Apply for Meals through Medicaid HCBS-LTSS

Please complete the following referral form to apply to receive meals through Medicaid HCBS-LTSS. A member of Meals on Wheels of RI’s team will call you within 3 business days to discuss your eligibility and options.

For additional questions about your eligibility through Medicaid HCBS-LTSS, please do not hesitate to email our team or view Frequently Asked Questions here.

This is an urgent request.

Person Making Referral

Name *

First

Last

Phone *

Referred by Email Address *

Client Information

Name *

First

Middle Initial

Last

Gender *

Birth Date *

Address *

Street Address

Address Line 2

City

State / Province/ Region

ZIP / Postal Code

Soc. Sec. # *

Medicaid #

Home Phone *

Cell Phone

Work Phone

Email *

Preferred Language *

Marital Status *

Race/Ethnicity *

Veteran Status *

Living Situation *

Apply for Meals through Medicaid HCBS-LTSS

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