How to Pay for In-Home Care
How to Pay for Home Care in Rhode Island
Jump to a state to see its Medicaid programs, waivers, and other ways to help pay for in-home care.
Rhode Island families typically start by screening for Medicaid LTSS, which can authorize home and community-based services for people meeting financial and clinical requirements, then look at Personal Choice as the primary self-directed option for eligible adults living at home, which provides an individual budget for participant-employed personal care attendants. Personal Choice can use a PCA already known to the participant, but Rhode Island rules bar the participant's spouse, representative, financial power of attorney, and Social Security representative payee from being the paid worker, and the participant sets the PCA wage within the current $15-$21 per hour program range, subject to the authorized budget. Those who don't fit ordinary self-direction should compare the state-funded At HOME Cost Share program (for eligible adults 65+ and adults 19-64 with Alzheimer's or related dementia, no asset limit, income capped at 250% of the federal poverty level), PACE for qualifying adults 55+, and RIte@Home LTSS Shared Living. Adults eligible for BHDDH developmental-disability services can self-direct funding, hire support staff, and use fiscal intermediary and support-broker services under BHDDH's own rules (separate from Personal Choice), and every plan can be layered with Medicare Savings Programs, Extra Help, RIPAE, SNAP, energy assistance, transportation, respite, Temporary Caregiver Insurance, home-modification financing, and Veteran benefits.
Updated August 2026
Reviewed by Valerie VanBooven, RN, BSN
Medicaid LTSS
Medicaid Long-Term Services & Supports (HCBS)
YesHelps pay for: Authorized home and community-based long-term care that can include personal care, homemaker/CNA services, respite, meals, PERS, equipment, modifications and other supports.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan.
How to start: Call the Rhode Island ADRC/The POINT or DHS to request LTSS options counseling and start the Medicaid LTSS application/assessment process.
Good to know: Family caregiver payment: Depends on service model; Personal Choice and BHDDH self-direction have separate worker rules.
Agency Homemaker / CNA Services
YesHelps pay for: Hands-on personal assistance and homemaker support delivered by an authorized home-care agency.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan. Prior authorization and active program enrollment are required for Medicaid home-care claims.
How to start: Call the Rhode Island ADRC/The POINT or DHS to request LTSS options counseling and start the Medicaid LTSS application/assessment process.
Good to know: Family caregiver payment: Generally no direct family wage under the agency model; employment by an agency is subject to agency and Medicaid rules.
Personal Care Services
YesHelps pay for: Nonmedical help with ADLs such as bathing, dressing, grooming, toileting, mobility/transfers and eating, plus authorized IADL assistance.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan.
How to start: Ask specifically whether agency personal care or Personal Choice best fits the participant’s needs.
Good to know: Family caregiver payment: Potentially through Personal Choice if the worker is eligible and not in an excluded relationship.
Respite Services
YesHelps pay for: Short-term substitute care that gives an unpaid caregiver a break.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan.
How to start: Include caregiver relief needs in the LTSS assessment and service plan.
Good to know: Family caregiver payment: Usually pays an approved respite provider rather than the primary family caregiver.
Personal Emergency Response System (PERS)
IndirectHelps pay for: Emergency alert device, installation and ongoing service when authorized.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan. Must be medically/functionally justified in the service plan.
How to start: Request PERS during service planning or reassessment.
Good to know: Family caregiver payment: No
Home-Delivered Meals
IndirectHelps pay for: Authorized meal delivery to help a functionally dependent participant remain in the community.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan. Meal service must fit the person-centered plan and may affect authorized meal-preparation assistance.
How to start: Ask the case manager whether home-delivered meals are appropriate.
Good to know: Family caregiver payment: No
Environmental / Home Modifications
IndirectHelps pay for: Approved home adaptations such as ramps, grab bars, lifts or other changes needed for health, safety or independence.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan. Prior approval and program-specific assessment/documentation apply.
How to start: Request a home-safety/modification assessment through the LTSS case manager.
Good to know: Family caregiver payment: No
Minor Environmental Modifications / Assistive Devices
IndirectHelps pay for: Smaller accessibility and safety items such as shower chairs, raised toilet seats, transfer benches, reachers and similar devices when authorized.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan. Item must address an assessed need and meet Medicaid/program rules.
How to start: Ask the case manager or service advisement team to add needed items to the plan.
Good to know: Family caregiver payment: No
Special Medical Equipment
IndirectHelps pay for: Approved devices, controls or appliances that improve ADL ability, communication, safety or independence when not available from another payer.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan. Prior Medicaid approval may be required; duplicate coverage is generally not allowed.
How to start: Ask the case manager to screen Medicaid/DME coverage and LTSS options.
Good to know: Family caregiver payment: No
Case Management / Supports Facilitation
IndirectHelps pay for: Assessment, person-centered planning, coordination, reassessment and support with accessing authorized LTSS.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan.
How to start: Select/engage the assigned conflict-free case management or LTSS service-planning entity.
Good to know: Family caregiver payment: No paid family role for case management.
Senior Companion (Medicaid-covered where authorized)
IndirectHelps pay for: Companionship and support that may be available as an LTSS HCBS service when included in an authorized plan.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan.
How to start: Ask the LTSS case manager whether Senior Companion is available under the participant’s service plan.
