Applying for Medicaid

Follow these steps

Ready to apply? Great! Fair warning: You have some work ahead of you.

The signup process has three basic parts:

  1. Fill out the application
  2. Provide info about yourself, your residence and your income
  3. Choose a health insurance plan

Part 1 is lengthy, but it’s straightforward. In paper form, the application is about 30 pages long.

When it comes to part 2, be prepared to have documents and information ready.

Checking your eligibility

You will need papers like your driver’s license, pay stubs or other proof of income (if they’re available), and other forms of identification. Don’t worry if it seems like a lot. The state needs these things to verify where you live, your age, your income and how many people live in your household.

Some of the rules for Medicaid have to do with immigration status. So the state will ask for papers to understand your status. You have to be a U.S. citizen, a U.S. national, a qualified immigrant or an immigrant with a legally present status in the state of Rhode Island to be eligible for the program.

It’s a lot of work for sure. But the goal is to make sure you get the right options for you. The state will review your information and get in touch with you about the next steps. The process may take a few weeks.

Be on the lookout for a letter from the Department of Human Services (DHS). Read the letter right away! DHS will let you know if you are approved or denied for Medicaid. DHS also may ask you for more information before they approve or deny your application.

If you’re denied, that means the state has decided you don’t qualify for Medicaid benefits or information was missing in your application. Read the letter carefully and call the number on the letter if you have questions. If you are denied Medicaid benefits, you have options. You may qualify for a tax credit or cost-sharing reduction. Use the HealthSource RI Plan Comparison and Savings Tool to find out.

If you ever have any questions, just call 855.697.4347.

Choose a health plan

Once the state says you’re eligible for Medicaid, it’s time to choose a health insurance plan. Follow the instructions in the eligibility notification you get in the mail.

Heads up: This part is important. If you don’t choose a health plan, the state will choose one for you. So look into what each health plan offers and think about what kind of services and access you need. It’s worth the homework!

Around 87% of eligible Rhode Islanders proactively choose a health plan every month.

In Rhode Island, all health insurance plans offer the same level of Medicaid benefits. That means all health plans offer the same covered services.

However, health plans are different from one another in a few important ways:

Provider network

Each health plan has its own provider network. A network is the group of doctors, hospitals and other providers that have a contract with the health plan. In other words, your health plan has you covered if you see these providers.

Make sure a health plan covers your doctors and health care providers before you sign up. You can search for a provider using a health plan’s provider directory online or by calling the health plan’s customer service number.

Pharmacy

Each health plan has its own formulary. The formulary is the list of medications covered under the plan.

Find out whether a health plan covers the medications you take before you sign up. You can search for medications online on a health plan’s formulary or by calling the health plan’s customer service number.

Health and wellness programs

Health plans may have special programs for members who are pregnant, dealing with complex issues or dealing with chronic conditions, like asthma or diabetes. Visit a health plan’s website to learn about its programs to help you get and stay healthy.

Discounts and extra perks

Health plans may offer rewards for members who do certain simple health activities, like getting a yearly checkup. Rewards can include gift cards or more.