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Children with Special Health Care Needs Frequently Asked Questions

Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.

The Affordable Care Act expanded Medicaid to include individuals adults (19-64 years old) without any dependent children or disability that make to less than $15,654 a year or less than $1,305 per month.  

The Affordable Care Act expands access to quality and affordable health coverage for millions of people. Signed into federal law by President Barak Obama in 2010, the ACA guarantees health coverage regardless of  income level, work situation, or previous health conditions. 

HealthSourceRI is Rhode Island’s health insurance marketplace. People are able to directly apply for health coverage directly on the website www.healthsourceri.com or, if you need assistance to apply, make an appointment with a Navigator at 855-840-4774.  

Some services and prescription drug medications may require prior authorizations. It is the responsibility of your doctor to get prior authorization when required.

The RIte Care and Rhody Health Partners Directory of Physicians and other Health Care Providers lists pharmacies where you can get your prescriptions. Just bring your prescription and show your identification card at a participating pharmacy to get your prescription filled. Your Physician and Health Care Provider Directory is part of your member materials packet. Many pharmacies stay open 24 hours a day so you can get a prescription filled in the middle of the night, if you need to.

Your UnitedHealthcare clinician needs to write an order on their prescription pad for over-the counter medications. Just bring the prescription and bring your UnitedHealthcare identification card to a participating pharmacy to get your OTC prescription filled. Examples of over-the counter-medications include aspirin, cough syrup, condoms and much more. These medications are available to you at no cost.

A formulary is a list of medications that UnitedHealthcare will pay for when ordered by your doctor. UnitedHealthcare has a large formulary. Some drugs require that your doctor get prior approval by UnitedHealthcare. Your doctor may contact us for more information about coverage or visit our website for our formulary.

All Medicaid members must use generic drugs first. Generic drugs may require prior authorization. There are a limited number of brand name drugs that will be covered. These will be limited to certain classes (or types) of drugs. Additionally, some of these may require prior authorization by UnitedHealthcare. If you feel you that you are unable to take the generic medication, please contact your provider. Health plan providers are aware of the criteria for approval of brand name drug coverage.

  • Injectable medications are covered under the medical benefit. Your doctor can make arrangements to have the injectable medication delivered, either to his/her office or your home. In some instances your doctor will write you a prescription for injectable medication (i.e. insulin), which can be filled at a pharmacy.

Most UnitedHealthcare RIte Care and Rhody Health Partners members do not have copays. Check your benefit summary to see if you have a co-pay.

To access your Behavioral Health benefits please call Optum Behavioral Health at 800-435-7486 (TTY: 711) and an intake specialist will assist you. Or visit the website.

if you received a bill for covered services, we will help you resolve the issues. This includes emergency services received out-of area but within the United States and territories. Call Member Service at 1-800-587-5187 (TTY 711). 

You may also send the bill to: 
UnitedHealthcare Community Plan 
Attention: Member Appeals 
P.O. Box 31364 
Salt Lake City, UT 84131

Yes. First contact your local Department of Human Service (DHS) office. Second call Member Services at 1-800-587-5187 (TTY:711), open Monday – Friday 8:00 a.m. – 7:00 p.m.

Yes. UnitedHealthcare is required by law to cover a minimum hospital stay of 48 hours after a vaginal birth and 96 hours after a caesarean birth, unless the mother requests an early discharge.

RIte Care Members: Beginning January 2014, families will no longer need to pay a monthly premium to keep children enrolled.

If you have RIte Care the other health insurance company will pay your health care bills first. When you receive care, always show both cards (your insurance card and your UnitedHealthcare RIte Care Insurance card.) If you have Rhody Health Partners or RIte Care and become eligible for other insurance please notify the Rhode Island Department of Human Services.

Notify your local Department of Human Service office and Member Services at 1-800-587-5187 or (TTY: 711) Monday – Friday 8:00 a.m. – 7:00 p.m.

No. UnitedHealthcare does not require you to get a second opinion for covered services. However a second opinion is available to you at no cost for all medical, surgical, and other healthcare covered services.

The following services are not covered by UnitedHealthcare:

  • Experimental procedures, except where a state mandate for coverage exists
  • Abortion services, except to preserve the life of the women or in case of rape or incest.
  • Private rooms in hospitals (unless medically necessary)
  • Cosmetic surgery
  • Infertility treatment services
  • Sexual and erectile dysfunction medications

Services outside Rhode Island are not covered unless the provider is participating with UnitedHealthcare New England's Medicaid plan, or with an authorization if a covered benefit is not available in network.

RIte Care and Rhody Health Partners Members:
Services outside of United States territory (emergency and non-emergency) are not covered. Emergency Services are covered within the 50 United States. If you have an emergency go to the closest emergency room.

UnitedHealthcare Community Plan
475 Kilvert Street
Warwick, RI 02886
Attn: Medicaid Program

When you apply for Medicaid through HealthSourceRI, you will need the following information:

  • Information about household members (name date of birth, Social Security number)
  • Employer name and income information (pay stubs)
  • Previous Tax Returns (w2 form, 1099 form)
  • Proof of citizenship  (or document numbers for legal immigrants)
  • Bank Statements

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Children with Special Health Care Needs


Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.