Rhode Island Medicaid pays for in-home personal care and related services through 2 programs, including the Rhode Island Comprehensive 1115 Demonstration - LTSS home care (agency) and the Personal Choice (self-directed LTSS). EOHHS is the Medicaid agency and HCBS are authorized under the 1115 Comprehensive Demonstration rather than separate 1915(c) waivers; BHDDH runs DD services. EVV has been required for personal care and homemaker services since 2021-01-01, using the state Sandata system or a paid third-party system. Confirm managed care delivery details and the July 2026 claims-validation date with EOHHS.
Partly. 210-RICR-20-05-1 lets non-LTSS Medicaid beneficiaries get physician-ordered, prior-authorized home care, limited to six hours for an individual and ten hours for a couple.
Which Rhode Island waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Rhode Island Comprehensive 1115 Demonstration - LTSS home care (agency)
Population
Medicaid LTSS-eligible people (elders and adults with disabilities, plus people with developmental disabilities) who receive HCBS based on a functional assessment.
Services covered
personal care
homemaker
combined personal care and homemaker
day habilitation
residential habilitation
Billing format
Fee-for-service claims (Gainwell) from RIDOH-licensed, EOHHS-authorized agencies; personal care may only be billed when delivered by a nursing assistant, and since 2026-07-07 FFS claims are denied when EVV data is missing from the Sandata aggregator.
Adults 65 or older, or people with disabilities 18 or older, with a high or highest level of care who can direct their own care (or have a representative) and want to live at home.
Services covered
personal care
homemaker
participant-directed goods and services
adult day care
home-delivered meals
personal emergency response systems
case management
Billing format
Participant-directed budget managed through a fiscal intermediary; the Independent Provider program was merged into Personal Choice.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
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