Sole Source Justification Form

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Bulletin Reference Number 26-478HFS-DIREC-B-51894

Requesting Agency/University Illinois Department of Healthcare and Family Services

Sole Source Justification Form - Part I Section I - General Information

Department/Bureau/Section: Bureau of Professional and Ancillary Services (2027-22-001)

Need Identified Date: Mar 1, 2026 Supply/Service Need By Date: Jul 1, 2026

Project Title: Dental Program of the Illinois Medical Assistance Program (MAP)

Vendor: DentaQuest of Illinois, LLC, d/b/a DentaQuest

Provide a description of the supplies or services required:

The Illinois Department of Healthcare and Family Services (HFS) is seeking to enter into a sole economically feasible source contract with DentaQuest of Illinois, LLC, d/b/a DentaQuest for one year to maintain the Dental Program of the Illinois Medical Assistance Program (MAP) to continue to provide administrative, customer and provider support to operate the Dental Program and ensure transition services. The administrative support improves access to dental care, leading to improved oral health outcomes by prevention of dental disease, which in turn leads to cost savings for the State.

Additionally, the services this vendor provides helps HFS meet federal mandates of the Early and Periodic Screening, Diagnosis and Treatment program (EPSDT). The vendor must comply with the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA or Public Law 111-3), which reduces the time it takes to process clean claims and requires reporting of provider database to the federal Insure Kids Now website.

Value: Estimated Value of Initial Term, this Change Order or Amendment: 45,000,000

Will this Sole Source amend a Professional or Artistic Services contract? Yes No

*Sole Source may not be used for amendments for Professional or Artistic Services if the amendment would increase the value by more than 5% of the initial award or extend the term by more than 60 days.

Type: New Sole Economically Feasible Source

Section II - Proposed Term

One-Time Purchase Term Contract

Estimated Contract Begin Date: Jul 1, 2026

Estimated Contract End Date: Jun 30, 2027

Number of Potential Renewals:

Length of Each Renewal in Months:

Total Value of All Renewals:

If a Term Contract, does the term, including renewals, exceed 12 months? Yes No

Section III - Funding Source Select the type of funding to be used (Check all that apply): State Appropriate Funds Federal Funds Other (Explain):

Section IV - Sole Source Justification

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Bulletin Reference Number 26-478HFS-DIREC-B-51894

Requesting Agency/University Illinois Department of Healthcare and Family Services

This purchase is economically only available from a single source primarily because it is: (If "Other" explain in one sentence)

Compatibility of Equipment, Accessories, Replacement Parts or Service

Are there secondary justification(s) for this sole source? Yes No

Another justification that this purchase is only available from a sole source is because it is:

Other: Federal Compliance

Another justification that this purchase is only available from a sole source is because it is:

Section V - Purchase History

Has the Agency or University Purchased these supplies or services in the past? Yes No

Term Term From Term To Value Description Contract Number Type

1 Dec 31, 2014 6/30/2019 335,312,000 Administrative Fees and Dental Services 2013-38-001 RFP

2 July 1, 2019 June 30, 2020 55,000,000 Administrative Fees and Dental Services 2013-38-001-2 Renewal

3 July 1, 2020 June 30, 2021 55,000,000 Administrative Fees and Dental Services 2013-38-001-3 Renewal

4 July 1, 2021 June 30, 2022 55,000,000 Administrative Fees and Dental Services 2013-38-001-4 Renewal

5 July 1, 2022 June 30, 2023 45,000,000 Administrative Fees and Dental Services 2013-38-001-5 Amendment

6 July 1, 2023 Sep 28, 2023 12,044,400 Administrative Fees and Dental Services 2024-22-002 Emergency

7 Sep 29, 2023 Jun 30, 2024 108,399,600 Administrative Fees and Dental Services 2024-22-002-2 Emergency Extension

8 Jun 10, 2024 Jun 30, 2024 11,000,000 Administrative Fees and Dental Services 2024-22-002-3 Amendment

9 July 1, 2024 Dec 31, 2024 24,000,000 Administrative Fees and Dental Services 2024-22-002-4 Emergency Extension

10 Jan 1, 2025 June 30, 2025 26,500,000 Administrative Fees and Dental Services 2024-22-002-5 Emergency Extension

If more than 10, or if other comments, explain:

July 1, 2025-June 30, 2026 $53,000,000 Administrative Fees and Dental Services- 2026-22-001 Sole Source

Section VI - Business Rationale

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Bulletin Reference Number 26-478HFS-DIREC-B-51894

Requesting Agency/University Illinois Department of Healthcare and Family Services

1. Provide a detailed explanation of the need for the supplies or services:

The Illinois Department of Healthcare and Family Services (HFS) is seeking to enter into a sole economically feasible sole source contract with DentaQuest of Illinois, LLC, d/b/a DentaQuest to maintain the Dental Program of the Illinois Medical Assistance Program (MAP) to continue administration of its Dental Program for customers in the MAP receiving fee-for-service (FFS) dental benefit. The sole economically feasible sole source contract will prevent and minimize serious disruption in critical State services that affect health and safety until the competitive procurement is completed.

The scope of required services includes, but is not limited to provider network management, claims processing, prior authorization review, customer service/call center operations, care coordination, and compliance with federal Medicaid requirements. These functions must operate continuously without interruption to ensure beneficiaries maintain access to care and providers receive timely reimbursement.

This sole economically feasible source contract will allow the completion of the competitive procurement and ensure a transition of services. A request for Proposal was issued January 30, 2025 with a due date of March 26, 2026.

HFS is currently conducting a competitive procurement to select a long-term vendor for these services. Transitioning to a new vendor, will require a minimum of 180 business days to cover critical tasks such as system integrations, staff on-boarding, training, claims reimbursement , and ensuring seamless service alignment. Without a vendor in place, HFS would be unable to meet federal mandates for providing Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) dental services. The continuation of this contract ensures uninterrupted access to vital dental care services.

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Bulletin Reference Number 26-478HFS-DIREC-B-51894

Requesting Agency/University Illinois Department of Healthcare and Family Services

2. Provide a list and describe in detail the specifications required to satisfy the need:

The vendor’s responsibilities will include at a minimum the following:

Customers who receive services on a fee-or-service (FFS) basis including ensuring that a customer receives necessary covered dental services; referring customers for dental care to those providers willing to accept customers in their practice; assisting customers with appointment assistance, monitoring access to care and ensuring that Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) participation for oral health increases; referring customers for transportation services to and from dental appointments; acting as prior approval agent; education and outreach, appeals, and adjudicating MAP claims. Vendor must also provide assistance and outreach to enrolled dental providers, including provider enrollment assistance, provider appeals, etc.

Call Centers- The Vendor shall maintain a Call Center dedicated to this contract, having separate toll-free numbers for Illinois customers and providers serving Illinois customers.

Claims Adjudication - The Vendor shall maintain a secure data system to process and pay all claims in accordance with 89 111. Admin.

Code 140 and Department policies and procedures.

Customer Outreach - The Vendor shall perform telephonic and written outreach in a language that is appropriate for the family, at a minimum in English or Spanish, and shall have access to language translator resources for communication to families who speak another language.

Educational Materials for Customers and Providers- The Vendor shall create and communicate both written and oral educational materials for a diverse customer population.

Data Systems and Security- The Vendor shall interface with HFS' data system for the exchange of information, including but not limited to, sending and retrieving all file transmissions in a secure electronic format.

Prior approval -Vendor shall establish step-by-step procedures to intake and adjudicate Prior Approval requests, considering customer eligibility, customer special healthcare needs, covered services, provider availability, and appropriate level of service.

• Quality Assurance Program – The vendor shall maintain a comprehensive Quality Assurance Program that monitors service delivery, identifies performance gaps, and implements corrective actions to ensure compliance with contractual and clinical standards.