Good to know: Family caregiver payment: No general family wage
Fee-for-Service / Agency Home Care
YesHelps pay for: Traditional Medicaid service delivery through enrolled providers when FFS is the chosen/assigned LTSS pathway.
Who qualifies: Must meet Rhode Island Medicaid LTSS financial eligibility and the applicable high/highest clinical level-of-care criteria; services must be in an authorized person-centered plan. Provider must be enrolled, authorized and available.
How to start: Ask EOHHS which delivery system applies and obtain the required prior authorization/referral.
Good to know: Family caregiver payment: No direct self-directed family wage under ordinary agency billing.
RIte@Home LTSS Shared Living
YesHelps pay for: Medicaid shared-living option for people who cannot live alone and need considerable ADL help; support is provided in a home-like setting.
Who qualifies: Must qualify for Medicaid LTSS and the shared-living service; provider/home and service-plan requirements apply.
How to start: Contact EOHHS or a RIte@Home partner to compare shared living with in-home Personal Choice/agency care.
Good to know: Family caregiver payment: Paid shared-living provider possible, but family relationship/certification rules are program-specific—do not assume any relative automatically qualifies.
Medicaid Assisted Living
Alternative to home careHelps pay for: 24-hour personal care, homemaker/chore, medication management, activities and transportation in a Medicaid-certified assisted living residence.
Who qualifies: Must meet Medicaid LTSS eligibility and assisted-living program/residence requirements.
How to start: Ask ADRC/EOHHS whether assisted living is a better fit than home-based care.
Good to know: Family caregiver payment: No direct family wage
Medicaid Adult Day Health
Indirect / partialHelps pay for: Daytime supervision, health monitoring, personal care, meals, activities and other supports when authorized.
Who qualifies: Must meet applicable Medicaid LTSS/service criteria and use an authorized provider.
How to start: Ask the LTSS case manager whether adult day can replace some paid in-home hours or provide caregiver relief.
Good to know: Family caregiver payment: No general family caregiver wage
Self-Directed Medicaid
Personal Choice Program
YesHelps pay for: Self-directed Medicaid LTSS for eligible adults at home; participant manages an authorized budget and chooses/supervises PCAs.
Who qualifies: Adults 18-64 with disabilities and people 65+ must be Medicaid LTSS eligible and meet high/highest level of care; must be able to self-direct or use a qualified representative.
How to start: Contact EOHHS or a Personal Choice community partner for screening and conflict-free case management.
Good to know: Family caregiver payment: Potentially yes for an eligible known person; spouse, representative, financial POA and Social Security representative payee are excluded as PCAs.
Personal Choice PCA Wages
YesHelps pay for: Authorized Personal Choice budget can pay qualified PCAs for personal care and homemaker work.
Who qualifies: Current active rule lets participants set the PCA hourly wage from $15 to $21, subject to the monthly authorized budget; employment taxes, workers’ compensation and administrative costs also come from the budget.
How to start: Complete assessment, budget, ISSP, worker enrollment/training/background checks and fiscal-intermediary setup before paid work begins.
Good to know: Family caregiver payment: Yes, subject to relationship exclusions and worker qualifications.
Personal Choice Homemaker / Chore Services
YesHelps pay for: Shopping, meal preparation, housework, laundry, bill assistance, transportation assistance and medication reminders within the authorized plan.
Who qualifies: Must be authorized through the Personal Choice budget/ISSP and tied to assessed ADL/IADL needs.
How to start: Ask the case manager to include authorized homemaker tasks in the ISSP.
Good to know: Family caregiver payment: Potentially yes through an eligible PCA; excluded relationships still apply.
Personal Choice Participant-Directed Goods & Services
IndirectHelps pay for: Approved nontraditional goods/services that address an identified need, increase safety/independence or reduce need for other Medicaid services.
Who qualifies: Must be in the approved ISSP, meet program criteria and generally cannot duplicate other available coverage.
How to start: Discuss proposed goods/services with the case manager before purchase.
Good to know: Family caregiver payment: No caregiver wage, but can reduce other care costs.
Personal Choice Home Modifications
IndirectHelps pay for: Medicaid-funded home adaptations that support safe community living when medically/functionally necessary and approved.
Who qualifies: Personal Choice participants remain eligible for certain medically necessary LTSS paid outside the individual PCA budget; prior approval/assessment rules apply.
How to start: Ask the case manager for the home-modification referral/approval process.
Good to know: Family caregiver payment: No
Personal Choice Out-of-Budget LTSS Supports
IndirectHelps pay for: Adult day, case management, home modifications, home-delivered meals, minor modifications, PERS, special medical equipment and supports facilitation may be paid outside the PCA budget when medically necessary.
Who qualifies: Must be a Medicaid LTSS-eligible Personal Choice participant and meet service-specific medical/functional criteria.
How to start: Coordinate through the Personal Choice case manager so services are reflected in the person-centered plan.
Good to know: Family caregiver payment: No direct caregiver wage for these supports.
Personal Care Attendant Registry
YesHelps pay for: State registry helps Personal Choice participants identify trained prospective PCAs; registry PCAs complete orientation and must meet program requirements.
Who qualifies: PCAs must be 18+, authorized to work, complete required training/certifications and background screening; registry applicants need CPR/First Aid.
