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Last updated: 13 September 2026
Rhode Island has several ways to reduce home-care costs. The right route depends on whether you need short-term medical home health or ongoing daily help. For most families, the best first call is MyOptionsRI at 401-462-4444.
Bottom Line
Medicare is mainly for short-term skilled home health, not long-term daily personal care. For ongoing home care in Rhode Island, the strongest payment paths are Medicaid LTSS, the At HOME Cost Share program for certain people who do not qualify for Medicaid, self-directed Medicaid options such as Personal Choice, PACE, and VA benefits. If you are not sure which path fits, call MyOptionsRI at 401-462-4444 before paying privately.
Emergency help now
If the older adult is not safe at home today, do not wait for a Medicaid application or care assessment.
- Medical emergency or immediate danger: Call 911.
- Suspected abuse, neglect, exploitation, or self-neglect of a person age 60 or older: Rhode Island Adult Protective Services takes reports 24/7 at 401-462-0555. The APS reporting page also accepts online reports.
- Care is breaking down but it is not a 911 emergency: Call MyOptionsRI at 401-462-4444 and explain that the person may not be safe without immediate help.
Start here
- Call MyOptionsRI: Ask for screening for Medicaid LTSS, At HOME Cost Share, caregiver supports, adult day care, and other home-based help.
- Name the care need: Say whether the person needs skilled nursing or therapy, or ongoing help with daily activities and safety.
- Do not self-reject: Medicaid LTSS looks at clinical need and financial rules. If Medicaid does not fit, ask about At HOME Cost Share.
- Ask about family-caregiver options: If a relative is already providing care, ask whether Personal Choice, RIte@Home, respite, or another approved route could help. Our Rhode Island caregiver-pay guide covers that question in more detail.
| Situation | Best first route | Why it matters |
|---|---|---|
| Short-term nursing or therapy after illness, surgery, or hospitalization | Medicare home health | Medicare may cover skilled home health when its medical rules are met. |
| Ongoing help with bathing, dressing, toileting, meals, or daily safety | Medicaid LTSS | This is Rhode Island’s main public long-term home-care payment route for people who meet clinical and financial rules. |
| Needs home care but does not qualify for Medicaid | At HOME Cost Share | The state shares eligible home-care or adult-day costs for certain Rhode Islanders. |
| Already has Medicaid and needs only limited weekly help | Preventive Services | Some aged or disabled Medicaid members can receive limited homemaker or personal care before they need full LTSS. |
| Wants more control over who provides care | Personal Choice | Eligible Medicaid LTSS members can self-direct certain services and hire a caregiver within program rules. |
| Age 55+ with high care needs who can still live safely in the community | PACE-RI | PACE can combine medical care, home care, transportation, day services, and other supports. |
| Veteran or eligible survivor | VA benefits and home care | VA pension additions and VA home-based services can reduce family care costs. |
Know which kind of home care you need
Families often use “home care” to mean two different things. The payment rules are very different, so start by separating medical home health from long-term personal care.
| Type | Typical help | Common payer | Main limit |
|---|---|---|---|
| Medical home health | Skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work, limited aide care tied to skilled care | Medicare, Medicare Advantage, Medicaid, other insurance | It is not a general long-term daily-care benefit. |
| Nonmedical home care | Bathing, dressing, toileting, transfers, meal preparation, housekeeping, supervision, companionship | Medicaid LTSS, At HOME, PACE, VA, long-term care insurance, private pay | Coverage depends on program eligibility, assessed need, authorized hours, and provider availability. |
Rhode Island licenses both Home Care Providers and Home Nursing Care Providers. Home Nursing Care Providers may provide skilled services; Home Care Providers provide non-skilled personal help. Use the state’s home healthcare overview to check the difference and verify licensed agencies.
If you are still deciding between home care and another setting, see our home care versus assisted living guide.
What Medicare may pay for at home
Medicare home health can cover part-time or intermittent skilled nursing, therapy, medical social services, and limited home health aide care when the person meets Medicare’s rules. A health care provider must order the care, and the agency must be Medicare-certified.
Medicare says covered home health services cost the patient $0, although durable medical equipment can have separate cost-sharing. The person must be homebound and need part-time or intermittent skilled services.
