Rhode Island Organ Transplant Fund

The RI Organ Transplant Fund is a state-funded program that started in May 1987. The intent of the program is to supplement certain costs that are usually not reimbursed fully by insurers.

Eligibility Requirements include the following:

1. Residency – The transplant recipient must have been a resident of Rhode Island for at least one (1) year prior to the date of the transplant operation.

2. Financial Requirements – In 2009, the adjusted gross income of the transplant recipient’s household as reported on the RI Personal Income Tax Return, must not have exceeded $76,953.27 in order to qualify for fund benefits. Each year, this income limit is raised by a Cost of Living Allowance.

3. Basic Coverage Requirement – In order to be considered eligible for funding, the transplant recipient must be covered under a health insurance plan, which specifically includes coverage for organ transplant expenses related to the recipient’s particular condition. After the recipient’s insurer has made payment, any resulting non-reimbursed costs such as plan deductibles and co-insurance will be considered for reimbursement as a covered service. Documentation is required for these costs.

How To Apply

There is a one-page application the recipient must complete as well as a release of information form and a W-9 tax form.

Release of Information
Application
W-9 Tax Form

Covered Services

The following covered services include only the costs for organ transplants that are not reimbursed, as described below:

1. Payment of COBRA premiums, up to 6 months (effective July 2005).

2. Hospital and other medically necessary health services payable according to the usual and customary costs as determined by the Department.

3. All drugs prescribed which relate to organ transplant maintenance, payable at the rate of fifty percent (50%) if the average wholesale price or fifty percent (50%) of non-reimbursed costs, whichever is less.

4. Out-of-state living expenses of the eligible family member for a period of not more than sixty (60) days at the time of the organ transplant operation. Reimbursement will be limited to the current per diem rate allowed state employees for accommodations and sustenance.

5. The maximum lifetime benefit per recipient is $15,000.00

For more information, call the Center for Adult Health Contracting and Payments Unit at
(401) 462-6390 or (401) 462-2183.