Quick Reference Guide: Medicaid Terms
Learn more about commonly used Medicaid terms below.
Commonly Used Terms
Additional Documentation Required (ADR): When the State does not have enough information on file to renew your Medicaid benefits, you will get a notice in the mail requesting additional documentation. This notice is commonly called an ADR.
Affordable Care Act (ACA): The name for the health care reform law (passed in 2010) and its amendments. The law addresses health insurance coverage, health care costs, and preventive care.
Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH): Rhode Island's Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) is dedicated to providing high-quality services for individuals with disabilities, mental health or substance use issues, or those under state care.
Beneficiary Advisory Committee (BAC): An advisory group open only to Medicaid beneficiaries, their families, or caregivers.
Benefits Decision Notice (BDN): When your application for Medicaid or other benefit programs is either approved or denied, you will get a notice in the mail that is called a Benefits Decision Notices, or a BDN. You may also get a BDN when your benefits or eligibility change.
Centers for Medicare and Medicaid Services (CMS): The federal agency that administers Medicare and Medicaid.
Certified Community Behavioral Health Clinics (CCHBHC): An outpatient clinic that is certified by the State of Rhode Island to offer expanded behavioral health services. CCBHCs serve anyone who walks through the door, regardless of age, diagnosis, or insurance status.
Children’s Health Insurance Program (CHIP): Provides health coverage to eligible children through Medicaid.
Conflict-Fee Case Management (CFCM): An interagency collaborative to create a statewide program that offers conflict-free case management (CFCM) for Medicaid long-term care and support (LTSS) members in the State's home and community-based services (HCBS) programs.
Continuous Eligibility: Often implemented for children through the Children’s Health Insurance Program (CHIP), continuous eligibility refers to an approach to Medicaid enrollment that allows for an individual to continue to receive Medicaid coverage and care – even if financial changes would otherwise change that eligibility.
- In 2024, Rhode Island enacted “continuous coverage” for children. This means that if everyone in a household is enrolled in Medicaid, but a parent or caregiver later reports a change that means they and their dependent are no longer eligible for Medicaid, the dependent may stay enrolled in Medicaid for the remainder of their 12-month coverage period.
Early and Periodic Screening, Diagnosis and Treatment (EPSDT): A benefit for children and adolescents who need treatments and other health services to correct or improve birth defects, and behavioral and physical health conditions. Your child may be eligible for this benefit if they are under 21 and receive Medicaid.
Department of Human Services (DHS): Rhode Island’s Department of Human Services (DHS) is dedicated to promoting access and success. Its vision is to ensure that every Rhode Islander has the chance to thrive in their home, workplace, and community.
Early Intervention Program: Rhode Island’s Early Intervention Program is a no-cost program that supports the growth and development of certain infants and toddlers. If your child has developmental disabilities or delays that can affect their physical abilities, social skills, or speech, they may be eligible for Early Intervention.
Executive Office of Health and Human Services (EOHHS): Rhode Island’s Executive Office of Health and Human Services (EOHHS) is the main government agency responsible for overseeing the state departments and programs. EOHHS also manages Medicaid.
Fee for Service (FFS): States deliver and pay for Medicaid services through a fee-for-service system, which directly pays physicians, clinics, hospitals and other medical providers a fee for each service they provide their patients with Medicaid plans.
Federal Poverty Level (FPL): A measure of income updated yearly by the Department of Health and Human Services (HHS) that’s used to determine eligibility for certain programs and benefits like Medicaid.
HealthSource RI (HSRI): HealthSource RI (HSRI) is Rhode Island’s official state health insurance available for Rhode Islanders at federally subsidized rates.
Home Based Therapeutic Services (HBTS): Provides intensive home and community services to children up to age 21 with severe behavioral health, developmental or physical disabilities. All HBTS Agencies provide Pre and Post Treatments, Intensive Specialized Treatment and Treatment Support.
Home and Community Based Services (HCBS): Provides opportunities for Medicaid beneficiaries to receive services in their own homes or communities rather than institutions or other isolated settings.
Katie Beckett: Children under the age of 19 who have long-term disabilities or complex medical needs could become eligible for Medicaid coverage. Katie Beckett eligibility enables children to be cared for at home instead of an institution. With Katie Beckett, only the child's income and resources are used to determine eligibility.
Long-term Services and Supports (LTSS): Serves people who have disabilities or chronic care needs in the setting ideal for them and their families. Services may be on-going.
Low Income Subsidy (LIS): Also known as “Medicare Extra Help,” is a federal program designed to help people with limited income and resources pay for their Medicare prescription drug costs.
Managed Care Organization (MCO): A health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.
Medicaid Advisory Committee (MAC): An advisory group; open to advocates, clinicians and administrators, community partners, and state, local or community-based organizations.
Modified Adjusted Gross Income (MAGI): A person's adjusted gross income (AGI) after factoring in specific allowed deductions and tax penalties.
Office of Healthy Aging (OHA): Rhode Island’s Office of Health Aging (OHA) supports Rhode Islanders over the age of 55 and adults living with disabilities.
Personal Assistance Services and Supports (PASS): Services provide specialized health care for children in their homes or communities. These services are consumer-directed, meaning parents can suggest workers to an agency and take responsibility for training and supervising them. Personal assistance focuses on helping children achieve goals in everyday tasks, make safe decisions, and engage in social activities and roles.
Prescription Drug Plan (PDP): Also known as Medicare Part D, helps pay for the brand-name and generic drugs.
Program of All-Inclusive Care for the Elderly (PACE): Provides comprehensive medical and social services to certain frail, elderly participants still living in the community. PACE participants are dually eligible for both Medicare and Medicaid.
Qualified Health Plan (QHP): A health insurance plan approved by the Health Insurance+ Marketplace. This includes important health services, follows cost-sharing rules, and meets other guidelines required during the application process.
Rhode Island Department of Health (RIDOH): Rhode Island’s Department of Health (RIDOH) prevents disease and protects and promotes the health and safety of the people of Rhode Island.
RIte Care: Rhode Island’s Medicaid managed care program for families with children, pregnant women, and children under age 19.
RIte Smiles: a dental plan for children who were born after May 1, 2000 and receive Medicaid.
Skilled Nursing Facility (SNF): An inpatient rehabilitation and medical treatment center staffed with trained medical professionals.
State Health Insurance Assistance Program (SHIP): Free health benefits counseling service for Medicare beneficiaries and their families or caregivers.
Supplemental Security Income (SSI): A federal program designed to help aged, blind, and disabled people, who have little or no income. It provides a cash supplement to meet basic needs for food, clothing, and shelter.
These programs serve a variety of groups, such as older adults, people with intellectual or developmental disabilities, physical disabilities, or mental health and substance use disorders.