Main limit: Medicare does not become a long-term custodial benefit when the only need is daily personal care, housekeeping, supervision, or companionship.
If you think Medicare wrongly denied home health, do not assume the agency is always right. Our Medicare counseling guide explains how to get free SHIP help and review appeal options.
Rhode Island Medicaid LTSS: the main long-term payment path
Rhode Island Medicaid Long-Term Services and Supports (LTSS) can pay for home and community-based care when a person meets financial rules and a clinical level-of-care test. Covered supports can include personal care, homemaker help, respite, meals, emergency response systems, case management, and equipment based on assessed need.
The current DHS eligibility page says an applicant must live in Rhode Island, meet the clinical level-of-care requirement, and meet financial rules. As of 13 September 2026, the page states that an individual’s countable resources may not exceed $4,000. DHS also reviews the income and assets of the applicant and spouse, so the financial test is not just one simple gross-income number.
Important 2027 change: Rhode Island’s FY2027 budget plan says the limit is scheduled to rise on January 1, 2027, from $4,000 to $8,000 for an individual and $6,000 to $12,000 for a couple for several groups, including most LTSS applicants. Federal approval and system changes are still required. These higher limits are not the September 2026 rule.
Rhode Island’s active LTSS financial rule reviews certain asset transfers during a five-year look-back. Do not give away money or property just to get under a Medicaid limit without qualified advice.
How to apply
Rhode Island provides a Medicaid LTSS packet with the main application and supplemental forms. The state also directs residents to the HealthyRhode customer portal and the DHS LTSS office. For LTSS help, call 401-574-8474 or the DHS call center at 1-855-697-4347.
Do not apply only for ordinary health coverage if the real need is long-term help at home. Tell DHS that you are asking for LTSS/home and community-based services and need a level-of-care assessment.
For a plain-English overview of how Medicaid differs from Medicare, see our Medicaid for seniors guide.
A smaller Medicaid option: Preventive Services
Not every Medicaid member needs full LTSS. Rhode Island’s April 2026 Preventive Services guidance says certain aged and disabled Medicaid customers with medical need may receive up to 6 hours per week of homemaker and/or personal care services for one person, or up to 10 hours per week for a couple.
If you have Medicaid through a managed care plan, contact Member Services. If not, the state directs members to DHS at 401-574-8474. If this limited help is not enough, ask for an LTSS screening.
At HOME Cost Share: Rhode Island’s key non-Medicaid option
The Rhode Island Office of Healthy Aging runs the At HOME Cost Share program for people who need help at home but do not qualify for Medicaid. It can help pay for in-home services and adult day services. Eligible in-home help can include housekeeping, personal care, and meal preparation.
The current OHA page says the program is for Rhode Islanders age 65 or older, plus people age 19 to 64 who have Alzheimer’s disease or a related dementia. Applicants must be ineligible for Medicaid, meet a needs assessment, and have annual income at or below 250% of the federal poverty guideline. OHA states there is no asset limit.
| Income band | 2026 one person | 2026 two people | Maximum cost share in rule |
|---|---|---|---|
| Up to 125% FPL | Up to $19,950/year | Up to $27,050/year | Home care up to $4.50/hour; adult day up to $7/day |
| Over 125% to 200% FPL | Over $19,950 to $31,920/year | Over $27,050 to $43,280/year | Home care up to $7.50/hour; adult day up to $15/day |
| Over 200% to 250% FPL | Over $31,920 to $39,900/year | Over $43,280 to $54,100/year | Home care up to $7.50/hour; adult day up to $15/day |
The dollar bands use the 2026 HHS guidelines. Rhode Island’s active At HOME rule sets the bands and maximum cost shares. Your actual share and service plan depend on assessment and program funding.
This program is especially important for an older adult who owns some savings or assets that would make Medicaid difficult but has modest annual income. Call 401-462-4444 and ask specifically for an At HOME Cost Share screening.
Personal Choice and family caregiver payment
Rhode Island’s Personal Choice program is a self-directed Medicaid LTSS option. The participant helps manage a service budget, chooses a caregiver, and sets the care schedule within program rules. A fiscal agency helps with payroll, timesheets, and background checks.
