This week, our In Focus section reviews two Medicaid managed care requests for proposals (RFPs) released on January 10, 2020. The District of Columbia Department of Health Care Finance (DHCF) issued an RFP for the DC Healthy Families Program (DCHFP); the District of Columbia Healthcare Alliance Program (Alliance); and the Immigrant Children鈥檚 Program (ICP) as part of a broader effort to fully transition Medicaid to managed care over the next five years. The new contracts will cover approximately 224,000 lives. Meanwhile, the Kentucky Cabinet for Health and Family Services (CHFS), Department for Medicaid Services (DMS) released a statewide Medicaid managed care RFP to serve approximately 1.2 million lives. In December 2019, Kentucky announced that it will cancel and rebid the current Medicaid managed care contracts.
328 Results found.
Texas STAR Kids 鈥� Dallas Service Area RFP
This week, our In Focus section reviews the Texas STAR Kids Medicaid Managed Care in the Dallas Service Area (SA) request for proposals (RFP) released by the Texas Health and Human Services Commission (HHSC) on December 13, 2019. The RFP comes after Children鈥檚 Medical Center, which covers approximately 9,000 members under the program, said it would be leaving the market. The contracts for the SA are worth approximately $500 million. Anthem/Amerigroup will remain in the Dallas SA and continue to provide services. STAR Kids provides Medicaid coverage to individuals with disabilities under age 21.
West Virginia releases Medicaid managed care RFP
This week, our In Focus section reviews the West Virginia Mountain Health Trust request for proposals (RFP) released by the West Virginia Department of Administration (DOA) for the Department for Health and Human Resources (DHHR) on December 17, 2019. Mountain Health Trust (MHT) is the statewide physical and behavioral Medicaid managed care program. West Virginia will award contracts, worth over $1.5 billion, to three managed care organizations (MCOs), with implementation beginning July 1, 2020.
Michigan Medicaid Managed Care Results Announced
In previous editions of The Michigan Update (most recently in August) we have reported on the Michigan Department of Health and Human Services鈥� (MDHHS) release of a Request for Proposals (RFP) to re-procure its Medicaid managed care contracts. The RFP was released in early May with bidder responses due in early August. This procurement is for at least five years, with the possibility of up to three one-year extensions. The total cost of the procurement for five years is estimated to be $35 billion. On October 13, 2015 the State of Michigan announced the much anticipated results of the re-procurement.
Since the prices paid to the contracted HMOs are set by the state, the health plan selection was based solely on technical scores. The HMOs were required to bid on entire regions, which were configured differently than in the past. The reconfiguration required a number of the HMOs to expand their service areas to meet the 鈥渆ntire region鈥� requirement. The new regional configuration appears in the map below:
Note: Region 2 and Region 3 were required to be bid together.
The RFP included a proposed number of HMOs that would be awarded contracts for each of these regions. To minimize disruptions for Medicaid enrollees, in each region (other than the Upper Peninsula) the number of plans selected was one more than the proposed maximum number of awards for that region. Proposals from the HMOs were evaluated based on demonstrated competencies and also statements of their proposed approaches to many new initiatives related to population health, care management, behavioral health integration, patient-centered medical homes, health information technology and payment reform.
Not every HMO was successful in each region for which it submitted a bid. Two plans were not successful in any region. One is Sparrow PHP, which is an incumbent plan in Region 7. The other is MI Complete Health (Centene/Fidelis SecureCare) which is not currently a Medicaid plan in any part of the state but does have an Integrated Care Organization contract to serve dual Medicare/Medicaid enrollees in Macomb and Wayne counties as part of Michigan鈥檚 dual eligible demonstration.
The following table indicates the regions for which each bidding HMO was and was not successful. In addition, the numerical values show the rank of that plan based on their evaluation scores among the successful bidders for each region. If an HMO is a current contractor for all counties in a region, their result is shaded green. If the HMO is a current contractor for some but not all counties in a region, their result is shaded yellow. The number of Medicaid enrollees currently served in each of the regions, eligible through both 鈥渢raditional鈥� Medicaid and the Healthy Michigan Plan, appear in the bottom row on the table; across all regions, this is more than 1.6 million Medicaid enrollees.
Technical Evaluation Results
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Region 1
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Region 2
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Region 3
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Region 4
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Region 5
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Region 6
| Region 6 |
Region 8
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Region 9
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Region 10
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Aetna Better Health
(CoventryCares)
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No
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Yes – 4
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Yes – 4
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Yes – 7
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Blue Cross Complete
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Yes – 3
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Yes – 5
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Yes – 3
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Yes – 3
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Yes – 5
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HAP Midwest Health Plan
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|
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|
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Yes – 6
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No
|
No
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Harbor Health
Plan
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Yes – 8
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McLaren Health
Plan
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Yes – 3
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Yes – 3
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Yes – 4
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Yes – 3
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Yes – 3
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Yes – 2
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Yes – 3
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Yes – 6
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Yes – 4
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Meridian Health Plan of MI
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Yes – 1
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Yes – 4
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Yes – 5
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Yes – 2
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Yes – 4
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No
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Yes – 5
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Yes – 5
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Yes – 3
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MI Complete Health
(Centene/Fidelis)
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No
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No
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Molina Healthcare
of MI
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Yes – 4
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Yes – 1
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Yes – 1
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Yes – 1
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Yes – 2
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Yes – 1
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Yes – 1
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Yes – 1
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Yes – 2
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Priority Health Choice
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No
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No
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