RI Medicaid - Health Plan Accreditation

Rhode Island Medicaid has required its Medicaid participating health plans to be accredited by the National Committee for Quality Assurance (NCQA) since the inception of our State’s managed care program in 1994. 

What is NQCA?

The National Committee for Quality Assurance (NCQA) is an organization dedicated to improving health care quality.

NCQA issues an accreditation status based on the health plan’s performance against the rigorous standards and audited HEDIS® and CAHPS® quality measure results. The standards evaluate the health plan’s quality management and improvement, network management, utilization management, credentialing and re-credentialing, member’s rights and responsibilities, member connections, and Medicaid benefits and services. Accreditation is issued at varying levels based on evaluation of the standards. 

How are Rhode Island's health plans rated?

Rhode Island Medicaid’s health plans have consistently been highly rated by NCQA. 

EOHHS has contracts with three (3) Managed Care Organizations (MCOs) and one (1) Prepaid Ambulatory Health Plan (PAHP)

For more information on RI health plans,’ see the 2022 NCQA Report Card results below or links to further information:


What is URAC?

The Utilization Review Accreditation Commission (URAC) is an independent, nonprofit accreditation entity dedicated to improve the quality of health care.

URAC helps facilitate this by providing health care organizations with renowned accreditation and certification programs that set the highest standards in quality and safety. Our standards use evidence-based measures and are developed in collaboration with a wide array of stakeholders, including health plans, providers and associations.