Personal Choice is only for Medicaid LTSS members. It is not a general family-caregiver stipend; the approved plan, budget, worker rules, and services control payment.
Rhode Island also offers RIte@Home shared living for some LTSS members who need considerable help and cannot live alone safely. Ask an options counselor to compare it with Personal Choice and agency care.
PACE-RI can combine home care and medical care
The Program of All-Inclusive Care for the Elderly (PACE) can be a strong fit for someone age 55 or older with complex needs who would otherwise need nursing-home-level care but can still live safely in the community with help. Medicare’s PACE page says PACE can cover medical care, prescription drugs, home care, personal care, therapy, transportation, adult day services, and other approved supports.
PACE-RI eligibility currently lists a service area covering Rhode Island except Block Island and Prudence Island. PACE-RI’s current main number is 401-434-1400, with toll-free service at 1-877-781-7223.
PACE changes how care is organized, so ask how current doctors, medications, and home-care workers would fit before enrolling.
Veterans, surviving spouses, and exhausted family caregivers
Veterans may have another route. VA offers home and community-based services, and some Veterans or survivors receiving VA pension may qualify for Aid and Attendance or Housebound additions.
The VA’s Aid and Attendance page explains the pension add-on, while the VA homemaker program covers trained home helpers for eligible Veterans who meet clinical and other requirements. Services can vary by location.
VA Providence also has a caregiver support coordinator. The current caregiver support page lists 401-273-7100 ext. 13283. For broader state and local veteran help, use our Rhode Island veteran guide.
Respite can reduce paid-care hours
The Office of Healthy Aging’s caregiver support page connects families to respite. CareBreaks offers free or low-cost respite on a sliding scale. Ask whether respite, adult day care, meals, or transportation could reduce private-pay hours.
How to start without wasting time
- List the care tasks. Note what the person cannot safely do alone and when help is needed.
- Call MyOptionsRI. Ask for screening for Medicaid LTSS, Preventive Services, At HOME Cost Share, PACE, respite, and other home services.
- Ask before changing finances. DHS can explain how income, resources, a spouse, a home, and recent transfers are treated for LTSS.
- Check other payers. Medicare, VA, long-term care insurance, and other coverage may pay for different pieces.
- Reduce paid hours where safe. Adult day care, meals, transportation, emergency response, respite, and family help may fill part of the schedule.
If you are comparing agencies with hiring a worker directly, read our agency versus caregiver guide. Rhode Island licenses home-care agencies, so verify a provider before signing a contract.
Document checklist
- Photo ID and proof of Rhode Island residence.
- Social Security, pension, bank, and investment records.
- Spouse income and resource information, when applicable.
- Medicare, Medicaid, and other insurance cards.
- Medication list, diagnoses, and recent discharge papers.
- Notes on which daily activities require help.
- Property, trust, annuity, and recent transfer information for Medicaid LTSS.
- Long-term care insurance policy, if any.
Reality checks for Rhode Island families
- Approval does not mean unlimited hours. Medicaid LTSS and At HOME services are based on assessed need and an authorized care plan.
- Provider availability can be separate. Eligibility does not guarantee the exact worker or schedule you want.
- A 2026 provider moratorium is not a consumer closure. Rhode Island Medicaid temporarily stopped newly enrolling certain home care/personal care, home health, and hospice provider categories from July 1, 2026 through January 1, 2027. The state says existing providers are unaffected. This does not mean Medicaid home care is closed to eligible members.
- Medicare and Medicaid solve different problems. Medicare may pay for skilled home health; Medicaid LTSS is the more important public route for long-term personal care.
- At HOME is not free home care. It is a cost-share program. Your contribution is based on income and the service plan.
- Private pay needs safeguards. Verify licensure and get rates, minimum hours, cancellation rules, and extra charges in writing.
Common mistakes to avoid
- Waiting until the caregiver is exhausted to ask for an assessment.
- Assuming Medicare pays for long-term nonmedical care.
- Rejecting Medicaid without asking how LTSS financial rules apply.
- Giving away assets before understanding the five-year look-back.
- Missing At HOME because the person has too many assets for Medicaid.
- Hiring privately without checking licensure, backup coverage, and written costs.
- Paying one-to-one for tasks that meals, adult day, transportation, or respite could cover.
