Rhode Island

Medicaid program name: Rhode Island Medicaid

Medicaid ACO program name: Accountable Entities (AE)

Status: Active

Summary:
Rhode Island has a Medicaid “Accountable Entities” (AE) program that began as a pilot in 2016. The Accountable Entities are a key enhancement of Rhode Island’s long-standing Medicaid managed care program and are viewed by the state as a reinvention of Medicaid based on value-based care principals. AEs contract with Rhode Island managed care organizations (MCOs) to deliver more cost-effective, coordinated and population-focused care. The pilot helped develop knowledge and experience before the full program started in 2018. The AE program, which serves 70 percent of Medicaid beneficiaries, is built on contracts between seven AEs and the state’s MCOs. The state is moving through a staged five-year implementation plan (2018-2023) using an 1115 waiver, with infrastructure grants available to certified AEs using the federal waiver funding. The state requires MCOs and AEs to adopt a defined population health approach that includes screening, assessment and referral to community partners to address population health issues and to provide better care for complex patients. From shared savings in the first two years of implementation, AEs will progress toward full risk under future contracts.  

More information:

• Accountable Entities Resource Documents
• How Rhode Island Tackles Social Determinants of Health through its Accountable Entity Model (2018)
• Rhode Island Medicaid Accountable Entity Program: Accountable Entity Certification Standards (2017)
• Rhode Island Executive Office of Health and Human Services Medicaid Program Accountable Entity Roadmap (2017)