursing Home Medicaid or RIte @ Home HCBS Waivers, applicants must demonstrate a Nursing Facility Level of Care (NFLOC) through documented limitations in:
ADLs (Activities of Daily Living): Mobility, bathing, dressing, eating, and toileting.
IADLs (Instrumental ADLs): Cooking, shopping, managing finances, medication management.
Cognitive or behavioral issues: Alzheimer’s or dementia — though diagnosis alone does not guarantee NFLOC. Functional limitations must be documented through a formal assessment.
For ABD Regular Medicaid, proof of disability or blindness per SSA standards is required. NFLOC is not required.
For the Sherlock Plan, the applicant must have a documented disability and be employed.
Estate Recovery in Rhode Island
Rhode Island’s Medicaid Estate Recovery Program may seek reimbursement from a beneficiary’s estate after death for long-term care costs paid by the program.
Recovery typically targets the primary home if not protected through a surviving spouse, qualifying disabled child, or caregiver child.
Planning ahead — well before a care need arises — is far more effective than trying to protect assets after an application is filed. A Certified Medicaid Planner can help identify available strategies within Rhode Island’s specific rules.
Options If You Exceed the Limits
Qualified Income Trusts (QITs): If income exceeds $2,901/month, a QIT redirects the excess into an irrevocable trust, restoring long-term care eligibility while protecting the $50/month Personal Needs Allowance and other protected amounts.
Rhode Island Medicaid must be named as the trust beneficiary upon death.
Irrevocable Funeral Trusts (IFTs): Pre-paid funeral and burial costs in an irrevocable trust are exempt from asset limits.
This reduces countable assets while making practical arrangements.
Spend Down: Convert countable assets into exempt ones — home improvements, a vehicle purchase, paying off debt, or purchasing medically necessary equipment.
Not all spend-down transactions avoid look-back scrutiny. Consult a planner before taking action.
Medicaid Compliant Annuities: Convert excess assets into a stream of income, reducing countable assets while directing income toward care costs.
Federal Policy Changes Coming to Rhode Island Medicaid
Work Requirements (January 2027): Will apply to ACA expansion adults (Rhody Health Partners) 19–64 who are not seniors, disabled, pregnant, or otherwise exempt.
For context on how these requirements work, see our guide on SNAP work requirements — the Medicaid version follows similar logic. Full policy overview: Big Beautiful Bill changes.
Reduced Retroactive Coverage (January 2027): Medicaid will cover only 2 months prior to application, down from 90 days.
Apply promptly if you think you qualify — delayed applications mean greater exposure to medical debt.
More Frequent Renewals (December 2026): Renewals will shift from annual to every 6 months for expansion adults.
Rhode Island’s HealthyRhode.ri.gov portal and mobile app allow online renewal — use them proactively.
New Cost-Sharing (October 2028): Non-exempt enrollees may face up to $35 per specialist visit.
Primary care and preventive services remain free. Nursing facility residents, children, pregnant women, and seniors are exempt.
Rhode Island Medicaid, SNAP, and WIC: How They Connect
Many Rhode Island households qualify for Medicaid and SNAP simultaneously — and applying for one often simplifies the other.
Rhode Island SNAP uses 185% FPL Broad-Based Categorical Eligibility and administers benefits through the RI Bridges portal. Medicaid is handled through the separate HealthSource RI / HealthyRhode portal.
Note that unlike Pennsylvania’s COMPASS, these are two different application systems — you’ll need to apply separately for SNAP and Medicaid in Rhode Island.
SNAP enrollment auto-qualifies most children for WIC, and RIte Care enrollment also triggers WIC auto-qualification for eligible children and pregnant women.
Useful links for Rhode Island residents:
- Rhode Island SNAP benefits and income limits
- How to apply for SNAP in Rhode Island
- Rhode Island WIC income guidelines
- Can seniors on Social Security get food stamps?
How to Apply for Rhode Island Medicaid
Online (Recommended): Apply through HealthyRhode.ri.gov — Rhode Island’s integrated health coverage portal, available as a website and mobile app.
A single application simultaneously screens you for Medicaid and HealthSource RI private coverage. The system uses electronic income verification in most cases, so you may not need to submit pay stubs separately.
By Phone:
- HealthSource RI: 1-855-840-4774
- DHS Call Center: 1-855-697-4347
By Mail: Complete a paper application (available in English, Spanish, Portuguese, Arabic, Cape Verdean Creole, French, Haitian Creole, Khmer, Laotian, Russian, Simplified Chinese, and Swahili) and mail to: EOHHS, 74 West Road, Cranston, RI 02920.
Or mail to: HealthSourceRI, HZD Mailroom, 74 West Road, Suite 900, Cranston, RI 02920-8413.
