Section 210-RICR-30-00-4.1 - Overview and Statutory AuthorityA. The goal of the federal Affordable Care Act (ACA) of 2010 is to improve access to high quality health insurance coverage for people of all ages and income levels. In keeping with this purpose, the ACA established a presumptive eligibility program for certain individuals and families in the newly reconfigured Medicaid Affordable Care Coverage (MACC) groups. The MACC groups in Rhode Island are described in Part 30-00-1 of this Title.B. Federal regulations governing the program at 42 C.F.R. § 435.1110 require the states to provide Medicaid for a limited period of time to individuals who are determined by a "qualified hospital", on the basis of preliminary information, to be presumptively eligible for Medicaid. This initial determination is made by the hospital on the basis of the characteristics for MACC group eligibility. The states have the discretion under these provisions to tailor presumptive eligibility requirements program within certain parameters to meet their own unique needs.C. Legal Authority 1. This Part is promulgated pursuant to Federal authorities as follows:a. Federal Law: § 1115 of the Social Security Act, 42 U.S.C. § 1315; Title XIX of the Social Security Act, 42 U.S.C. §§ 1396a - 1396w -7 ; Title XXI of the Social Security Act, 42 U.S.C. §§ 1397aa - 1397mm ; 42 U.S.C. § 1396k; § 1413(b)(1)(A) of the Patient Protection and Affordable Care Act, Pub. Law No. 111-148.b. Federal Regulations: 42 C.F.R. Parts 431.1110.c. The Medicaid State Plan and the Section 1115 Demonstration Waiver granted pursuant to § 1115 of the Social Security Act, 42 U.S.C. § 1315.210 R.I. Code R. 210-RICR-30-00-4.1
Amended effective 12/25/2024