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Dive Overview:
- Rhode Island has awarded Medicaid managed care contracts to two insurers, UnitedHealthcare of New England and Neighborhood Health Plan of Rhode Island, with first-year contract value estimated at $3.1 billion, according to the state Department of Health and Human Services.
- Currently, the state has three managed care organizations: UnitedHealthcare, Neighborhood Health Plan and Tufts Public Health Plan. Tufts is not entering into any new managed care contracts.
- new According to a press release on Tuesday, the contract runs for five years, beginning July 1, 2025, with an option to extend for an additional five years.
Dive Insights:
Most states use managed care arrangements to provide medical benefits to Medicaid recipients, where state agencies contract with insurance companies and pay them a monthly fee per enrollee. Contract lengths vary by state, but typically last three to five years.
Rhode Island’s Medicaid managed care organizations administer about 320,000 benefits each year, or 90 percent of the state’s Medicaid program, the Rhode Island Department of Health and Human Services said.
These contracts can be lucrative for the health insurers that win them, especially in states with large Medicaid programs like Florida. Rhode Island’s contract could be worth $15.5 billion over five years, WPRI 12 News reported.
The state issued a request for proposals in December, and four organizations submitted bids: UnitedHealthcare, Neighborhood Health Plan, Tufts University and newcomer Blue Cross Blue Shield of Rhode Island, according to the Rhode Island Current.
The Rhode Island Department of Health and Human Services said in a release Tuesday that other bidders did not meet the minimum technical proposal score required to qualify for the bid.
According to a memo posted by Current, the plan was required to receive an 85-point technology score that would be assessed based on metrics such as utilization, quality management, provider network and access.
However, Blue Cross received just 63.22 points, while Tufts received 54.38 points.
Neighborhood received a technology score of 88.46, while UnitedHealthcare received 87.86.
The new contract between UnitedHealthcare and Neighborhoods includes quality improvement measures, such as increased oversight of pharmacy benefit managers, financial sanctions and performance metrics, the agency said.
“Many of the improvements made in this contract will positively impact member care, increase medical and behavioral health parity, incorporate long-term services and supports (LTSS) as an in-plan benefit, reduce unnecessary prior authorizations, and focus on health equity,” EOHHS Secretary Richard Charest said in a statement.