How to start: Participant can search the registry; prospective workers can apply after required orientation/certification steps.
Good to know: Family caregiver payment: A family member can be a known PCA only if allowed by Personal Choice relationship rules; registry listing is not required for every known worker.
Integrated Care
PACE Organization of Rhode Island
YesHelps pay for: Comprehensive medical, long-term care, therapies, medications, transportation and home/community services designed to help eligible adults remain in the community.
Who qualifies: Generally age 55+, meet state nursing-facility level-of-care criteria, live in the PACE service area and be able to live safely in the community at enrollment.
How to start: Request a PACE eligibility screen and compare with Medicaid LTSS/Personal Choice.
Good to know: Family caregiver payment: No direct family caregiver wage under ordinary PACE employment/benefit rules.
INTEGRITY for Duals (FIDE-SNP)
Yes when LTSS authorizedHelps pay for: Integrated Medicare-Medicaid plan for eligible dual beneficiaries; coordinates medical care, behavioral health and long-term services and supports.
Who qualifies: For Rhode Islanders eligible for both Medicare and Medicaid who meet plan/enrollment rules. Replaced the former INTEGRITY MMP beginning January 1, 2026.
How to start: Contact Neighborhood/EOHHS or SHIP to compare the integrated plan with other dual-eligible options.
Good to know: Family caregiver payment: Caregiver payment depends on the underlying LTSS service/model, not simply FIDE-SNP enrollment.
Medicaid / Medical
Rhode Island Medicaid Home Health
Yes - skilled/medical home careHelps pay for: Skilled nursing, therapy and home-health services when medically necessary and authorized through Medicaid.
Who qualifies: Requires Medicaid eligibility, medical necessity and applicable orders/authorizations; provider must be enrolled.
How to start: Ask the treating clinician and Medicaid plan/EOHHS for a home-health referral and authorization.
Good to know: Family caregiver payment: No general family caregiver wage
Transition Support
Community Transition Services
IndirectHelps pay for: One-time supports to establish a household after leaving an institutional setting, including possible security deposit, moving costs, furniture and essential household items.
Who qualifies: Determined individually during the nursing-home transition process based on living arrangement, needs and other available resources.
How to start: Ask the Nursing Home Transition Program to screen for Community Transition Services during discharge planning.
Good to know: Family caregiver payment: No
Nursing Home Transition Program / Money Follows the Person
Yes through resulting HCBS planHelps pay for: Planning and coordination to help eligible nursing-facility residents return to a home/community setting and connect to Medicaid HCBS.
Who qualifies: Must meet transition program requirements and be able to move safely to a qualified community setting with needed supports.
How to start: Submit/ask for a Nursing Home Transition referral before discharge.
Good to know: Family caregiver payment: Family payment depends on the post-transition service model.
Medicaid / Disability
Medicaid Preventive Services for Adults with Disabilities
PotentiallyHelps pay for: Preventive/community supports that can be authorized for eligible adults with disabilities, including home-care provider services in qualifying program enrollments.
Who qualifies: Eligibility and service authorization are program-specific; current EOHHS home-care billing guidance recognizes Medicaid Preventive Services as an eligible enrollment for home-care claims.
How to start: Ask EOHHS/DHS for screening and the appropriate referral/application.
Good to know: Family caregiver payment: Program-specific
State Cost Share
At HOME Cost Share
YesHelps pay for: State shares the cost of approved in-home and/or adult-day services for eligible non-Medicaid participants.
Who qualifies: Age 65+ or age 19-64 with Alzheimer’s or related dementia; income up to 250% FPL; no asset limit; needs assessment required. Participant share is income-based.
How to start: Call ADRC/The POINT for assessment and enrollment.
Good to know: Family caregiver payment: No direct family caregiver wage; services are through participating providers.
At HOME In-Home Personal Care / Housekeeping
YesHelps pay for: Cost-sharing for approved housekeeping, personal care and meal-preparation assistance at home.
Who qualifies: Must meet At HOME eligibility and care-plan requirements; participant pays an income-based share.
How to start: Ask ADRC for an At HOME needs assessment and provider options.
Good to know: Family caregiver payment: No direct family caregiver wage
At HOME Adult Day Health
Indirect / partialHelps pay for: Cost-sharing for adult-day programming including personal care, nursing support, meals and social/recreational activities.
Who qualifies: Must meet At HOME eligibility and needs assessment; service must be included in the care plan.
How to start: Ask ADRC to compare adult day with in-home At HOME services.
Good to know: Family caregiver payment: No
Caregiver Support
OHA Lifespan Respite Care Program
Indirect / respiteHelps pay for: Respite, peer support, mentorship, advocacy and caregiver resources through community partners.
Who qualifies: Program/partner eligibility varies; OHA describes caregivers as people providing care without financial compensation.
How to start: Call ADRC for current respite/caregiver-support options.
Good to know: Family caregiver payment: No wage to the unpaid caregiver; respite pays/arranges substitute care.
CareBreaks
Yes - respiteHelps pay for: Free or low-cost short-term respite for Rhode Island unpaid caregivers of a child/adult with disabilities or an older loved one.
Who qualifies: Rhode Island resident; caregiver is unpaid; cost is determined on a sliding scale within income guidelines.
