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Rhode Island Rebids Medicaid Managed Care Services

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By OPEN MINDS Circle

On December 15, 2023, the Rhode Island Executive Office of Health and Human Services (EOHHS) released a request for proposals (RFP24003614) to rebid its $3.5 billion Medicaid managed care organization (MCO) contracts and integrated dual special needs plans (D-SNPs). Proposals are due by February 23, 2024. The new contracts are slated to begin by July 1, 2025. The state intends to contract with up to three MCOs. The initial base contract period will be for five years, from July 1, 2025, until June 30, 2030, for Medicaid MCOs and from January 1, 2026, through December 31, 2030, for integrated D-SNPS. The contracts can be renewed for up to five additional 12-month periods.

The three current contractors are Neighborhood Health Plan of Rhode Island; Tufts Health Public Plans, Inc.; and United Healthcare NE, Inc.; they have held the contracts since 2017. The state has 350,000 Medicaid beneficiaries, representing about one-third of the state’s population.  

The RFP noted the following Medicaid populations are excluded from enrollment in Rhode Island Medicaid managed care and will be served through the fee-for-service program:

  • Beneficiaries receiving services in an Intermediate Care Facility for Intellectual or Developmental Disabilities (ICF/IDD).
  • Partial dual eligible individuals that qualify for a Medicare Savings Program but do not receive full Medicaid medical benefits.
  • Full benefit dual eligibles (FBDEs) who do not select a fully integrated dual eligible Medicare Advantage Special Needs Plan (FIDE-SNP) for the coverage of their Medicare benefits.
  • Beneficiaries incarcerated for more than five days.
  • People enrolled in Program of All-inclusive Care for the Elderly (PACE).
  • People enrolled in RIteShare, the state’s premium assistance program that provides help paying for an employer’s health insurance plan.

The RFP includes the following new requirements:

  • Allow children in custody of the Department of Children, Youth, and Families (DCYF) to enroll in any of the MCOs. Currently, they are enrolled in a single MCO, Neighborhood Health Plan of Rhode Island.
  • Add long-term services and supports (LTSS) benefits.
  • Require all MCOs to become FIDE-SNP that will cover primary, acute, behavioral health, durable medical equipment, and LTSS benefits. Currently only a single MCO, Neighborhood Health Plan of Rhode Island, is participating in the state’s Medicare Financial Alignment Demonstration program.
  • Reduce use of prior authorization for behavioral health care.
  • Require the MCOs to disclose executive salaries.
  • Require state approval of insurer subcontractors.
  • Raise penalties for MCO non-compliance.

The MCOs will be responsible for all Medicaid state plan services and the newly added LTSS benefits. The state seeks proposals that demonstrate a commitment and expertise in primary and preventive care, care delivery, payment reform, and incorporating technology-based solutions to reduce redundancy and administrative burden. The technology solutions can include the use of emerging technologies such as artificial intelligence (AI) and advanced data analytics for sophisticated population health data analysis and rising risk prevention, minimize redundancy and burdensome administrative processes, enhance consumer satisfaction, enforce program integrity safeguards, promote better health outcomes for vulnerable populations, and reduce provider organization abrasion with the delivery of covered services through an efficient Medicaid managed care program.

The MCOs will receive a monthly per-member per-month (PMPM) capitated payment. The state intends to move toward a full risk bearing health care delivery system in the contract’s second year. The RFP includes provisions allowing the state to remove risk corridors that currently provide a financial cushion if costs exceed projections.

The contracts will go live in three phases.

  • In Phase I, on July 1, 2025, core populations will be enrolled, and the plans will be responsible for LTSS for Medicaid-only beneficiaries.
  • In Phase II, on January 1, 2026, current fully dual eligible members will be enrolled in the MCO’s FIDE-SNPs. The MCOs can additionally offer a Coordination-Only D-SNP for partial dual eligible beneficiaries.
  • In Phase III, on January 1, 2027, new dual eligible members who become newly eligible for Medicare will be enrolled. By July 1, 2027, each selected MCO must become a qualified health plan (QHP) on the Rhode Island Health Insurance Exchange.

For more information about the RFP, contact: David Francis, Rhode Island Department of Administration, Office of Purchases, One Capitol Hill, Providence, Rhode Island 02908; 401-574-8100; Email: David.Francis@purchasing.ri.gov; Website: https://eohhs.ri.gov/

For more information about the current MCO contracts, contact: Kerri White, Spokesperson, Rhode Island Executive Office of Health and Human Services, 3 West Road, Cranston, Rhode Island 02920; 401-462-5274; Fax: 401-462-3677; Website: https://eohhs.ri.gov/