Medicaid

Children with Special Healthcare Needs (CSN) is Rhode Island's Medicaid managed care plan for Children with a disability or chronic condition and they are determined eligible for: Supplemental Security Income (SSI), Katie Beckett or Adoption Subsidy through the Department of Children, Youth, and Families (DCYF). When eligible for Medicaid, parents or guardians are then given a choice of enrollment in a participating health plan. Children who live in an institutional facility are excluded from health plan enrollment. In those situations, children will be enrolled in traditional Medicaid Fee-For-Service.

Children with Special Healthcare Needs may qualify for RIte Care under UnitedHealthcare Community Plan. The Department of Human Services will enroll Children with Special Healthcare Needs who are eligible for Medicaid.

NHPRI follows the Network model and serves the following Medicaid populations in Rhode Island:

• Families with low to moderate income
• Children with special health care needs
• All children in the RI foster care system
• Medicaid-only adults with disabilities
• Medicaid expansion population, and
• Dually eligible (Medicare/Medicaid) beneficiaries https://www.nhpri.org/medicare-medicaid/
• We also serve individuals and small businesses through HealthSource RI (Rhode Island’s health benefits exchange).

ACCESS is Neighborhood’s plan through the RIte Care program for children, families and pregnant women. 

Care Coordination programs are available through Neighborhood including:

• Neonatal Case Management Program can help you coordinate and manage the many needs of your baby after being discharged from the Neonatal Intensive Care Unit (NICU).
• The Children with Special Health Care Needs (CSN) Care Management Program can help to improve a child's health and wellness if they are at risk due to complex medical and/or social issues.
• The Substitute Care Program can help improve the health and wellness of children in foster care.

Neighborhood Health Plan of Rhode Island (Neighborhood) is a non-profit HMO that was founded in 1994 to make sure everyone in the state has access to high-quality, low-cost health care. Neighborhood has been ranked as one of the top Medicaid health plans in America for the past twelve years and currently serves more than 190,000 members. Neighborhood also recently extended its great service, benefits and value to individuals and businesses through HealthSource RI – the state’s health insurance exchange.

• Medicare

The National Academy of Social Insurance is a non-profit, non-partisan organization made up of the national experts on social insurance. Its mission is to advance solutions to challenges facing the nation by increasing public understanding of how social insurance contributes to economic security. Social insurance encompasses broad-based systems that help workers and their families pool risks to avoid loss of income due to retirement, death, disability, or unemployment and ensure access to health care. They provide information on social security, Medicare, workers' compensation and disability, unemployment insurance, and long-term services and supports.

Provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. States are required to provide comprehensive services and furnish all Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines. 

Services Include:

• Comprehensive Health and Developmental History
• Comprehensive Physical Exam
• Appropriate Immunizations 
• Laboratory tests (including lead screening)
• Health Education 
• Vision Services
• Dental Services
• Hearing Services
• Diagnostic Services and Treatment