Medicaid Costs and Coverage in Rhode Island

“How much is Medicaid in Rhode Island?” is a common question for families in need of affordable health coverage. To understand how much Medicaid costs in Rhode Island, potential benefits recipients must first know which state Medicaid program they expect to participate in. The different types of Medicaid insurance in RI has its own eligibility requirements, costs and medical benefits coverage that can affect how much a benefits recipient must pay for coverage. How much does Medicaid cost for individual medical services for eligible program participants? The Rhode Island Department of Human Services (DHS) determines Medicaid cost estimates for all state health programs in addition to application procedures, eligibility requirements and more.

Wondering, “What services are covered by Medicaid in Rhode Island health programs?” All Medicaid programs in Rhode Island must include coverage for certain federally required medical treatments or services, with or without a required copayment. What does Medicaid not cover in Rhode Island? Like Medicaid programs across the country, the RI health scheme does not provide coverage for all medical procedures, especially those deemed unnecessary. Some types of Medicaid insurance for special groups, like children or pregnant people, include additional medical coverage not available to the general Medicaid population. It is important for qualified applicants and recipients alike in the state of Rhode Island to understand the costs and coverage of the Medicaid program in which they participate. Read on to learn more about Medicaid coverage and estimated costs in Rhode Island.

How much is Medicaid in Rhode Island?

“How much does Medicaid cost in Rhode Island?” is a question frequently asked when individuals consider the information required to apply for Medicaid. The cost for Medicaid coverage in Rhode Island varies by income bracket and accompanying Medicaid health group. Because each Medicaid group has differing income limitations and accompanying fee schedules, benefits applicants should be familiar with coverage details of their specific health program. The primary types of Medicaid insurance in Rhode Island are:

  • Affordable Care Coverage (ACC)
  • Adults with Disabilities (EAD)
  • Elders and Medicare Premium Payments (MPP)
  • General Public Assistance (GPA)
  • Long Term Services and Supports (LTSS)
  • Child Care Assistance Program (CCAP) and Katie Becket (KB) program

Most low-income recipient benefits will not have to pay any copayment costs for eligible medical services. Medicaid cost estimates for benefits recipients in health programs with higher income limitations may need to provide a small copayment for some medical services or procedures. This copayment fee does not usually cost more than a few dollars per visit or procedure, though can be significant for participants in Medicaid groups with high or no income limitations. Rhode Island Medicaid coverage also covers most common prescription drugs, costing some benefits applicants nothing while others are requested to make a small copayment. Medical services that can incur a copayment charge for some RI benefits recipients include but are not limited to:

  • Outpatient doctor visits, except for prenatal or preventative visits
  • Ambulatory surgical procedures
  • Unauthorized non-emergency use of the emergency room or emergency transportation
  • Some family planning services such as free contraceptives or voluntary sterilization procedures
  • Some types of dental and vision services and care

Learn how to navigate the Medicaid application process, download our helpful guide to affordable health coverage.

What Services Are Covered by Medicaid in Rhode Island?

Medicaid coverage in Rhode Island includes medical services and healthcare needs that are required to be covered by the federal Medicaid program, in addition to some optional state programs. What are the medical services that are included in all types of Medicaid insurance in Rhode Island?

Medicaid Coverage in Rhode Island for General Healthcare Services

What general services are covered by Medicaid in Rhode Island? RI Medicaid coverage is intended to provide comprehensive healthcare to program benefit recipients. To meet these ends, Medicaid coverage in the state of Rhode Island includes physical health checkups, emergency care services and transportation, prevention care and services, lab tests and x-rays, pregnancy and neonate health services and much more. Some types of Medicaid insurance also include coverage for dental, vision and hearing preventive care and treatment. In addition, Medicaid coverage in Rhode Island includes free or discounted access to necessary prescription medications.

Behavioral Health Medicaid Coverage for Rhode Island Residents

What behavioral health services are covered by Medicaid in the state of Rhode Island? All types of Medicaid insurance in PA include some form of mental health insurance coverage, with benefits varying significantly by program. Pregnant women and senior citizens, for example, are usually able to access more covered mental and behavioral benefits than typical adult applicants. Children and young adults are eligible for comprehensive behavioral health Medicaid coverage through the Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. Some benefit claimants in the state of Rhode Island are also covered for addiction cessation services for tobacco, drugs or alcohol issues.

Rhode Island Community Health Medicaid Covered Benefits

Many community health medical services are required to be part of Medicaid coverage in every state according to federal guidelines. Some of the healthcare services covered by Medicaid include family planning services, rehabilitative therapy, transportation to necessary doctor appointments, medical supplies and equipment, nursing home and hospice care, meal services and more. Benefit recipients who are unsure if a mental or behavioral health service or treatment is included in their Medicaid coverage should contact their nearest DHS office for assistance before accepting medical treatment.

Download our comprehensive guide to affordable coverage to learn more about how to you can discover the best way to apply for Medicaid.

What does Medicaid not cover in Rhode Island?

Some medical treatments and procedures are never included in Medicaid coverage in Rhode Island, regardless of the specific Medicaid program a benefits recipient participates. These healthcare services will have to be paid for completely by the patient or another Non-Medicaid health provider. What does Medicaid not cover in Rhode Island? The following medical services are not covered under the RI Medicaid program:

  • Experimental procedures, except as permitted under Rhode Island state law
  • Abortion services, except when performed to preserve the life of the woman
  • Private rooms in hospitals, unless medically necessary
  • Cosmetic surgery
  • Infertility treatment services and medications that treat erectile dysfunction or other sexual disorders
  • Any portion of behavioral health services that exceeds 15 days for adults between the ages of 19 years of age and 64 years of age
  • In most cases, out-of-state care is not included in RI Medicaid coverage unless an emergency or other extraordinary situation arises that requires immediately medical attention or treatment that cannot be received within Rhode Island