Utilization Review Plan – The vendor shall develop a comprehensive Utilization Review Plan specific to HFS Fee For Service Dental program that ensures services rendered are medically necessary, appropriate, and cost-effective.

Peer Review Plan – The vendor shall operate a Peer Review Plan that facilitates clinical oversight by licensed dental professionals.

Quality Metrics and Outcomes – The vendor shall track, report, and improve performance based on established quality metrics tied to access, service timeliness, and oral health outcomes.

Provider Retention and Recruitment – The vendor shall maintain strategies to retain existing dental providers and actively recruit new providers to ensure an adequate network.

All Kids School-Based Dental Program – The vendor shall support and facilitate the All Kids School-Based Dental Program by coordinating on-site services, outreach, and reporting.

InsureKids Now Website – The vendor shall comply with federal requirements by regularly updating the provider directory on the InsureKidsNow website.

Transition at the end of the contract – The vendor shall support a structured transition process at the end of the contract to prevent service disruptions. The transition will require a minimum of 180 business days to cover critical tasks such as system integrations, staff on-boarding, training, claims reimbursement, and ensuring seamless service alignment and a180 day run-out period for processing claims. Vendor shall process any claim or claim decision appeal submitted by a Provider that has a service date prior to the cutover date to the incoming Vendor and is within one hundred eighty (180) days from the service date.

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Bulletin Reference Number 26-478HFS-DIREC-B-51894

Requesting Agency/University Illinois Department of Healthcare and Family Services

3. Provide detail explaining the justification selected in Section IV to explain why the requested supplies or services are the only ones available that can satisfy the agency or university requirements?

The State requires the continued provision of Medicaid dental program services, including claims processing, prior authorization, provider network administration, encounter data reporting, customer service operations, and compliance with federal EPSDT requirements, during the ongoing competitive procurement and transition period.

These services must remain uninterrupted to ensure continuity of care, timely adjudication and payment of claims, maintenance of provider participation, and compliance with federal requirements and associated funding. These services rely on existing system integrations and operational processes that support core program functions, which would require significant time to replicate or transition.

Transition Requirements: Transitioning these services to a different vendor would require the development, testing, and certification of new system interfaces; rebuilding and credentialing of the provider network; migration of historical and active claims data; and implementation of customer service and care coordination functions. Based on prior procurements and industry standards, this transition require a minimum of 180 business days.

The Contract further requires continuity of operations during transition, including the 180 day run-out period of processing claims and fulfillment of all program obligations, reinforcing that these services must remain in place until transition is complete.

Due to the time required to complete the competitive solicitation and transition to a new vendor, these services cannot be feasibly provided by an alternative source within the required timeframe without risk of disruption to services, claims payment, provider access, and federal compliance.

4. What are the unique features of the supplies or services that are not available in any other product or by any other vendor? Provide specific quantifiable factors/qualifications:

Approving the sole economically feasible source is essential to maintaining continuity of critical public health services and preventing immediate service gaps or long-term disruptions in Illinois’ oral healthcare infrastructure while the competitive procurement is completed. This approval will also ensure adequate transition services and provide a run-out period to finalize outstanding claims and fulfill any remaining obligations specified in the agreement.

Without a contracted dental administrator, children and other at-risk populations could go without necessary dental care, increasing the likelihood of serious medical complications. The loss of referral support, appointment scheduling assistance, and other care-coordination functions would create significant access barriers for Medicaid enrollees, particularly those in low-income or rural communities. Disruptions in claims adjudication would result in unpaid providers, potentially destabilizing the Medicaid dental network and further limiting access to care.

The State could also face federal enforcement actions for failing to meet EPSDT requirements, jeopardizing essential health and safety protections for thousands of Illinoisans.

5. Has the Agency or University considered alternative supplies or services to satisfy their need? Yes No

5a. If no, why weren't alternatives evaluated?

