Rhode Island Medicaid Expansion

Rhode Island is fully participating in the Medicaid Expansion under provisions of the Affordable Care Act (ACA). For additional background on the State’s policy decisions regarding the Medicaid Expansion option, see: Background.

Medicaid in Rhode Island

The RI Department of Human Services administers the state’s Medicaid program. Information about the state Medicaid program, including beneficiary information, can be found at: http://www.dhs.ri.gov/.

Provider Participation

Providers must enroll in the Medicaid fee-for-service program to receive payments for covered services. Information about enrolling in the Medicaid fee-for-service program can be found at: http://www.dhs.ri.gov/. The Medicaid website provides information about services covered by fee-for-service payments and payment amounts: http://www.dhs.ri.gov/.
In order to retain access to all Medicaid patients in the state, providers must also connect to the managed care plans individually.

Medicaid Managed Care

Some beneficiaries are enrolled in managed care plans. Basic information about the programs, called RIte Care can be found at: http://www.dhs.ri.gov/People/FamilieswithChildren/HealthCare/RIteCare/tabid/213/Default.aspx.
Some managed care plans cover individual Rhode Island counties and independent cities. The Medicaid website has jurisdictional information: http://www.dhs.ri.gov/.

Beneficiaries Participating in Managed Care

Managed care plans participating in RIte Care offer detailed information about covered benefits for individuals enrolling in their plans. This information is available on the managed care websites shown below.

Reporting Problems

The state Medicaid office is primarily responsible for examining and addressing issues with the Medicaid Managed Care plans offered in the state, and for working with the companies that offer them. If you are experiencing problems as a medical provider with the Managed Care plans or companies operating in the state, or if your patients are experiencing problems with the Managed Care plans or companies in the state, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state Medicaid Office:

http://www.dhs.ri.gov/
800-984-8989
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies

Managed Care Plans Participating in RIte Care

Neighborhood Health Plan of RI
Plan Website: http://www.nhpri.org/
Provider Enrollment: http://www.nhpri.org/Providers/BecomeaNetworkProvider.aspx

United Healthcare of New England
Plan Website: http://www.uhccommunityplan.com/plan/state/RI/index
Provider Enrollment: http://www.uhccommunityplan.com/health-professionals/RI/provider-information