Medicaid agency: Executive Office of Health and Human Services (EOHHS)
Rhode Island Medicaid is administered directly out of the Executive Office of Health and Human Services (EOHHS), which state law designates as the single state Medicaid agency; six agencies operate under EOHHS, including the Department of Human Services, which determines Medicaid eligibility, and the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. Three managed care organizations, Neighborhood Health Plan of Rhode Island (NHPRI), UnitedHealthcare of Rhode Island Community Plan, and Tufts Health Public Plans (branded RITogether), deliver RIte Care, Rhody Health Partners, and Medicaid Expansion coverage under contracts dating to 2017; no new competitive procurement has been announced since the state's most recent re-procurement attempt was cancelled. Rhode Island runs its entire Medicaid program under a single, comprehensive Section 1115 demonstration, currently authorized through 2030, rather than the mix of 1915(b), (c), (i), and (k) authorities most states use; it is one of only four states nationally, alongside Arizona, New Jersey, and Vermont, that runs no standalone Section 1915(c) HCBS waivers, with home- and community-based services instead delivered under 1115 expenditure authority and a Home Stabilization Services program operating under a "1915(i)-like" authority. RIte Care continues to serve as the delivery vehicle for CHIP-eligible children, whose federal authority now sits in the Medicaid state plan rather than the 1115 demonstration; Rhode Island expanded Medicaid in January 2014. Work requirements begin in 2027 with six-month renewal cycles, and non-citizen eligibility changes take effect October 1, 2026.
CMS's most recent managed care enrollment data, report year 2024, lists six entities for Rhode Island. Three comprehensive MCOs (Neighborhood Health Plan of Rhode Island, UnitedHealthcare of Rhode Island Community Plan, and Tufts Health Public Plans) cover RIte Care, Rhody Health Partners, and Medicaid Expansion enrollees statewide, with combined enrollment of 267,202. A fourth statewide plan, UnitedHealthcare Dental of Rhode Island, administers the RIte Smiles dental prepaid ambulatory health plan (132,957 enrolled). Medical Transportation Management, Inc. reports 312,709 enrollees as the statewide non-emergency medical transportation broker, and PACE Organization of Rhode Island reports 410 enrollees in Rhode Island's small PACE program.
Long-term services and supports are not integrated into the three comprehensive MCO contracts serving Rhode Island's general Medicaid population; CMS's own dataset classifies those contracts as comprehensive medical coverage only, without an LTSS designation. A narrower track serves dually eligible members separately: Neighborhood Health Plan of Rhode Island converted its Medicare-Medicaid Plan into INTEGRITY for Duals, a Fully Integrated Dual-Eligible Special Needs Plan, effective January 1, 2026, coordinating Medicare and Medicaid benefits including LTSS for enrolled members. Four coordination-only D-SNP agreements (with Blue Cross Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island, Oxford Health Plans, and UnitedHealthcare) coordinate benefits for other dually eligible members outside the FIDE-SNP, and a small Program of All-Inclusive Care for the Elderly serves individuals over 55 who require a nursing-facility level of care through direct contracts with PACE providers rather than through an MCO.
Not integrated into managed care
Behavioral health is capitated directly into the same RIte Care, Rhody Health Partners, and Medicaid Expansion MCO contracts as physical health, rather than carved out to a separate vendor. EOHHS's managed care contracts set the same time-and-distance access standards for behavioral health prescribers as for primary care and specialty providers.
Carved in
RIte Smiles, Rhode Island's managed dental program, is administered by UnitedHealthcare Dental of Rhode Island. RIte Smiles had long covered only children; as part of its November 2025 extension approval, CMS approved expanding the program to all adult Medicaid beneficiaries.
Each MCO manages its own pharmacy benefit and drug formulary rather than routing through a single statewide pharmacy benefit manager, subject to EOHHS's Pharmacy Home Program, its Generics First Initiative, and the direction of EOHHS's own Pharmacy and Therapeutics Committee. A separate fee-for-service preferred drug list, also set by that committee, applies to members outside managed care.