In Person: Visit your nearest DHS office. Rhode Island has no county government — all DHS offices are state-operated, making administration more uniform than in most states.
Long-Term Care / HCBS: Contact the Office of Healthy Aging at 1-401-462-4441 for RIte @ Home waivers and to initiate the NFLOC assessment before applying.
For long-term care applicants who are also receiving Medicare or SSI, complete the DHS-2 application directly (available at eohhs.ri.gov) rather than going through HealthSource RI.
For the complete step-by-step application guide: how to apply for Medicaid in Rhode Island.
Documents You’ll Need
- Rhode Island residency proof (utility bill, lease, or official mail)
- U.S. citizenship or qualifying immigration status documentation
- Income proof: pay stubs, SSA award letters, pension statements
- SSNs for all household members
- For LTC / ABD: bank statements, property records, 60 months of financial history
- For disability programs: SSA disability documentation or physician letter
- For the Sherlock Plan: proof of employment plus disability documentation
- For pregnancy: physician verification
Processing Times
- Standard applications: Up to 45 days
- Disability-based applications: Up to 90 days
- Expedited: Pregnant women and urgent cases can be expedited
If your Medicaid is denied or lost, you may be eligible for a HealthSource RI private plan with financial assistance. You have 60 days from your Medicaid loss notice to enroll in HealthSource RI during a Special Enrollment Period.
Frequently Asked Questions
What makes Rhode Island’s Medicaid asset limit different from other states?
Rhode Island’s long-term care Medicaid asset limit is $4,000 for a single applicant — double the $2,000 federal minimum used by most states.
The same $4,000 limit applies to ABD Regular Medicaid, and the Sherlock Plan allows up to $10,000 in assets. This gives Rhode Islanders more room to hold modest savings without disqualifying themselves.
What is the Sherlock Plan?
The Sherlock Plan is a Rhode Island Medicaid program designed for working adults with disabilities.
Eligible adults can earn up to 250% FPL ($3,260/month for a single person) and hold up to $10,000 in assets. Items needed to maintain employment — like a wheelchair-accessible vehicle — are excluded from the asset count. This allows people with disabilities to work and build some savings without losing Medicaid coverage.
What is the difference between RIte Care and RIte Share?
RIte Care is Rhode Island’s Medicaid managed care plan for children and families — functioning like a standard health insurance plan delivered through one of three MCOs.
RIte Share is a premium assistance program — instead of placing an eligible family on the state Medicaid plan, it pays all or part of their share of an available employer-sponsored health insurance plan. RIte Share makes sense when employer coverage is available and covers needed services.
What happens to my coverage after I have a baby in Rhode Island?
Your RIte Care postpartum coverage extends for 12 full months after delivery, regardless of income changes during that period.
If you lose RIte Care when postpartum coverage ends and your income is now above the eligibility threshold, you qualify for Extended Family Planning — two years of gynecological check-ups and contraceptive services at no cost, with no income test.
Does Rhode Island count VA benefits as income for Medicaid?
No — Rhode Island excludes the VA Aid & Attendance Allowance (the amount above the Basic VA Pension) from countable income for Medicaid purposes.
This can be significant for veterans receiving this benefit, as it may help them stay within the income limit for ABD or long-term care Medicaid.
What is HealthSource RI and how does it relate to Medicaid?
HealthSource RI is Rhode Island’s official health insurance marketplace — similar to HealthCare.gov but state-run.
When you apply for coverage through HealthSource RI, it automatically determines whether you qualify for Medicaid first. If you don’t qualify for Medicaid, it shows you available subsidized private plans. If you later lose Medicaid, you have 60 days to enroll in a HealthSource RI plan through a Special Enrollment Period.
Can I get both Rhode Island Medicaid and SNAP?
Yes — many Rhode Island households qualify for both.
However, note that Rhode Island uses two separate portals: RI Bridges for SNAP and DHS benefits, and HealthyRhode.ri.gov for Medicaid. You’ll need to apply in both systems. See Rhode Island SNAP benefits for income limits and eligibility details.
What is the look-back period in Rhode Island and does it apply to my spouse?
Rhode Island enforces a 60-month (5-year) look-back for nursing home Medicaid and RIte @ Home HCBS.
Uniquely, Rhode Island reviews transfers made by either spouse — not just the Medicaid applicant. If the non-applicant spouse transferred assets below fair market value within 5 years of the application date, that transfer can still generate a penalty. Always consult a Certified Medicaid Planner before any asset transfer.
Last updated: 2026 | Sources: Rhode Island EOHHS, Rhode Island DHS, HealthSource RI, USDA FPL guidelines, CMS.gov. Verify current figures at eohhs.ri.gov or HealthyRhode.ri.gov, or by calling DHS at 1-855-697-4347. This guide is for informational purposes only — eligibility is determined by Rhode Island EOHHS.