The proposed audit represents a significant shift in how Medicaid services are managed in Rhode Island, particularly in response to ongoing concerns regarding the profitability and operational effectiveness of private health insurers acting as intermediaries. The bill cites a lack of adequate oversight in the management of MCOs, where concerns have been raised about their ability to control costs and improve healthcare accessibility for consumers. It reflects a growing dissatisfaction with the managed care model as evidence mounts that it may not be delivering desired outcomes for the state's vulnerable populations.
Summary
House Bill H5402 aims to reform the Medicaid program in Rhode Island by increasing the oversight and accountability of managed care organizations (MCOs) that administer Medicaid benefits. Introduced in February 2023, the bill mandates that the state's auditor general conduct an audit of the Medicaid programs administered by these MCOs. The intent is to assess whether they are actually delivering better outcomes and savings compared to a traditional state-run fee-for-service Medicaid program. If the audit suggests that transitioning back to a fee-for-service model would be more beneficial, a plan will need to be developed to make this change within a specified timeframe.
Contention
One of the notable points of contention surrounding H5402 is the administrative burden it may place on the health department and the political implications of potentially transitioning away from managed care organizations that supporters argue help streamline operations. Opponents may view this move as a politically motivated effort to counteract privatization trends within healthcare. Furthermore, there are concerns that returning to a fee-for-service model could have negative implications for the financial viability of healthcare providers accustomed to the managed care environment, especially in light of increased Medicaid enrollment during the COVID-19 pandemic.
To Amend The Medicaid Fraud Act And The Medicaid Fraud False Claims Act; And To Update Language And Definitions To Reflect Changes Within The Healthcare System;.
Requires Medicaid reimbursement for covered behavioral health services provided by local education agency to student who is eligible Medicaid beneficiary.
Requires Medicaid reimbursement for covered behavioral health services provided by local education agency to student who is eligible Medicaid beneficiary.
Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.