This bill aims to address issues with the current Medicaid system in Rhode Island by conducting an audit of the state's managed care entities. The audit will determine if these entities are providing better savings, access, and outcomes compared to a fee-for-service program managed by the state. If the audit concludes that a fee-for-service program would be better, a plan for transitioning to such a program will be developed within two years. Contracts with managed care entities will include terms that allow for the transition, require a medical loss ratio of over 90%, and set penalties for failure to meet contract terms. The attorney general will have the authority to enforce these contractual obligations and other legal requirements through civil and criminal actions.

This bill requires the auditor general to oversee an audit of Medicaid programs administered by managed care organizations. The auditor general must report their findings to the general assembly and the director of the executive office of health and human services within six months. If the audit demonstrates that ending privatized managed care and transitioning to a fee-for-service state-run program would result in savings and better access to healthcare, the director of EOHHS must provide the general assembly with a plan to make this transition within two years. The act would take effect upon passage.