Rhode Island Code of Regulations
Title 210 - Executive Office of Health and Human Services
Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults
Subchapter 05 - Service Delivery Options
Part 2 - Medicaid Managed Care Delivery Options
Section 210-RICR-30-05-2.46 - Transitioning Members between MCOs and Delivery Systems

1. Change in MCOs within a delivery system - The transition between Medicaid MCOs may occur as a result of change in MCO during open enrollment or a change that is ordered as part of a grievance resolution. The MCOs have written policies and procedures for transferring relevant patient information, including medical records and other pertinent materials, when transitioning a member to or from another MCO. The MCO must transfer this information at no cost to the member.

2. Change in delivery systems - Medicaid members may be transitioned from one managed care delivery system into another as a result of changes in eligibility status. Adults enrolled in RIte Care who are between the ages of nineteen (19) and sixty-four (64) may be eligible under the MACC group for adults when their dependent children age out of MACC group for children and young adults. Once a RHP member has given birth, both newborn and/or parents may be transitioned to RIte Care if income is within the eligibility thresholds set forth in Medicaid Affordable Care Coverage Groups Overview and Eligibility Pathways (Subchapter 00 Part 1 of this Chapter). Enrollment in MCOs during such transitions will strive to preserve the continuity of care to the full extent feasible. Accordingly, Medicaid members enrolled in a particular MCO subject to a delivery system transition will be enrolled in the same health plan, if participating, in the new delivery system.