Rhode Island Code of Regulations
Title 210 - Executive Office of Health and Human Services
Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults
Subchapter 05 - Service Delivery Options
Part 2 - Medicaid Managed Care Delivery Options
Section 210-RICR-30-05-2.6 - Excluded Medicaid Coverage Groups

1. Members of these coverage groups who are covered by employer-sponsored or other third (3rd) party health insurance, may receive Medicaid on a fee-for-service basis, rather than through enrollment in a RIte Care MCO:

2. Medically needy populations. Flex-test cases are included in the RIte Care program but receive services in the fee-for-service system. With the exception of Katie Beckett children, long-term care coverage groups (Part 50-00-1 of this Title) do not receive services through a RIte Care MCO.

3. Extended family planning group. Beneficiaries eligible through this pathway in this RIte Care waiver group are entitled to a limited scope of services rather than comprehensive benefits. The group consists of women who meet the following conditions: income must be above the Medically Needy income limit; if pregnant, income must not exceed two hundred fifty-three percent (253%) of FPL; the women must be twelve (12) months postpartum or twelve (12) months post-loss of pregnancy and, as a result, subject to discontinuation of Medicaid eligibility. Coverage is available for up to twenty-four (24) months.