Medical Transportation Management, Inc. has served as Rhode Island's statewide non-emergency medical transportation broker since January 2019.
Gainwell Technologies is Rhode Island's Medicaid fiscal agent, processing claims and operating the provider portal. RIBridges, built by Deloitte, is the state's integrated eligibility system covering Medicaid, SNAP, and other benefits.
28 agency updates tracked for Rhode Island. Available with Pro.
See them with ProBrown University Health, Rhode Island's largest hospital system, announced buyouts for up to 200 non-clinical supervisors and layoffs of an unspecified number of executives, effective the start of its new fiscal year. CEO John Fernandez cited rising pharmaceutical, labor and supply costs alongside growing uncompensated care, insurer denials and bad debt. The system attributes much of the pressure to federal policy changes restricting Medicaid eligibility and ending exchange subsidies, projecting $346 million in charity care, denials and debt costs for fiscal 2027, $71 million more than the prior year, and a $64 million deficit. Despite the cuts, the system plans $210 million in capital facility upgrades and a January merit increase, and will end employee health plan coverage of GLP-1 drugs for weight loss starting Jan. 1.
Rhode Island Medicaid implemented five changes effective Oct. 1, the start of the federal fiscal year. Under the federal H.R. 1 law, asylees, refugees, parolees, and trafficking victims lose Medicaid eligibility unless they qualify through another status; the state estimates fewer than 3,500 noncitizens will be affected, though green card holders, Compact of Free Association migrants, and lawfully residing children and pregnant/postpartum women retain coverage. Separately, driven by the state budget rather than federal law, Rhode Island Medicaid will stop covering GLP-1 drugs like Wegovy and Zepbound when prescribed for weight loss, while continuing coverage for diabetes indications. The state projects the GLP-1 cut will save $6.3 million in general revenue and $20.3 million in combined state-federal funding; managed care plans were directed to review affected patients' treatment plans before the cutoff. Rhode Island is at least the seventh state in 2026 to drop GLP-1 obesity coverage.
Rhode Island Attorney General Peter Neronha's office rejected a financial turnaround plan submitted by CharterCARE Health of Rhode Island, the new owner of Roger Williams Medical Center and Our Lady of Fatima Hospital, saying it relied on unrealistic assumptions. The plan was required under conditions imposed when the hospitals' sale to nonprofit owner The Centurion Foundation closed in March. Neronha gave the owners until October 2 to submit a revised plan, warning the hospitals could be at risk of closing by year's end despite an $85 million cash infusion required at sale closing. Both hospitals serve large shares of Medicaid and Medicare patients and face pressure from new federal Medicaid eligibility requirements and funding cuts expected to increase uncompensated care.
Rhode Island is developing plans for its $156.17 million allocation from a nationwide rural healthcare funding program enacted in July 2026. The state is working to finalize project details ahead of an October federal deadline. The funding is part of a $50 billion national initiative targeting rural health infrastructure and services. Rhode Island Medicaid agencies and providers serving rural populations should monitor how these dollars will be deployed and whether Medicaid-funded services or facilities are included in the state's implementation plan.
Rhode Island has redesigned the decision notices sent to approximately 60,000 residents monthly regarding Medicaid coverage and other public benefits. The redesigned notices aim to make approval, denial, and change decisions easier to understand for beneficiaries. The changes took effect this month. The redesign matters for state agencies and health plans because clearer notices can reduce appeals, call center volume, and coverage gaps caused by beneficiary confusion about eligibility decisions.
2 active waivers tracked for Rhode Island. Available with Pro.
See them with Pro1 active solicitations tracked for Rhode Island. Available with Pro.
See them with Pro95 managed care contracts tracked for Rhode Island. Available with Pro.
See them with Pro54 bills tracked for Rhode Island. Available with Pro.
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