How to start: Call CareBreaks or ADRC for screening and scheduling.
Good to know: Family caregiver payment: No direct caregiver wage
Community Support
Senior Companion Program
IndirectHelps pay for: Volunteers age 55+ provide companionship, help with daily tasks/errands/meal preparation and caregiver respite.
Who qualifies: Service availability depends on volunteer capacity and program screening.
How to start: Call the Rhode Island Senior Companion Program.
Good to know: Family caregiver payment: No paid family caregiver wage
Adult Day Health Centers
Indirect / partialHelps pay for: Daytime care, therapeutic activities, meals, transportation and personal/health supports can reduce the number of paid home-care hours needed.
Who qualifies: Program and payer eligibility vary; Medicaid, At HOME cost share or private payment may apply.
How to start: Contact ADRC to locate a center and screen funding options.
Good to know: Family caregiver payment: No
Home-Delivered Meals / Nutrition Programs
IndirectHelps pay for: Meal delivery and nutrition programs can reduce meal-preparation burden and preserve care hours for hands-on needs.
Who qualifies: Age/program eligibility and contribution rules vary by nutrition program.
How to start: Call ADRC or use OHA food and nutrition resources to locate services.
Good to know: Family caregiver payment: No
Transportation
Elderly Transportation Program / MTM
IndirectHelps pay for: Transportation for Rhode Island residents age 60+ without transportation to non-emergency medical appointments and certain other services.
Who qualifies: Age 60+ and no access to transportation; trip type and advance-notice rules apply.
How to start: Call MTM; routine trips generally require advance scheduling.
Good to know: Family caregiver payment: No
Developmental Disabilities
BHDDH Adult Developmental Disability Services
YesHelps pay for: Medicaid-funded supports for eligible adults with I/DD, including self-direction, community supports, residential/shared living, transportation, respite and professional services.
Who qualifies: Generally age 18+, I/DD diagnosed before age 22, Rhode Island residency, BHDDH clinical eligibility and Medicaid LTSS financial eligibility.
How to start: Apply through the BHDDH DD Eligibility Unit.
Good to know: Family caregiver payment: Potentially through self-directed DSP arrangements; program approval rules apply.
BHDDH Self-Directed Supports
YesHelps pay for: Participant controls DD service budget, hires/supervises support staff and chooses schedule/pay within program parameters.
Who qualifies: Must be eligible for BHDDH adult DD services and have self-directed supports authorized in the individual service plan/budget.
How to start: Ask the service team to switch/start self-direction and choose fiscal intermediary/support-broker resources.
Good to know: Family caregiver payment: Yes, potentially; BHDDH has separate parent/guardian-as-DSP request procedures.
BHDDH Participant-Hired Direct Support Professional (DSP)
YesHelps pay for: Authorized DD budget pays DSPs hired and managed by the participant for approved support tasks.
Who qualifies: Worker must meet BHDDH/FI requirements, and services/hours must fit the approved ISP and budget.
How to start: Complete DSP hiring and fiscal-intermediary paperwork before services begin.
Good to know: Family caregiver payment: Potentially yes subject to relationship/approval rules.
BHDDH Parent / Guardian as DSP Request Pathway
YesHelps pay for: Allows a family to request approval for a parent or guardian to serve as a paid DSP under BHDDH self-direction.
Who qualifies: Not automatic. BHDDH publishes a Parents and Guardians as DSP Request Form and a separate request form for more hours; all self-direction and service-plan rules apply.
How to start: Discuss the request with the service team and Self Direction Coordinator before scheduling paid care.
Good to know: Family caregiver payment: Yes, if specifically approved.
BHDDH Fiscal Intermediary Services
IndirectHelps pay for: Payroll, hiring paperwork and financial management for self-directed DD budgets.
Who qualifies: Must be enrolled in self-directed DD services and select an approved FI.
How to start: Choose an FI with the service team; complete employer/worker setup.
Good to know: Family caregiver payment: Supports payment of approved family/nonfamily DSPs.
BHDDH Support Broker
IndirectHelps pay for: Coaching to help a participant manage staff, budget and community resources in self-direction.
Who qualifies: Must be authorized within the self-directed service arrangement.
How to start: Ask the service team about Support Broker selection and funding.
Good to know: Family caregiver payment: No caregiver wage; supports self-directed employer role.
BHDDH Self-Directed Goods & Services
IndirectHelps pay for: Approved purchases that support health, well-being, independence and individual goals.
Who qualifies: Must be discussed with the service team and meet BHDDH goods/services rules; request form is required.
How to start: Submit the required Goods and Services request through the self-direction process.
Good to know: Family caregiver payment: No direct caregiver wage
BHDDH Community-Based Supports
Yes / support hoursHelps pay for: Staff support in home/community to build daily living skills, independence and community participation.
Who qualifies: Must be BHDDH DD eligible and have the service authorized in the ISP/funding level.
How to start: Work with the case manager/service team to select provider or self-directed model.
Good to know: Family caregiver payment: May be delivered by an approved agency or self-directed DSP depending the person’s plan.
BHDDH Respite
Yes - respiteHelps pay for: Short-term relief/support services for eligible people with I/DD and their caregivers.
Who qualifies: Must be authorized as part of BHDDH services/ISP and meet service-specific rules.
