Financing Care
Affording life isn't easy for many families. If you're raising a child with special needs, it can be even more difficult. Parents might have to adjust or reduce their work hours, and paying for care and services that health insurance doesn’t always cover in full can add up fast. There are resources that can help pay for care.
Health Insurance Coverage
HealthSource RI is the place Rhode Islanders can buy health insurance and dental insurance. This website helps anyone who does not get health insurance from their employer or a family member’s employer get coverage. It can also help someone enroll in Medicaid if they are eligible. Visit the Walk-in Center at 401 Wampanoag Trail, East Providence; Monday-Friday, 8 a.m.-6 p.m. or call 855-840-4774/TTY 888-657-3173. Go online to apply or to find local, in-person help with enrollment.
The Rhode Island Medicaid Program pays for medical and health-related services for eligible Rhode Islanders, including low-income individuals, families, children, pregnant women, older adults, and people with disabilities and special needs who otherwise might not be able to afford or get healthcare.
You must be a Rhode Island resident and meet specific citizenship status requirements. Eligibility depends on a variety of factors including income, age, and healthcare needs. For some programs, your eligibility also depends on other resources or assets you have, like savings accounts, stocks, bonds, or other investments. Learn more about eligibility on Rhode Island Medicaid’s website.
Families who are eligible for Medicaid have a choice of managed care plans. These plans offer the same essential benefits through a large network of providers. Each plan also offers a Care Management Program to help with coordination of care, transportation, or other services.
Medicaid Managed Care Organizations
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Neighborhood Health Plan of Rhode Island
800-459-6019
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Tufts Health Plan (RITogether)
866-738-4116
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United Healthcare of New England
800-587-5187
Medicaid Health Programs for Children
All children younger than 21 who are enrolled in Medicaid are eligible for preventive and routine healthcare and medically necessary specialized care and services.
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RIte Share Program
RIte Share helps families who have health insurance through an employer by paying all or part of the eligible employee's cost for coverage. Learn more about RIte Share at RIte Share
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RIte Smiles
RIte Smiles is a Medicaid dental plan for children and young adults up to age 26. Call 866-375-3257/TTY 711 or visit RIte Smiles
Medicaid Benefits for Children with Special Healthcare Needs
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Children’s Services
Rhode Island's Medicaid offers CSHCN additional specialized services that might otherwise be unavailable. These services are available when a child has been diagnosed with a chronic condition and is determined to be eligible for Supplemental Security Income (SSI), Katie Beckett, or an adoption subsidy through the Department of Children, Youth, and Families (DCYF). Find a comprehensive list of services at Children’s Services.
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Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Benefits
EPSDT is a benefit that provides healthcare services for children younger than 21 who are enrolled in Medicaid. It makes sure that children and adolescents get the services they need as soon as they need them. EPSDT covers treatments children and adolescents need to correct or improve birth defects, physical health, and behavioral conditions. It’s more extensive than services for adults, emphasizing early care to prevent or treat health issues.
Children and adolescents receive services as part of a well-child visit. These services are provided during regular well-child visits with the doctor and include:
- Assess and identify problems early;
- Check children's health at periodic, age-appropriate times;
- Provide physical, mental, developmental, dental, hearing, vision, and other screening tests to find potential problems;
- Perform diagnostic tests to follow up when a risk is found.
Oral health is also a part of EPSDT and children and adolescents also receive specific services as part of their regular visits with their dentist.
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Durable Medical Equipment (DME)
DME are resources used for medical or rehabilitative purposes in the home or community. Examples of DME are diapers, nutritional supplements, respiratory supplies, assistive technology, or mobility supports. DME benefits are available for children if the equipment is medically necessary. (Prior authorization is required.)
Families can get DME benefits by working with their doctor and other specialists to determine what equipment is needed and then calling a DME vendor who will submit for authorization from RI Medicaid. The vendor will evaluate the child’s specific needs and help get the necessary documentation to the health insurance provider for review and approval.
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Katie Beckett - Katie Beckett
Katie Beckett provides Medicaid coverage to children up to age 19 who live at home and have complex health needs. This benefit is typically used when a child already has commercial or other insurance. Katie Beckett provides a type of Medicaid to help cover the costs of additional services that are not covered by the commercial insurance plan. With Katie Beckett, only the child’s income and resources (not the parents’) are used to determine eligibility. To be eligible for Katie Beckett, a child must:
- Require a level of care at home that is typically provided in a hospital or nursing facility;
- Meet the Social Security Administration’s definition of disability;
- Live at home and meet the income and resource requirements;
- Be a Rhode Island resident; and
- Be a US citizen or eligible non-citizen.
If you have questions about the application or the Katie Beckett Medicaid coverage, you can talk with a RIPIN Parent Consultant that works in the Katie Beckett unit. The Parent Consultant can tell you if you meet eligibility requirements and go over the application process. Call the Katie Beckett Parent Consultant at 401-574-8195
Rhode Island Department of Human Services (DHS)
DHS delivers critical support services to ensure that individuals and families in Rhode Island have access to the supports they need to achieve their goals. Families can use the DHS-2 application to apply for several different assistance programs at the same time. Families can locate and contact their local Community Action Program for help completing the form.
The DHS-2 application is available in
English | Spanish | Portuguese
Other Financial Support Resources
- If you need help paying for your child's behavioral healthcare, visit Financing Care for Behavioral Health Services to learn about what insurance covers and financial assistance programs.
- The Center for Economic Progress has a Guide to Assistance that includes government programs and community organizations that can help pay for healthcare, food, housing, utilities and childcare. All programs have eligibility requirements.
- RIPIN Call Center offers free support to any Rhode Islander who needs help accessing healthcare, health insurance, or special education for children with disabilities. Staff can help Rhode Islanders access healthcare or health insurance; resolve insurance company denials and medical bills; and answer questions about HealthSource RI and Medicaid eligibility. Call 401-270-0101 or email callcenter@ripin.org. Include your name, phone number, a good time for us to contact you, and a short description of your issue.