HFS has issued a request for proposal with a due date of 3/26/26. To ensure uninterrupted services and timely claims payments, all current services must remain in place throughout the competitive procurement process and continue through any subsequent transition period."

No other vendor is currently positioned with the required infrastructure, provider relationships, and system access to ensure uninterrupted service.

A rushed, unplanned transition to a new vendor without the required 180 business day would likely cause system integration failures, claim processing delays, and service interruptions. These disruptions could lead to financial penalties, duplicated administrative costs, and a breakdown in both customer and provider support infrastructure.

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Bulletin Reference Number 26-478HFS-DIREC-B-51894

Requesting Agency/University Illinois Department of Healthcare and Family Services

6. Are there resellers or distributors?

Yes No N/A

7. What efforts were made to get the best possible price (i.e. did the agency/university negotiate) and how did you determine the price for this purchase is considered fair and reasonable?

The estimated cost of $45,000,000 is based a Per Member Per Month (PMPM) rate of $0.70. HFS estimates $8.5 million for the administrative PMPM costs (Number of enrollees per month X $0.70) and $36.5 million for claim reimbursement.

DentaQuest's administrative rate has been held at $0.66 PMPM since July 1, 2023. The proposed 6% adjustment is slightly below the general rate of inflation 6.6% cumulatively. The proposed rate adjustment is conservative and consistent with independently verifiable, federally published cost trends.

8. Will this purchase obligate the State to this vendor for future purchases such as maintenance, licensing or continuing need?

Yes No

9. What will be the financial or other impact to the State if this sole source is not approved and a competitive bid is required?

Failure to approve the sole economically feasible source contract would put HFS out of compliance with federal law. The dental administrator is essential for processing claims, conducting outreach, and maintaining provider relations. Without this contract, HFS could not deliver federally mandated EPSDT dental services.

Loss of the contract would immediately disrupt dental benefits for thousands of fee-for-service enrollees. Without a vendor to manage claims, referrals, and prior authorizations, beneficiaries would lose access to necessary oral healthcare, risking worsening health outcomes and higher long-term costs.

An unplanned transition without a minimum of 180-business day period would likely cause system failures, delayed payments, service interruptions, and increased administrative expenses. Providers might stop participating due to unpaid claims, collapsing the Medicaid dental network and further limiting access—especially for low-income and rural communities.

The State could also face federal enforcement actions for failing to meet EPSDT requirements. Approving the sole economically feasible source contract ensures continuity of essential dental services, protects vulnerable populations, and prevents serious public health and operational risks.

10. Is there any additional information you would like to add to justify this sole source?

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Bulletin Reference Number 26-478HFS-DIREC-B-51894

Requesting Agency/University Illinois Department of Healthcare and Family Services

Section VII

Requesting Department Representative

Requesting Department Signature Required

I know and understand the contents of this Sole Source Justification and attest that all statements are true and correct and the fairness and reasonableness of the price was adequately confirmed.

Date Apr 8, 2026

Printed Name Jose Jimenez E-mail Address jose.jimenez@illinois.gov

Phone Number 2175575777

State Agency Bureau/Division Head or University Purchasing Director Approval and Signature Required

I know and understand the contents of this Sole Source Justification and attest that all statements are true and correct and the fairness and reasonableness of the price was adequately confirmed. (All prior form fields will lock once this e-signature is completed)

E-mail Address Monique.n.wantland@illinois.gov

Phone Number 217.577.5777 Date Apr 8, 2026

Printed Name Monique Wantland

Agency Bureau/Division Head or University Purchasing Director and Not a Designee

SPO Approval and Signature Required

I have reviewed and understand the contents of this Sole Source Justification and agree with the State Agency or University determination.

I have reviewed and understand the contents of this Sole Source Justification and do not agree with the State Agency or University determination. As a result, the State Agency or University must explore other sourcing methods to satisfy their need.