How to start: Request respite through the service team and identify an approved provider.
Good to know: Family caregiver payment: Usually substitute-care payment rather than wage to the primary caregiver; self-directed rules may affect provider choice.
Shared Living Arrangement (SLA)
YesHelps pay for: Residential/shared-living support where an adult with I/DD lives with a paid home provider in a private/home-like setting.
Who qualifies: Must be BHDDH DD eligible; provider, home, matching and service-plan requirements apply.
How to start: Ask the service team to compare SLA with independent in-home/self-directed supports.
Good to know: Family caregiver payment: A paid home provider is part of the model; family relationship eligibility must be verified rather than assumed.
Whole Life Shared Living Arrangement
YesHelps pay for: Enhanced shared-living model intended to support an integrated life in the community under BHDDH program requirements.
Who qualifies: Must be BHDDH DD eligible and meet Whole Life SLA program requirements in the person-centered plan.
How to start: Ask BHDDH/service team whether Whole Life SLA is appropriate and available.
Good to know: Family caregiver payment: Paid home provider; relationship rules/approval apply.
BHDDH Transportation
IndirectHelps pay for: Transportation supports to access community activities, services and employment can reduce family-paid transportation burden.
Who qualifies: Must be an authorized DD service/support in the individual plan or provider package.
How to start: Include transportation needs in person-centered planning.
Good to know: Family caregiver payment: No direct caregiver wage
BHDDH Professional / Nursing Supports
Yes - skilled/professionalHelps pay for: Authorized nursing and professional services can address skilled needs in the home/community and reduce privately purchased care.
Who qualifies: Must be clinically necessary and authorized in the person’s BHDDH/Medicaid service plan.
How to start: Ask the case manager/service team for nursing or professional-service assessment/referral.
Good to know: Family caregiver payment: No general family caregiver wage
Children / Medicaid
Katie Beckett Medicaid
Yes through covered Medicaid servicesHelps pay for: Medicaid eligibility pathway for certain Rhode Island children under 19 with long-term disabilities or complex medical needs who can be cared for at home.
Who qualifies: Child under 19, Rhode Island resident, meets disability/institutional level-of-care and other program criteria; child’s income/resources are considered under Katie Beckett rules.
How to start: Contact the Katie Beckett/children’s clinical team or DHS for application guidance.
Good to know: Family caregiver payment: No automatic paid-parent benefit; caregiver payment requires a separate authorized program/service.
Working With Disability
Ticket to Work Medicaid (ages 16-64)
Yes when LTSS authorizedHelps pay for: Full Medicaid medical benefits plus HCBS LTSS for eligible working people with disabilities while allowing higher earnings/savings.
Who qualifies: Age 16-64, disability eligibility and active paid employment; current Rhode Island program has no income or asset limit, though premiums may apply based on income.
How to start: Apply through DHS using the assistance application or call DHS for screening.
Good to know: Family caregiver payment: Family caregiver payment depends on the LTSS delivery model used.
Sherlock Plan (age 65+)
Yes when LTSS authorizedHelps pay for: Medicaid buy-in pathway for eligible working adults 65+ with disabilities; includes full Medicaid and HCBS LTSS.
Who qualifies: Age 65+, disability eligibility, active paid work, income up to 250% FPL and countable asset limits of $10,000 individual / $20,000 couple; premiums may apply.
How to start: Apply through DHS and request Sherlock Plan screening.
Good to know: Family caregiver payment: Family caregiver payment depends on the LTSS delivery model used.
Medicare Cost Offset
Medicare Premium Payment Program (QMB / QI)
IndirectHelps pay for: Pays some Medicare premiums and, for QMB, Medicare cost-sharing; frees household funds for long-term care expenses.
Who qualifies: 2026 income/resource limits apply. As of February 1, 2026, people who would have qualified for SLMB in Rhode Island qualify for QMB instead; QI funding is limited.
How to start: Apply through DHS; Benefits Enrollment Center/SHIP can help compare programs.
Good to know: Family caregiver payment: No
Medicare Navigation
Rhode Island SHIP / Medicare Counseling
IndirectHelps pay for: Free counseling on Medicare, Medigap, Medicare Advantage, Part D, Medicare Savings Programs and cost-reduction strategies.
Who qualifies: Available to Medicare beneficiaries, families and caregivers seeking counseling.
How to start: Call SHIP or ADRC for one-to-one counseling.
Good to know: Family caregiver payment: No
Medicare
Medicare Home Health
Yes - limited skilled home healthHelps pay for: Part-time/intermittent skilled nursing, therapy and limited home-health aide services when Medicare eligibility and home-health criteria are met.
Who qualifies: Requires Medicare coverage criteria, including need for qualifying skilled services; Medicare does not cover long-term custodial care solely because help with ADLs is needed.
How to start: Ask the treating clinician to certify/order home health and use a Medicare-certified agency.
Good to know: Family caregiver payment: No general family caregiver wage
Medicare Hospice
Yes - hospice-related home careHelps pay for: Hospice team services for eligible terminally ill beneficiaries, including symptom management, equipment, medications related to the terminal illness and respite components.
Who qualifies: Requires hospice eligibility/election and plan of care; Medicare does not pay room and board for hospice at home.
