Older Adults (Age 65 and Older)

If you are eligible for both Medicare and Medicaid, this means you are dual eligible. You can choose how you get Medicaid. You can get all the services covered by both Medicare and Medicaid without any extra costs, no matter which type of Medicaid you choose. 

You can choose: 

Medicaid managed care 

When you enroll in Medicaid managed care, your managed care provider coordinates your Medicaid and Medicare benefits. This helps make sure all the healthcare services you receive are part of one system. You’ll have one contact for any questions you have about your healthcare coverage. 

Rhode Island offers two Medicaid managed care choices if you have Medicare and Medicaid: 

Medicare-Medicaid program (MMP) 

Neighborhood Health Plan of Rhode Island (NHPRI) is Rhode Island’s MMP managed care provider. This plan is called Neighborhood INTEGRITY. The NHPRI team coordinates all your Medicare and Medicaid benefits.  

MMP also pays for long-term services and supports if you need long-term care in your home or in a healthcare facility. 

Program for All-Inclusive Care for the Elderly (PACE) 

The Program for All-Inclusive Care for the Elderly (PACE) provides long-term services and supports (LTSS) to older adults. These services can help you stay in your home or another community setting when you need more support and have more healthcare needs. If you receive care in a hospital or nursing home, PACE coordinates and manages your healthcare services. Learn more about PACE. 

Fee-for-service Medicaid 

If you’re eligible for Medicare and Medicaid, you can choose to have Medicaid pay your healthcare provider directly for any healthcare services you receive. This option is called fee-for-service Medicaid.  

If you don’t have Medicare or other health insurance, you may be eligible for Medicaid if you meet financial eligibility requirements. You can choose from one of three Medicaid managed care organizations (MCOs). These are also known as Medicaid health plans:  

• Neighborhood Health Plan of Rhode Island
• Tufts Health Plan
• UnitedHealthcare 

The Medicare Premium Payment (MPP) program, also known as the Medicare Savings Program (MSP), can help you save money on Medicare premiums, co-payments, and deductibles. Learn more about the Medicare Premium Payment Program. 

You may be eligible for Medicaid Long Term Services and Supports (LTSS) if you are over 65 and have a disability or healthcare needs that require help to take care of yourself. You must show that you need this level of care. LTSS eligibility criteria are different from Medicaid eligibility criteria. You are allowed to have a higher income and still qualify for LTSS than for standard Medicaid, but you may have to pay for part of your LTSS. This is called a co-share. 

Medicaid covers long-term care in your home, in another community-based setting, or in a nursing home or other healthcare facility when you are eligible for Medicaid LTSS. You can get help with daily tasks like eating, dressing, and using the bathroom as part of the LTSS program. 

You can choose to get LTSS services through: 

• A managed care health plan
• Fee-for-service Medicaid  

Some Rhode Islanders choose to self-direct their LTSS. This is called Personal Choice. With Personal Choice, you can choose who provides your care and when. When you select this option, you manage your service budget, how much your caregivers are paid (within certain limits), and you decide the type of training they receive. If you are eligible for Home and Community-Based LTSS, you will also get conflict-free case management. A case manager gives you information to help you decide which services you want and need, as well as how you want to receive them.  

You may qualify for help with paying for part of the cost of some prescription drugs you take. The Rhode Island Pharmaceutical Assistance to Elders (RIPAE) Program pays some of the cost of RIPAE-approved medications purchased during the deductible stage of a Medicare Part D plan. Visit MyOptionsRI to learn more about prescription drug assistance. 

The Office of Healthy Aging (OHA) has programs for people who are over age 65, or under 65 and living with Alzheimer’s Disease or a related dementia. If you are eligible, Medicaid will cover a limited set of home and community-based services such as personal care and homemaker services. Visit OHA's website to learn more. 

You can get dental care as part of your Medicaid benefits. Search for a dentist who may accept patients with Medicaid or find free or low-cost dental care. Nursing home residents who have Medicaid may qualify for mobile dentistry through CareLink. 

If you have both Medicaid and Medicare, contact the RI Aging and Disability Resource CenterThan to learn about your options for dental care.