ATTACHMENT J_S-DASOBO-00010624_Project Timeline-Enrollment Baseline (1).docx
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- Attached to
- Oregon State Based Insurance Marketplace Solution State and local contract opportunity
- Solicitation number
- S-DASOBO-00010624
- Issued by
- Marion County, Oregon
About this file
This document is an attachment to a Request for Proposal (RFP) issued by the Oregon Department of Administrative Services (DAS) on behalf of the Oregon Health Authority (OHA) for a State-Based Insurance Marketplace (SBM) Solution Platform and related Customer Assistance Center. The State is seeking a coordinated eligibility solution that can estimate consumer Medicaid eligibility and transfer accounts to the Medicaid system. The solution must be cloud-based, support multi-tenancy capabilities, and integrate with Oregon's Medicaid health plan systems. The target plan year for full SBM operations is 2027, with key milestones including implementation planning by March 2025, securing CMS authority by June 2026, platform operational readiness by July 2026, customer assistance center operational readiness by September 2026, and open enrollment go-live by November 2026. The RFP provides background on the current enrollment baseline, including 183,319 individuals applying for coverage in 2023, with 165,241 determined eligible for marketplace plans and 20,391 determined or assessed eligible for Medicaid/CHIP.
The State reserves the right to renegotiate pricing for contract years beyond the initial term if the number of enrollees or call volumes decrease significantly from the previous year's peak. Funding information and sources are not provided in the document.
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RFP ATTACHMENT J
solution model-project timeline-enrollment baseline Solution Model.
The State is interested in a coordinated eligibility Solution whereby the Platform can, in addition to qualified health plan (“QHP”) determination, estimate a consumer’s Medicaid eligibility and, as appropriate, transfer that consumer’s account to the Medicaid system for Medicaid/Children's Health Insurance Program determination and potential processing. An integrated eligibility solution, a platform that can directly determine and process both QHP and Medicaid programs, is not envisioned for the State at this time.
The Solution must connect to other State systems. At a minimum, the Solution must integrate with Oregon Medicaid health plan systems (e.g., ONE Eligibility system).
The Platform must be implemented using cloud technology and support multi-tenancy capabilities, such as Software-as-a-Service (“SaaS") or hosted Commercial-off-the-Shelf ("COTS"). For the purposes of this RFP, SaaS refers to a subscription-based services model, and COTS refers to packaged or canned software that can be configured to the needs of the State. Deployment options may include a Contractor- or third party hosted cloud solution; the State will not accept an on-Agency-premises Solution. The Solution must be configurable to meet current Agency specific requirements and future enhancements.
The State is not interested in Enhanced Direct Enrollment (“EDE”), a “version of direct enrollment that allows consumers to apply for and enroll in individual health insurance coverage though the Federally Facilitated Marketplace (FFM) and State-based Marketplaces that use the Federal Platform (SBM-FPs) without visiting HealthCare.gov.”
(https://www.agentbrokerfaq.cms.gov/s/article/What-is-Enhanced-Direct-Enrollment-EDE) Project Timeline.
The target plan year for full SBM Operations is 2027, meaning consumers may use the Solution for open enrollment in QHPs beginning November 1, 2026, for effective coverage beginning January 1, 2027.
All Proposals must consider optimal integration of Platform CAC of the Solution, with several firm dates, including:
1) On or before March 15, 2025 – Begin implementation planning
2) On or before June 01, 2026 – Secure CMS authority to operate
3) On or before July 1, 2026: Platform Operational Readiness – Fully operational enrollment Platform
4) On or before September 1, 2026: CAC Operational Readiness – Full operational CAC
5) On or before November 01, 2026: Open Enrollment Go-Live – QHP open enrollment begins Following is the anticipated timeline for the entire SBM Project consisting of both scopes of service.
Enrollment Baseline.
As background to assist Proposers with the scale of the anticipated Solution, the tables below provide application and enrollment information for Plan Year 2023.
Table 1: Plan Year 2023 Applications for QHP Coverage
| Individuals Applying for Coverage on Submitted Applications |
| Individuals Determined Eligible to Enroll in a Marketplace Plan |
| Individuals Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace |
| 183,319 |
| 165,241 |
| 20,391 |
Table 2: Plan Year 2023 Plan Selections
| Total Number of Consumers Who Have Selected a Marketplace Plan |
| New Consumers |
| Total |
Re-enrollees Active Re-enrollees Automatic Re-enrollees
| 145,509 |
| 29,960 |
| 115,549 |
| 83,751 |
| 31,798 |
The State reserves the right to renegotiate pricing for Contract years beyond the initial term, including if the number of enrollees reach a point 20% lower than the peak from the prior year, or call volumes are determined to be 15% lower after a full quarter than they were for the same quarter in the prior year.
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