How to start: Ask the treating clinician/hospice provider for eligibility evaluation.
Good to know: Family caregiver payment: No general family caregiver wage
Prescription Cost Offset
Medicare Part D Extra Help
IndirectHelps pay for: Reduces Part D premiums, deductibles and prescription copays for people with limited income/resources, preserving funds for care.
Who qualifies: Federal Extra Help eligibility rules apply; some people are automatically deemed eligible through Medicaid/MSP status.
How to start: Apply with Social Security or ask SHIP/BEC for assistance.
Good to know: Family caregiver payment: No
Rhode Island Pharmaceutical Assistance to Elders (RIPAE)
IndirectHelps pay for: State program pays a portion of approved prescription costs during the deductible stage of a Part D plan.
Who qualifies: Age and income level rules apply; levels 1-3 generally serve age 65+, and level 4 serves qualifying people ages 55-64 with disabilities.
How to start: Apply through OHA/Benefits Enrollment Center and coordinate with Part D coverage.
Good to know: Family caregiver payment: No
Food Cost Offset
SNAP
IndirectHelps pay for: Monthly food assistance that can reduce grocery spending and preserve household funds for care.
Who qualifies: Income/household rules apply; special deductions/standards may apply to households with older adults or people with disabilities.
How to start: Apply through the RI DHS customer portal, by phone or paper application.
Good to know: Family caregiver payment: No
Utility Cost Offset
LIHEAP / Energy Assistance
IndirectHelps pay for: Heating assistance and crisis support can reduce utility burden, preserving money for care.
Who qualifies: Program-year income limits and application windows apply. The FFY 2026 heating-assistance application period closed April 15, 2026; screen for the next program year or crisis/other energy supports.
How to start: Contact DHS/community action energy-assistance resources for the current application period.
Good to know: Family caregiver payment: No
Caregiver Income Replacement
Temporary Caregiver Insurance (TCI)
IndirectHelps pay for: Rhode Island wage-replacement benefit for eligible workers who take leave to care for a seriously ill qualifying family member.
Who qualifies: Worker must have Rhode Island covered earnings/contributions and meet TCI claim rules; current program provides up to 8 weeks of caregiver benefits in a benefit year.
How to start: File a TCI claim promptly after leave begins and provide required medical/family documentation.
Good to know: Family caregiver payment: Yes - income replacement to caregiver, not a home-care wage
Housing Cost Offset
Rhode Island Property Tax Relief Claim (RI-1040H)
IndirectHelps pay for: State tax credit may offset property tax/rent burden for qualifying Rhode Island residents, preserving household funds for care.
Who qualifies: Annual tax-year income, residency, property/rent and filing rules apply; use the current RI-1040H instructions/form for the applicable tax year.
How to start: Review current Division of Taxation RI-1040H guidance or ask a tax preparer.
Good to know: Family caregiver payment: No
Home Modification Financing
RIHousing Access Independence
IndirectHelps pay for: Home-modification financing for eligible families/caregivers of people with developmental disabilities; can fund accessibility improvements and reduce out-of-pocket adaptation costs.
Who qualifies: Loan/program underwriting and disability/home-modification requirements apply; RIHousing advertises loans up to $50,000 for this program.
How to start: Contact RIHousing for current terms, eligibility and application.
Good to know: Family caregiver payment: No caregiver wage
Private Funding
Long-Term Care Insurance / Personal Savings / Private Home Care
YesHelps pay for: Private LTC insurance, life-insurance riders, annuities, savings, family cost-sharing or direct private-pay home care can fill gaps after public benefits are maximized.
Who qualifies: Coverage depends on policy terms and benefit triggers. Private-pay arrangements require budgeting, contracts, worker classification/payroll and quality/safety checks.
How to start: Review existing policies first, then compare licensed agencies or properly structured direct-hire arrangements.
Good to know: Family caregiver payment: Yes if privately arranged and lawful; tax/employment rules may apply when paying an individual directly.
VA Benefits
VA Homemaker & Home Health Aide Care
Direct in-home supportHelps pay for: Trained aides help an eligible Veteran with daily activities and personal care in the home.
Who qualifies: Veteran must be enrolled in VA health care and clinically eligible; availability and copay rules can vary. Ask the VA primary care team/social worker for a Geriatrics & Extended Care assessment/referral.
How to start: Ask the VA social worker or care team about VA Homemaker & Home Health Aide Care.
Good to know: Family caregiver payment: No direct family wage under ordinary H/HHA agency care
Veteran-Directed Care (VDC)
Direct / self-directed home careHelps pay for: Consumer-directed HCBS budget that may allow eligible Veterans to hire workers and purchase approved supports.
Who qualifies: Veteran must be VA health-care eligible, need nursing-home-level/community supports and have VDC available through the serving VA/community partner. Ask VA Providence social work/Geriatrics whether VDC is available and appropriate locally.
How to start: Ask the VA social worker or care team about Veteran-Directed Care (VDC).
Good to know: Family caregiver payment: Potentially yes; worker relationship rules and local program availability apply.
VA Skilled Home Health Care
Direct skilled home careHelps pay for: Short-term or intermittent skilled nursing, therapy and other clinical home services when ordered/authorized.
Who qualifies: Clinical need, VA eligibility and authorization apply; may be delivered by VA or community providers. Ask the VA care team for a skilled-home-health referral.
