Page 6

primary/acute and specialty care through a medical home that focuses on prevention and promoting healthy outcomes. The Rules for RHP for adults ages nineteen to sixty-four (19 – 64) in the MACC groups are located in Part 30-05-2 of this Title. 26. “SSI income standard” means the basis for determining Medicaid eligibility that uses the definitions and calculations for evaluating income and resources established by the U.S. Social Security Administration for the Supplemental Security Income (SSI) program. 27. “SSI protected status” means the class of beneficiaries who retain categorical eligibility for Medicaid even though they are no longer eligible for SSI due to certain changes in income or resources. 1.3 Rhody Health Partners (RHP) 1.3.1 Authority and Scope A. In 2005, R.I. Gen. Laws § 40-8.5-1.1 authorized the Medicaid agency to establish mandatory managed care delivery systems for adults nineteen (19) years of age or older who are eligible on the basis of participation in the Supplemental Security Income (SSI) program (see § 00-1.5 of this Chapter) or an SSI-related characteristic associated with age or a disability and income. In Rhode Island, persons with SSI-related characteristics are eligible under the Medicaid State Plan option for low-income elders and adults living with disabilities (EAD) in accordance with R.I. Gen. Laws Chapter 40-8.5. The requirements for adults in associated special eligibility groups that have unique financial (e.g., SSI Protected Status) or clinical criteria (e.g., breast and cervical cancer coverage group) or limited benefits (e.g., partial dual eligible group and the Medicare Premium Payment Program) are also located in § 05-1.6 of this Chapter. B. Beneficiaries eligible in these coverage groups who do not require LTSS are sometimes referred to as “Community Medicaid” and are members of the State’s Integrated Health Care Coverage (IHCC) groups. The provisions governing eligibility set forth in Subchapter 05 Part 1 of this Chapter and § 00-3.1.2 of this Chapter and enrollment as established herein will remain in effect unless or until replaced. C. IHCC group beneficiaries who are eligible on the basis of SSI income standard, do not require LTSS, and do not have third (3rd) party coverage are subject to mandatory enrollment in a Rhody Health Partners (RHP) Medicaid managed care plan. Eligible beneficiaries have the choice of two (2) RHP-participating health plans. 1.3.2 EOHHS Responsibilities