State Purchasing Officer Signature Phone Number 217-993-1719 Date Apr 8, 2026

Printed Name Jennifer Klein E-mail Address jennifer.klein@illinois.gov

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Bulletin Reference Number 26-478HFS-DIREC-B-51894

Requesting Agency/University Illinois Department of Healthcare and Family Services

Sole Source Justification Form - Part II Section I - General Information

Project Title Dental Program of the Illinois Medical Assistance Program (MAP)

Vendor DentaQuest of Illinois, LLC, d/b/a DentaQuest

Initial Date of Procurement Bulletin Posting Apr 8, 2026

Was a Sole Source hearing held per 30 ILCS 500/20-25?

Yes - Complete Section II and III below (Section II will only be visible when this option is selected)

No - Section II not required, go to Section III below Section III - CPO Approval and Signature Required

Based on my review, I authorize the Agency/University to proceed in accordance with the published Notice referenced above.

Based upon my review, I authorize the Agency/University to proceed with the following Changes.

Based on my review, the Agency/University is not authorized to proceed with this sole source as presented and my recommendation is that it be cancelled.

Other

CPO Signature CPO Phone 217-662-1857

Printed Name Ellen H. Daley Date

CPO E-mail ellen.h.daley@illinois.gov

Version 7.01 Page of Sole Source Justification Form - Part I Section I - General Information Will this Sole Source amend a Professional or Artistic Services contract?

If yes, what was the original contract value?

*Sole Source may not be used for amendments for Professional or Artistic Services if the amendment would increase the value by more than 5% of the initial award or extend the term by more than 60 days.

Section II - Proposed Term If a Term Contract, does the term, including renewals, exceed 12 months?

If yes, provide a detailed justification including any economic benefit received for agreeing to a multi-year term:

Section III - Funding Source Select the type of funding to be used (Check all that apply):

Section IV - Sole Source Justification Are there secondary justification(s) for this sole source?

Section V - Purchase History Has the Agency or University Purchased these supplies or services in the past?

Term Term From Term To Value Description Contract Number Type Section VI - Business Rationale

1. Provide a detailed explanation of the need for the supplies or services:

2. Provide a list and describe in detail the specifications required to satisfy the need:

3. Provide detail explaining the justification selected in Section IV to explain why the requested supplies or services are the only ones available that can satisfy the agency or university requirements?

4. What are the unique features of the supplies or services that are not available in any other product or by any other vendor? Provide specific quantifiable factors/qualifications:

5. Has the Agency or University considered alternative supplies or services to satisfy their need?

5a. If yes, name the alternative vendors whose supplies or services were evaluated:

5b. If yes, what were the alternatives for each vendor and why were they unacceptable? Be specific with regard to features, characteristics, requirements, capabilities and compatibility:

5c. Explain how the market evaluation was conducted?

*This evaluation is to determine available options within a market. If the evaluation is to determine quality or best suited option, this is not the appropriate source selection. Under no circumstances shall the evaluation consist of testing alternative options. These activities must be conducted in a competitive transparent environment (i.e. IFB or RFP).

5a. If no, why weren't alternatives evaluated?

6. Are there resellers or distributors?

7. What efforts were made to get the best possible price (i.e. did the agency/university negotiate) and how did you determine the price for this purchase is considered fair and reasonable?

8. Will this purchase obligate the State to this vendor for future purchases such as maintenance, licensing or continuing need?

8a. If yes, please provide details regarding future obligations and/or needs:

9. What will be the financial or other impact to the State if this sole source is not approved and a competitive bid is required?

10. Is there any additional information you would like to add to justify this sole source?

Section VII Requesting Department Signature Required I know and understand the contents of this Sole Source Justification and attest that all statements are true and correct and the fairness and reasonableness of the price was adequately confirmed.

State Agency Bureau/Division Head or University Purchasing Director Approval and Signature Required I know and understand the contents of this Sole Source Justification and attest that all statements are true and correct and the fairness and reasonableness of the price was adequately confirmed. (All prior form fields will lock once this e-signature is completed) SPO Approval and Signature Required Sole Source Justification Form - Part II Section I - General Information Was a Sole Source hearing held per 30 ILCS 500/20-25?

