Medicaid Managed Care Procurements: A Toolkit for State Medicaid Agencies
Bailit Health
Implementing a statewide, competitive procurement for Medicaid managed care is one of the more important things state purchasers do to improve value. Medicaid managed care contracts have evolved over time to cover more enrollees and services, often making them the largest contracts awarded by states. Medicaid managed care procurements are a powerful tool to advance Medicaid programs, policies, and innovations; however, their size, scope, and intensity can pose significant resource challenges for Medicaid agencies. In addition, because these large, multi-year procurements occur only once or twice a decade, Medicaid leaders and state staff responsible for the procurement may not have experience with a procurement of this nature or size.
This toolkit is designed to help states develop a procurement process focused on improving program performance in specific areas valued by the state. It guides Medicaid agencies through key action steps and considerations in the major phases of the procurement cycle: 1) strategic procurement planning, 2) solicitation development, 3) bid review and selection, 4) contract execution, readiness review and implementation, and 5) contract management.
Initially published in 2017, this 2022 update to the toolkit reflects current procurement best practices and refreshed state examples, drawn in part from a scan of recent Medicaid managed care procurements.
Congress is considering a variety of federal policy changes that will have significant impacts on the Medicaid program, widely expected to reduce enrollment and federal Medicaid funding to states. A variety of state-level estimates have been released, which can be helpful for states as they consider how various policy proposals might impact their Medicaid programs. This expert perspective highlights state agencies that have estimated and quantified the potential impacts of various proposals on enrollment and spending. SHVS will continue to regularly monitor published estimates from states and update this expert perspective.
The budget reconciliation process is continuing to move forward in Congress and includes developing proposals in the House to identify $880 billion in federal savings over the next ten years, the vast majority of which will need to come from Medicaid. To support states in informing and validating their own fiscal and program impact estimates of federal policy changes, Manatt Health has developed, with support and input from State Health and Value Strategies, a new toolkit providing national and state-by-state data on the potential impact of key cuts under consideration in Congress. This expert perspective provides an executive summary of the toolkit and has been updated to include estimates of state-by-state impacts of making work requirements a condition of Medicaid eligibility.
