Rhode Island Medicaid Office

Rhode Island Medicaid office (EOHHS)

Rhode Island runs its Medicaid program out of one agency — the Executive Office of Health and Human Services (EOHHS) — but routes applicants through a shared eligibility system jointly operated with the state's ACA marketplace, HealthSource RI. The same application screens for Medicaid (RIte Care, Rhody Health Partners, Medicaid Expansion) and for subsidized marketplace coverage, so a household above the Medicaid line lands in HealthSource RI's marketplace plans rather than having to file twice.

Four consumer pathways segmented by population

How to reach EOHHS and DHS

• DHS Call Center — 1-855-697-4347, for applications, eligibility questions, and case changes.
• HealthSource RI — 1-855-840-4774, the marketplace + Medicaid combined help line.
• Apply online — HealthyRhode.ri.gov, the joint EOHHS/HealthSource RI portal.
• Agency website — eohhs.ri.gov for the consumer pages, forms, and policy documents.

Intro to Medicaid in 12 languages

EOHHS publishes its "Intro to Medicaid" flyer in twelve languages: English, Spanish, Portuguese, Arabic, Cape Verdean Creole, French, Haitian Creole, Khmer, Laotian, Russian, Simplified Chinese, and Swahili. The flyer set reflects Rhode Island's relatively wide-language Medicaid outreach — broader than many small states.

Who qualifies for Rhode Island Medicaid?

Rhode Island took the Affordable Care Act Medicaid expansion in 2014. The Medicaid Expansion eligibility test EOHHS publishes today — five specific criteria, with income capped at 133% of the federal poverty level — is more constrained than the federal default. Members who clear the test pick from three managed care plans or RIte Share Premium Assistance.

Medicaid Expansion eligibility test (the published five-criterion list)

• Rhode Island resident between ages 19 and 64.
• U.S. citizen or a legally present non-citizen who has been in the US for five years or meets certain exemptions.
• Not pregnant (pregnant individuals use the pregnancy track, which has higher income thresholds).
• Not eligible for other Medicaid programs or Medicare Part A or B.
• Household income at or below 133% of the federal poverty level. With the federal 5% FPL disregard for MAGI households, the effective standard rounds to 138% FPL — both figures appear across EOHHS documentation.

RIte Care thresholds for families and pregnancy

Children's coverage at 261% FPL is one of the higher children's standards in the country — a Rhode Island choice, not a federal requirement. CHIP fills the band above Medicaid for children whose families exceed the children's MaineCare income line.

Three eligibility tracks by population

• MAGI tracks — families, children, pregnant women, and the Medicaid Expansion group all budget income using modified adjusted gross income. EOHHS verifies income electronically in most cases, so members don't have to submit pay stubs.
• Non-MAGI tracks — older adults (65+), adults with special needs and disabilities, and members applying for long-term services and supports use SSI-linked income and resource tests through a separate intake process.
• Rhody Health Partners (RHP) — the Medicaid coverage type for adults age 21 and older who don't fit a family or LTC category. Members in this group pick from the same MCO roster the expansion group uses.

Rhode Island Medicaid income limits (2026 FPL)

EOHHS republishes the federal poverty level (FPL) chart on its consumer site every year. The 2026 values below come straight from the EOHHS FPL Guidelines page. The federal poverty level updates every January when HHS issues new guidelines; the percentages of FPL that Rhode Island Medicaid applies (133%, 253%, 261%) stay stable from year to year.

2026 FPL — 100% of Federal Poverty Level

How to apply the percentages

To check whether your household is under the Medicaid line for a specific group, multiply the 100% FPL figure for your household size by the relevant percentage. A family of three at 133% FPL is roughly $36,336 a year ($27,320 × 1.33); a family of three at 253% (pregnant women) is roughly $69,120; a family of three at 261% (children's coverage) is roughly $71,305. EOHHS uses the formal HHS guidelines, not these rounded estimates, when making eligibility decisions.

Long-term care and spousal impoverishment

EOHHS links to the federal CMS Medicaid Spousal Impoverishment Standards page for the figures applied to LTC applicants with a community spouse. Those standards update each January and protect the community spouse's income and resources up to specified federal floors and ceilings.

How to apply for Rhode Island Medicaid

Rhode Island uses a single online eligibility system shared between Medicaid and HealthSource RI, the state's ACA marketplace. The same application screens for RIte Care, Rhody Health Partners, the Medicaid Expansion group, RIte Share Premium Assistance, and HealthSource RI marketplace plans — one form, one set of documents.

Ways to apply

• Online (recommended) — HealthyRhode.ri.gov. Create an account, complete the step-by-step application, upload documents, and check status from the same portal.
• By phone — DHS Call Center — 1-855-697-4347 for application questions, eligibility status, and change reports.
• By phone — HealthSource RI — 1-855-840-4774 for help applying through the joint portal.
• In person — visit a Department of Human Services office or a HealthSource RI service location.
• By mail — print the DHS-2 paper application (English, Spanish, Portuguese), fill it out, and return it.

When you need to bypass HealthSource RI and use the DHS-2

Most adults applying for long-term care who already have Medicare or SSI must complete the DHS-2 application instead of going through the standard HealthyRhode flow. EOHHS publishes the DHS-2 in three paper languages (English, Spanish, Portuguese) and also accepts it online. The DHS-2 captures the resource-test detail and clinical-level-of-care information that the standard MAGI-based intake doesn't ask for.

Federal decision deadlines

Federal rules give EOHHS up to 45 days to decide a non-disability application and up to 90 days for applications based on disability. Coverage can be retroactive up to three months before the application month when the applicant had qualifying medical bills during that window. Pregnancy and presumptive-eligibility decisions move faster — often same-day or next-day at a hospital or qualified clinic.

What Rhode Island Medicaid covers

Rhode Island Medicaid has three umbrella programs and a premium-assistance option. RIte Care is the managed-care program for families, children under 19, and pregnant women. Rhody Health Partners (RHP) covers adults age 21 and older. RIte Share is the Premium Assistance Program — the state pays all or part of an eligible member's employer-provided health insurance premium rather than enrolling them in a Medicaid MCO. Members of every track choose from the same three contracted health plans.

The three RIte Care / Rhody Health Partners health plans

RIte Share has its own contact line at (401) 462-0311 for members who already have access to employer coverage and want EOHHS to help pay the premium.

Covered benefits in RIte Care

• Doctor's office visits, referrals to specialists, hospital care, emergency care
• Immunizations, lab tests, prescriptions
• Mental health services, drug or alcohol treatment
• Home health care, skilled nursing care
• Nutrition services, smoking cessation programs
• Interpreter services, childbirth education, parenting classes
• Transportation services to covered appointments
• Dental care

Long-term services and supports

For members who need long-term care, EOHHS covers Home and Community-Based Services across several settings — the member's own home, an assisted living facility, a shared living arrangement, or a group home — and institutional settings including nursing homes and certain hospitals. Members applying for LTC use the DHS-2 application path described in the how-to-apply section above, which captures the additional resource-test and clinical-level-of-care detail.

Children under 21 (EPSDT)

Children enrolled in RIte Care receive Early and Periodic Screening, Diagnostic, and Treatment benefits — the federal mandate that covers any medically necessary screening or treatment for a child, including dental, vision, hearing, and behavioral health services that adult Medicaid in many states does not cover.

Other state Medicaid pages