Section II - Sole Source Hearing Details The State posted to the Illinois Procurement Bulletin a description of the State's need, the justification for the sole source decision, and information regarding the opportunity to submit comments and testify at a public hearing. Notice of the hearing was also posted outside of the hearing room 48 hours prior to the hearing.

The public hearing was conducted for the purpose of receiving testimony regarding the sole source determination. The Hearing Officer recommends the following:

The following relevant documents are attached:

Section III - CPO Approval and Signature Required 9.0.0.2.20101008.1.734229 ellen.h.daley@illinois.gov

The scope of required services includes, but is not limited to provider network management, claims processing, prior authorization review, customer service/call center operations, care coordination, and compliance with federal Medicaid requirements. These functions must operate continuously without interruption to ensure beneficiaries maintain access to care and providers receive timely reimbursement.

This sole economically feasible source contract will allow the completion of the competitive procurement and ensure a transition of services. A request for Proposal was issued January 30, 2025 with a due date of March 26, 2026.

HFS is currently conducting a competitive procurement to select a long-term vendor for these services. Transitioning to a new vendor, will require a minimum of 180 business days to cover critical tasks such as system integrations, staff on-boarding, training, claims reimbursement , and ensuring seamless service alignment. Without a vendor in place, HFS would be unable to meet federal mandates for providing Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) dental services. The continuation of this contract ensures uninterrupted access to vital dental care services.

Q2Answer: The vendor’s responsibilities will include at a minimum the following:

Customers who receive services on a fee-or-service (FFS) basis including ensuring that a customer receives necessary covered dental services; referring customers for dental care to those providers willing to accept customers in their practice; assisting customers with appointment assistance, monitoring access to care and ensuring that Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) participation for oral health increases; referring customers for transportation services to and from dental appointments; acting as prior approval agent; education and outreach, appeals, and adjudicating MAP claims. Vendor must also provide assistance and outreach to enrolled dental providers, including provider enrollment assistance, provider appeals, etc.

Call Centers- The Vendor shall maintain a Call Center dedicated to this contract, having separate toll-free numbers for Illinois customers and providers serving Illinois customers.

Claims Adjudication - The Vendor shall maintain a secure data system to process and pay all claims in accordance with 89 111. Admin. Code 140 and Department policies and procedures.

Customer Outreach - The Vendor shall perform telephonic and written outreach in a language that is appropriate for the family, at a minimum in English or Spanish, and shall have access to language translator resources for communication to families who speak another language.

Educational Materials for Customers and Providers- The Vendor shall create and communicate both written and oral educational materials for a diverse customer population.

Data Systems and Security- The Vendor shall interface with HFS' data system for the exchange of information, including but not limited to, sending and retrieving all file transmissions in a secure electronic format.

Prior approval -Vendor shall establish step-by-step procedures to intake and adjudicate Prior Approval requests, considering customer eligibility, customer special healthcare needs, covered services, provider availability, and appropriate level of service.

• Quality Assurance Program – The vendor shall maintain a comprehensive Quality Assurance Program that monitors service delivery, identifies performance gaps, and implements corrective actions to ensure compliance with contractual and clinical standards.

Utilization Review Plan – The vendor shall develop a comprehensive Utilization Review Plan specific to HFS Fee For Service Dental program that ensures services rendered are medically necessary, appropriate, and cost-effective.

Peer Review Plan – The vendor shall operate a Peer Review Plan that facilitates clinical oversight by licensed dental professionals.

Quality Metrics and Outcomes – The vendor shall track, report, and improve performance based on established quality metrics tied to access, service timeliness, and oral health outcomes.

Provider Retention and Recruitment – The vendor shall maintain strategies to retain existing dental providers and actively recruit new providers to ensure an adequate network.

All Kids School-Based Dental Program – The vendor shall support and facilitate the All Kids School-Based Dental Program by coordinating on-site services, outreach, and reporting.

