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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. The highest accreditation status issued is “Excellent,” followed by “Commendable,” “Accredited,” “Provisional,” “Interim,” then “Denied.”

How are Rhode Island's health plans rated?

Rhode Island Medicaid’s health plans have consistently been highly rated by NCQA. Both Neighborhood Health Plan of RI and United Healthcare Community Plan have an overall accreditation of “Excellent.”  Tufts Health Plan, RI Together, is new to Rhode Island and does not yet have accreditation. United Healthcare Dental is not yet accredited. For more information on RI health plans,’ see the 2018 NCQA Report Card results below or links to further information:

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