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demographic information and information regarding enrollment in a Qualified Health Plan through HealthSource RI. 2. State’s Responsibilities – EOHHS must review and determine eligibility for financial assistance within sixty (60) days. If additional information is needed by EOHHS, a new review period will begin once the additional information has been received. 1.6 Eligibility Approval – Premium Amount A. If a caretaker is approved, EOHHS calculates the AHCCA subsidy amount in accordance with the following chart: Rhode Island Affordable Health Care Coverage Assistance Program Assistance Total Family Size 138 % FPL to 150% FPL 151% FPL to 175 % FPL 2 $39 $28 3 $49 $43 4 $59 $58 5 $69 $73 6 $79 $88 1.7 Notice

EOHHS, or its agent, must send a notice to the caretaker with an eligibility determination for AHCCA. All notices must include a statement of the rights of the caretaker applying. 1.8 Payment of Subsidies

The payment option for the AHCCA subsidy includes the following: The caretaker pays the premium due to the insurer to HealthSource RI. EOHHS or its agent mails a check to the caretaker monthly. 1.9 Duration and Continuing Eligibility A. Period of eligibility – Eligibility for the AHCCA subsidy is on a month-to-month basis. The subsidy may be curtailed sooner if there is a change in any eligibility factor that affects household or enrollment in the Qualified Health Plan selected