InsureKids Now Website – The vendor shall comply with federal requirements by regularly updating the provider directory on the InsureKidsNow website.

Transition at the end of the contract – The vendor shall support a structured transition process at the end of the contract to prevent service disruptions. The transition will require a minimum of 180 business days to cover critical tasks such as system integrations, staff on-boarding, training, claims reimbursement, and ensuring seamless service alignment and a180 day run-out period for processing claims. Vendor shall process any claim or claim decision appeal submitted by a Provider that has a service date prior to the cutover date to the incoming Vendor and is within one hundred eighty (180) days from the service date.

Q3Answer: The State requires the continued provision of Medicaid dental program services, including claims processing, prior authorization, provider network administration, encounter data reporting, customer service operations, and compliance with federal EPSDT requirements, during the ongoing competitive procurement and transition period.

These services must remain uninterrupted to ensure continuity of care, timely adjudication and payment of claims, maintenance of provider participation, and compliance with federal requirements and associated funding. These services rely on existing system integrations and operational processes that support core program functions, which would require significant time to replicate or transition.

Transition Requirements: Transitioning these services to a different vendor would require the development, testing, and certification of new system interfaces; rebuilding and credentialing of the provider network; migration of historical and active claims data; and implementation of customer service and care coordination functions. Based on prior procurements and industry standards, this transition require a minimum of 180 business days.

The Contract further requires continuity of operations during transition, including the 180 day run-out period of processing claims and fulfillment of all program obligations, reinforcing that these services must remain in place until transition is complete.

Due to the time required to complete the competitive solicitation and transition to a new vendor, these services cannot be feasibly provided by an alternative source within the required timeframe without risk of disruption to services, claims payment, provider access, and federal compliance.

Q4Answer: Approving the sole economically feasible source is essential to maintaining continuity of critical public health services and preventing immediate service gaps or long‑term disruptions in Illinois’ oral healthcare infrastructure while the competitive procurement is completed. This approval will also ensure adequate transition services and provide a run‑out period to finalize outstanding claims and fulfill any remaining obligations specified in the agreement.

Without a contracted dental administrator, children and other at‑risk populations could go without necessary dental care, increasing the likelihood of serious medical complications. The loss of referral support, appointment scheduling assistance, and other care‑coordination functions would create significant access barriers for Medicaid enrollees, particularly those in low‑income or rural communities. Disruptions in claims adjudication would result in unpaid providers, potentially destabilizing the Medicaid dental network and further limiting access to care.

The State could also face federal enforcement actions for failing to meet EPSDT requirements, jeopardizing essential health and safety protections for thousands of Illinoisans.

No other vendor is currently positioned with the required infrastructure, provider relationships, and system access to ensure uninterrupted service.

A rushed, unplanned transition to a new vendor without the required 180 business day would likely cause system integration failures, claim processing delays, and service interruptions. These disruptions could lead to financial penalties, duplicated administrative costs, and a breakdown in both customer and provider support infrastructure.

DentaQuest's administrative rate has been held at $0.66 PMPM since July 1, 2023. The proposed 6% adjustment is slightly below the general rate of inflation 6.6% cumulatively. The proposed rate adjustment is conservative and consistent with independently verifiable, federally published cost trends.

Loss of the contract would immediately disrupt dental benefits for thousands of fee‑for‑service enrollees. Without a vendor to manage claims, referrals, and prior authorizations, beneficiaries would lose access to necessary oral healthcare, risking worsening health outcomes and higher long‑term costs.

An unplanned transition without a minimum of 180‑business day period would likely cause system failures, delayed payments, service interruptions, and increased administrative expenses. Providers might stop participating due to unpaid claims, collapsing the Medicaid dental network and further limiting access—especially for low‑income and rural communities.

The State could also face federal enforcement actions for failing to meet EPSDT requirements. Approving the sole economically feasible source contract ensures continuity of essential dental services, protects vulnerable populations, and prevents serious public health and operational risks.