Section 40-8.7-6 - Eligibility(a) To be eligible for benefits under the Medicaid buy-in program: (1) The person shall be an individual with disabilities as defined in § 40-8.7-4, but without regard to his or her ability to engage in substantial gainful activity, as specified in the Social Security Act, 42 U.S.C. § 423(d)(4); (2) The person shall be employed as defined in § 40-8.7-4; (3) For the Sherlock Act Medicaid buy in program the person's net accountable income shall either not exceed two hundred fifty percent (250%) of the federal poverty level, taking into account the SSI program disregards and impairment-related work expenses as defined in 42 U.S.C. § 1396a(r)(2) or for the Ticket to Work Program buy in program there are no income or asset limits to be considered as part of the eligibility determination;(4) A maximum of ten thousand dollars ($10,000) of available resources for an individual and twenty thousand dollars ($20,000) for a couple shall be disregarded as shall any additional resources held in a retirement account, in a medical savings account, or any other account, related to enhancing the independence of the individual and approved under rules to be adopted by the executive office for the Sherlock Act; there are no income or asset limits for the Ticket to Work Program; and(5) The person shall be a current medical assistance recipient under § 40-8.5-1 or § 40-8-3(5)(v) ; or shall meet income, assets, (except as modified by subsection (a)(4) of this section) and eligibility requirements for the medical assistance program under § 40-8.5-1 or § 40-8-3(5)(v) , as such requirements are modified and extended by this chapter.(b) Appeals Process. The director or designee shall review each application filed in accordance with regulations, and shall make a determination of whether the application will be approved and the extent of the benefits to be made available to the applicant, and shall, within thirty (30) days after the filing, notify the applicant, in writing, of the determination. If the application is rejected, the applicant shall be notified the reason for the denial. The director may at any time reconsider any determination. Any applicant for or recipient of benefits aggrieved because of a decision, or delay in making a decision, shall be entitled to an appeal and shall be afforded reasonable notice and opportunity for a fair hearing conducted by the director, pursuant to chapter 8 of this title.R.I. Gen. Laws § 40-8.7-6
Amended by 2023 Pub. Laws, ch. 79,§ 9-6, eff. 6/16/2023. P.L. 2004, ch. 343, § 1; P.L. 2004, ch. 354, § 1; P.L. 2011, ch. 241, § 1; P.L. 2011, ch. 253, § 1.