This resolution addresses concerns about the adequacy of managed care organizations (MCOs) in providing access to necessary specialists for individuals with disabilities, chronic diseases, or psychological trauma. Managed care, which integrates the financing and delivery of healthcare to minimize costs, often operates through health maintenance organizations (HMOs) that provide care within a fixed budget. The resolution identifies an urgent need to evaluate whether MCOs in Rhode Island are delivering cost savings and improved access and outcomes compared to a potential state-managed fee-for-service program.

To address these concerns, the resolution calls for the Auditor General to conduct an audit of Medicaid programs administered by MCOs in Rhode Island and report the findings within six months. If the audit suggests that a state-run fee-for-service Medicaid program could offer better savings, access, and outcomes, the resolution requests that the Office of Health and Human Services and the Auditor General develop a plan to transition to such a program within two years. The proposed state-run program would require MCOs to meet specific financial criteria, including a medical loss ratio (MLR) of over 90% net of certain costs, and to return excess revenues if they fail to meet this MLR. Penalties for not meeting contract terms would also be established. The resolution directs the Secretary of State to send certified copies of the resolution to the Office of the Auditor General and the Executive Office of Health and Human Services (EOHHS).