How to start: Ask the VA social worker or care team about VA Skilled Home Health Care.
Good to know: Family caregiver payment: No general family caregiver wage
VA Respite Care
Direct respite / caregiver reliefHelps pay for: Short-term in-home, adult-day or institutional respite to give a family caregiver a break.
Who qualifies: Veteran must be eligible for VA respite; VA Providence notes respite is pre-planned and generally not to exceed 30 days in a calendar year. Contact the VA Providence Caregiver Support Program or care team.
How to start: Ask the VA social worker or care team about VA Respite Care.
Good to know: Family caregiver payment: Pays/arranges substitute care, not the primary caregiver
VA Adult Day Health Care
Can reduce paid home-care hoursHelps pay for: Daytime health, rehabilitation, socialization, personal care and supervision in an adult-day setting.
Who qualifies: Clinical eligibility, local availability and VA authorization apply. Ask VA Geriatrics/social work for an Adult Day Health assessment/referral.
How to start: Ask the VA social worker or care team about VA Adult Day Health Care.
Good to know: Family caregiver payment: No direct family wage
VA Home Based Primary Care (HBPC)
Reduces need for some outside medical home visitsHelps pay for: Interdisciplinary primary care delivered in the home for Veterans with complex chronic conditions who have difficulty traveling for clinic care.
Who qualifies: VA-enrolled Veteran with clinical need and local HBPC availability. Ask the VA primary care team or social worker for HBPC screening.
How to start: Ask the VA social worker or care team about VA Home Based Primary Care (HBPC).
Good to know: Family caregiver payment: No direct family wage
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Direct caregiver supportHelps pay for: Education, support and—when eligibility criteria are met—a monthly stipend and other benefits for an approved primary family caregiver.
Who qualifies: Veteran and caregiver must meet current PCAFC clinical, service-connection and program requirements; stipend is not hourly home-care wages. Apply through VA Caregiver Support or contact the VA Providence Caregiver Support Program.
How to start: Ask the VA social worker or care team about Program of Comprehensive Assistance for Family Caregivers (PCAFC).
Good to know: Family caregiver payment: Yes - stipend for approved primary family caregiver
Program of General Caregiver Support Services (PGCSS)
Indirect caregiver supportHelps pay for: Training, coaching, peer support, referrals and resources for caregivers of Veterans.
Who qualifies: Generally available to caregivers of Veterans enrolled in VA health care; local program participation rules apply. Contact VA Providence Caregiver Support.
How to start: Ask the VA social worker or care team about Program of General Caregiver Support Services (PGCSS).
Good to know: Family caregiver payment: No stipend under PGCSS
VA Pension Aid & Attendance / Housebound
Cash can offset private home careHelps pay for: Additional pension amount for qualifying Veterans/survivors who need help with daily activities, are housebound or meet specified criteria; cash can help fund care.
Who qualifies: Must first qualify for VA pension/survivors pension and meet Aid & Attendance or Housebound criteria. File with VA or work with an accredited claims representative/VSO.
How to start: Ask the VA social worker or care team about VA Pension Aid & Attendance / Housebound.
Good to know: Family caregiver payment: Can be used toward eligible care expenses; not a VA hourly caregiver wage
VA Community Care Network - Rhode Island Region 1
Can include authorized home health/community servicesHelps pay for: VA-authorized community providers can deliver approved care when Community Care eligibility/referral applies.
Who qualifies: Rhode Island is in VA Community Care Network Region 1, administered by Optum Serve. Non-emergency community care generally requires VA referral/authorization. Work through the VA care team/community care office before scheduling non-emergency community services.
How to start: Ask the VA social worker or care team about VA Community Care Network - Rhode Island Region 1.
Good to know: Family caregiver payment: Depends on the underlying authorized benefit
VA Providence Caregiver Support Program
Direct navigation to home-care supportsHelps pay for: Local navigation to in-home help, caregiver programs, respite and VA/community resources.
Who qualifies: Caregiver for a Veteran receiving/eligible for VA services; each benefit has its own eligibility. Call the local Caregiver Support Program and describe the Veteran’s ADL, supervision and respite needs.
How to start: Ask the VA social worker or care team about VA Providence Caregiver Support Program.
Good to know: Family caregiver payment: Connects to PCAFC/other caregiver programs
Rhode Island Office of Veterans Services (RIVETS)
Indirect - helps unlock pension, health and other benefitsHelps pay for: Benefits counseling, claims assistance, case management and connection to VA/DHS/community supports.
Who qualifies: Veteran/service-member/family eligibility depends on the benefit being pursued. Submit the RIVETS intake form or call the Veterans Resource Center.
How to start: Ask the VA social worker or care team about Rhode Island Office of Veterans Services (RIVETS).
Good to know: Family caregiver payment: No direct caregiver wage
Where Rhode Island Families Can Start
Not sure where to begin? Match your situation to a contact below.
Best first call for aging/disability home-care options, At HOME, caregiver support, Medicare/Medicaid navigation and local resources.
Rhode Island Aging and Disability Resource Center (ADRC / The POINT)
Apply for/manage Medicaid LTSS, SNAP, Medicare assistance, Katie Beckett, Ticket to Work/Sherlock and other public benefits.
