Official State of Rhode Island website
For information about Medicaid Renewals, please visit https://staycovered.ri.gov/
Please note Call Center hours for the week of Thanksgiving. The Call Center will be open normal business hours on Monday, Tuesday, and Wednesday, Nov. 20-22. The Call Center will be closed on Thursday in observance of the Thanksgiving holiday, though self-service options will remain accessible, including the Customer Portal (healthyrhode.ri.gov), and mobile app. The Call Center will not take incoming calls on Friday for processing work, normally completed on Wednesdays. Please plan accordingly and Happy Thanksgiving!
Have you moved in the past three years? Have you gotten a new phone number or email address? If your contact information is out of date, you might miss important information regarding your Medicaid benefits. Stay connected to health coverage, and update your contact information today! Click here for more information. You can access your account online at https://healthyrhode.ri.gov.
ebtEDGE will never call or text you to ask for your personal information, card number or PIN. Do not share your information with anyone. Protect yourself by changing your PIN frequently -- using a different PIN each time -- or by freezing your card.
The Executive Office of Health and Human Services (EOHHS) and DHS have together cared for our consumers on the State's Medicaid program. Specifically, EOHHS has been responsible for the Medicaid clinical eligibility determinations through its Office of Medical Review (OMR) while DHS determines the financial eligibility for those applicants.
To create a more efficient process, the State in the fall of 2021 moved all eligibility, both financial and clinical, to DHS. The Office of Medical Review, now called the DHS Clinical Team, is responsible for determination of LTSS clinical levels of care, Katie Beckett clinical eligibility, the Medical Assistance Review Team and Pediatric Private Duty Nursing (PDN) assessments, authorizations and oversight.
LTSS level of care determinations are necessary for the determination of LTSS eligibility. Katie Beckett (KB) is a Medicaid eligibility category for children under age 19, who are disabled and meet an institutional level of care and who are otherwise ineligible for Medicaid due to family income.
The Medical Assistance Review Team (MART) is responsible for adult disability determinations. Medically-necessary Pediatric PDN is a covered benefit for children under age 21 who are considered severely disabled and/or technology dependent and would otherwise require inpatient care in a hospital or pediatric nursing facility.
The PDN Policy Guidance Document details the current processes for the administration of PDN.