Rhode Island Department of Human Services - RIte Care (Cranston, RI)

The Pacific Health Policy Group (PHPG) assisted in the design and implementation of " RIte Care," a statewide initiative to convert the existing fee-for-service Medicaid program to a managed care program with expanded benefits, and to extend health coverage to 10,000 uninsured children and pregnant women.  

PHPG was involved in all aspects of the program design and implementation, including drafting the original waiver proposal, negotiating with the federal government on its financial participation, development of participation standards for managed care plans, and advising on reorganization and privatization of certain state agency functions.

The RIte Care program has been singled out by the federal government as a successful model for other states. The program has created savings for the state, which are currently being utilized to expand coverage to an additional 10,000 uninsured persons.

Specific activities and responsibilities included:

• Overall project design

• Preparation of a Section 1115(a) Demonstration Waiver proposal, including evaluation design

• Assisted in procurement of an administrative services organization

• Managed the state's procurement process, including development of the RFP and evaluation and scoring methodologies