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.
The Center for Medicaid and CHIP Services (CMCS) explained the transition to “Account Transfer 2.0” (AT 2.0) in a CMCS Informational Bulletin (CIB) released on October 10, 2024. The CIB indicates significant federal investment in improving the process of transferring consumer application information between state Medicaid and CHIP agencies and the Marketplace in the states using the federal platform. This expert perspective reviews the CIB and highlights opportunities for states to improve account transfer data under the CIB.
On September 9, the Centers for Medicare & Medicaid Services (CMS) released a new collection of federal Medicaid and CHIP reporting templates designed to assist states in monitoring Mental Health Parity and Addiction Equity Act (MHPAEA) compliance in Medicaid and CHIP. Informal public comment is requested by December 2, 2024. This expert perspective reviews the reporting templates to highlight considerations for states and support the formulation of comment submissions.
On April 2, 2024, the Centers for Medicare & Medicaid Services offered a new option for states to update their essential health benefits (EHB) benchmark plan to require coverage of routine adult dental benefits. While there are multiple drivers of inequities in oral health, a primary barrier to accessing dental services is the cost of care, a barrier that can be reduced with dental insurance. This expert perspective provides an overview of the newly available flexibility and discusses considerations for states weighing whether to add a requirement that plans subject to EHB cover routine adult dental care.