Denied, delayed, or overwhelmed
If Medicaid LTSS is denied, get the written notice and exact reason. Financial, clinical, missing-document, and service-plan problems can require different next steps. Keep copies and notes of calls and dates.
If Medicaid does not fit financially, ask MyOptionsRI about At HOME Cost Share, PACE, respite, adult day care, meals, transportation, and other community supports. If the person has a disability, our Rhode Island disability guide may point to additional routes.
If the main issue is simply choosing and budgeting for care, our home care guide explains care types, hiring questions, and common payment strategies. If a long-term care insurance policy exists, see our long-term care insurance guide before paying out of pocket.
Rhode Island starting points
- MyOptionsRI / Aging and Disability Resource Center: 401-462-4444. Best general starting point for LTSS options, home care, caregiver help, and referrals.
- DHS LTSS: 401-574-8474. Use for Medicaid long-term care questions and application help.
- DHS Call Center: 1-855-697-4347.
- PACE-RI: 401-434-1400 or 1-877-781-7223.
- Adult Protective Services: 401-462-0555, 24/7 for suspected abuse, neglect, exploitation, or self-neglect of adults age 60+.
For a broader map of state programs, see our Rhode Island senior assistance guide and Rhode Island aging agencies guide.
Phone scripts for the most important calls
MyOptionsRI / At HOME
“I am helping a Rhode Island resident who needs daily help at home. Can you screen us for Medicaid LTSS, At HOME Cost Share, PACE, respite, and other home-care programs? What should we have ready?”
DHS LTSS
“We need long-term care at home. Please confirm this is being reviewed for LTSS with a level-of-care assessment. What financial and clinical documents are still needed?”
Doctor or discharge planner
“Which care is skilled and may qualify for Medicare home health, and which part is long-term personal care? Please put the needed home health services in writing.”
PACE-RI or VA
“The person needs daily help and wants to stay home. Can you screen them for your services, explain eligibility, and tell me what the family may have to pay?”
Resumen breve en español
En Rhode Island, Medicare puede cubrir atención médica especializada en el hogar por tiempo limitado. Para ayuda continua con actividades diarias, las opciones principales incluyen Medicaid LTSS, At HOME Cost Share, PACE, servicios para veteranos y apoyo para cuidadores.
El mejor primer paso para muchas familias es llamar a MyOptionsRI / Aging and Disability Resource Center al 401-462-4444. Pida una evaluación de Medicaid LTSS y At HOME Cost Share. Si solicita Medicaid LTSS, no regale dinero ni propiedad para tratar de cumplir con el límite de recursos sin entender primero las reglas de transferencias.
Frequently asked questions
Does Medicare pay for home care in Rhode Island?
Medicare can cover qualifying home health when a homebound person needs part-time or intermittent skilled care ordered by a provider. It usually does not cover long-term personal care when that is the only need.
Does Rhode Island Medicaid pay for long-term home care?
Yes. Medicaid LTSS can cover home and community-based services for people who meet financial and clinical rules. As of September 13, 2026, DHS states that an individual’s countable resources may not exceed $4,000. Other financial rules also apply.
What is At HOME Cost Share?
At HOME Cost Share helps certain Rhode Islanders who need home or adult-day services but do not qualify for Medicaid. It covers people 65+ and certain adults 19–64 with Alzheimer’s disease or related dementia. The income cap is 250% of the federal poverty guideline, OHA states there is no asset limit, and participants pay a share of approved services.
Can a family member be paid to provide care in Rhode Island?
Possibly. Medicaid Personal Choice lets eligible LTSS members choose and manage a caregiver within program rules and an approved budget. It is not an automatic payment for every family caregiver.
What if I have too many assets for Medicaid LTSS?
Do not give assets away just to qualify. Rhode Island applies a five-year look-back to certain transfers. Ask DHS first. If Medicaid does not fit, At HOME Cost Share has no asset limit according to OHA, but it does have an income cap and needs assessment.
Is PACE available everywhere in Rhode Island?
PACE-RI says its service area covers Rhode Island except Block Island and Prudence Island. Applicants must be 55+, meet the required level of care, and be able to live safely in the community at enrollment.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 13 September 2026 · Next review: 13 December 2026
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