Rhode Island Medicaid Waivers & Home and Community Based Programs Overview

Rhode Island, known as The Ocean State, has a streamlined Medicaid Waiver and Home and Community-Based Services (HCBS) system designed to provide long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.

Unlike most states that operate multiple Medicaid waivers, Rhode Island administers its HCBS services under a 1115 Demonstration Waiver, known as the Rhode Island Global Consumer Choice Compact Waiver. This waiver consolidates multiple HCBS programs into a single, flexible system that allows eligible individuals to receive services in their homes or community settings instead of institutional facilities.

Key HCBS programs under this waiver include Core Community-Based Services (CCBS) for Aging and Disabled Populations, The Intellectual and Developmental Disabilities (IDD) Program, which offers habilitative, employment, and residential services, and Specialized HCBS programs for individuals with severe mental illness (SMI) and traumatic brain injuries (TBI). Rhode Island also provides Self-Directed Services, giving participants the ability to choose and manage their caregivers for greater independence.

Regulatory oversight in Rhode Island is managed through the Rhode Island Executive Office of Health and Human Services (EOHHS), Office of Healthy Aging (OHA), and the Division of Developmental Disabilities (DDD), with additional provider licensing and compliance enforcement by the Rhode Island Department of Health (RIDOH).

The state operates under a Managed Care model, with HCBS services integrated into Rhody Health Partners (RHP), Neighborhood Health Plan of Rhode Island (NHPRI), and Medicaid Managed Care Organizations (MCOs) to enhance service coordination and efficiency. Rhode Island has also implemented Electronic Visit Verification (EVV) for personal care services, ensuring compliance and accountability in home-based care programs.

Providers must navigate Medicaid enrollment, waiver-specific service authorizations, and rigorous quality assurance measures to successfully participate in the state’s HCBS system. With a strong emphasis on flexible service delivery, person-centered planning, and cost-effective care, Rhode Island’s Medicaid waiver system ensures that individuals receive high-quality, sustainable long-term care while maintaining independence, dignity, and full community inclusion.

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