RI Department of Human Services (DHS)
Questions about Medicaid LTSS delivery, Personal Choice, RIte@Home Shared Living and Nursing Home Transition.
EOHHS LTSS / Personal Choice / Shared Living / NHTP
Personal Choice case-management/service-planning support and enrollment navigation.
AccessPointRI - Personal Choice Partner
Personal Choice and RIte@Home Shared Living partner support.
Seven Hills Rhode Island
Personal Choice support and service-planning assistance.
Tri-County Community Action - Personal Choice Partner
Screen for PACE comprehensive medical/LTSS/home-care model for eligible adults 55+.
PACE Organization of Rhode Island
Help enrolling in Medicare Savings Programs, Extra Help, RIPAE, SNAP, LIHEAP and related benefits.
OHA Benefits Enrollment Center
Adult I/DD eligibility, self-direction, parent/guardian-as-DSP questions and service planning.
BHDDH Division of Developmental Disabilities
Schedule Medicaid NEMT or eligible Elderly Transportation Program trips.
MTM Transportation
Paid caregiver-leave claim questions for eligible Rhode Island workers.
RI Department of Labor & Training - TCI
VA home-care/caregiver support plus pension/benefit claims and Rhode Island Veteran navigation.
VA Providence / Rhode Island Office of Veterans Services
Before You Rely on Any Payment Source
Planning Point
Why It Matters
Start with ADRC/The POINT unless the person already has an active Medicaid LTSS case
The ADRC at 401-462-4444 can compare Medicaid LTSS, At HOME Cost Share, PACE, adult day, caregiver respite and other community options. DHS handles financial applications, while EOHHS handles many LTSS program/service questions.
Personal Choice has explicit family-role exclusions
The active Personal Choice rule bars the participant’s spouse, representative, financial power of attorney and Social Security representative payee from working as the paid PCA. Do not assume a spouse can be paid simply because another family member could potentially qualify.
Personal Choice wages must fit the authorized budget
The current rule allows the participant to set a PCA wage from $15-$21 per hour, but taxes, workers’ compensation and administrative costs are also charged to the monthly budget. A higher hourly wage can therefore reduce the number of hours the budget can support.
At HOME is the major non-Medicaid home-care cost-share option
At HOME serves eligible people 65+ and adults 19-64 with Alzheimer’s/related dementia, uses a needs assessment, has no asset limit and caps income at 250% FPL. It uses income-based participant cost sharing rather than a Medicaid spend-down model.
RIte@Home and Personal Choice solve different problems
RIte@Home is a Shared Living option for a person who cannot live alone and needs considerable ADL help; Personal Choice is self-directed care in the participant’s own home. Compare living arrangement, supervision needs and desired employer role before choosing.
BHDDH parent/guardian DSP payment is separate from Personal Choice
BHDDH’s self-direction page includes specific Parents and Guardians as DSP request forms and a separate request for more hours. Approval must run through the adult DD service plan and BHDDH/FI rules; Personal Choice spouse/representative rules do not govern BHDDH self-direction.
INTEGRITY changed on January 1, 2026
Rhode Island’s former INTEGRITY Medicare-Medicaid Plan ended December 31, 2025. Beginning January 1, 2026, eligible dual members transitioned to Neighborhood’s FIDE-SNP, INTEGRITY for Duals. Use current 2026 plan materials rather than older MMP guidance.
New-provider enrollment is temporarily constrained in 2026
Rhode Island Medicaid imposed a six-month moratorium from July 1, 2026 through January 1, 2027 on newly enrolling certain Home Care/Personal Care providers and on newly enrolling Hospice/Home Health providers. Existing enrolled providers are not the target of the moratorium, but local capacity can still affect start dates.
Rhode Island expanded Medicare cost assistance in February 2026
As of February 1, 2026, people who would previously have qualified for SLMB now qualify for QMB and are automatically enrolled in that group. QDWI-related coverage is coordinated through Rhode Island’s Sherlock/Ticket to Work structure. Verify current MPP status before paying Medicare costs out of pocket.
Ticket to Work and Sherlock split at age 65
Ticket to Work covers eligible working people with disabilities ages 16-64 and currently has no income or asset limit; Sherlock is the age-65+ pathway with a 250% FPL income cap and $10,000 individual/$20,000 couple asset limits. Both can include HCBS LTSS if otherwise authorized.
Temporary Caregiver Insurance is income replacement, not a Medicaid caregiver wage
TCI can provide up to 8 weeks of paid leave to an eligible Rhode Island worker caring for a seriously ill qualifying relative. It replaces some wages while the worker is on leave; it does not authorize home-care hours or make the caregiver a Medicaid provider.
Use Veteran benefits as a separate funding layer
Rhode Island is in VA Community Care Network Region 1, administered by Optum Serve. VA Homemaker/HHA, Veteran-Directed Care, respite, PCAFC, Aid & Attendance, VA Providence caregiver support and RIVETS claims help each have separate eligibility/authorization rules and may complement state/federal benefits.
Program rules, income limits, and availability change over time and can vary by county. Confirm current details with the program directly, or ask a home care provider in Rhode Island to help you navigate the application process.
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These providers serve families in Rhode Island and can help you apply what you've learned above to your specific situation.
