Rhode Island Consumer Choice Medicaid Reform Plan

Individuals will mandatory enroll in a managed care delivery system and have an option to enroll in a managed care plan or in a primary case management plan. Every Medicaid beneficiary will have a medical home and will have access to services that are design to meet their needs, are based on quality and performance measures. The Plan will ensure that each person has access to appropriate services, a medical home, and support in coordinating, managing and navigating services. It will ensure personal responsibility and that individual’s participation in decisions about their care. The Plan will encourage new provider markets and create incentives for innovation and broadened care options within the continuum of care. It will promote diversion to less restrictive, appropriate settings; create incentives for cost-conscious healthy choices; promote and reward independence, personal accountability, health and wellness. There will be ongoing monitoring of performance and quality; performance base payment incentives; and cost containment through competitive based purchasing. Included are proposals that would implement co-payments for certain services and increase premium responsibility for beneficiaries. Efforts to enhance fair share contributions from employers of public health beneficiaries are proposed. These initiatives build on, re-engineer and expand upon long established and newly developed program options, including RIte Care, Connect Care Choice and Rhody Health Partners. In combination, these initiatives help fulfill the commitment for cost effective, person centered care management is in place for all Medicaid beneficiaries.