Managed Health Services.docx

This is a Pre-Proposal Network Opportunities Form submission for RFP 27-88343, managed by Indiana's Family and Social Services Administration Office of Medicaid Policy and Planning, soliciting proposals from managed care organizations to provide statewide risk-based Medicaid services. The RFP seeks MCO partners to serve approximately 1.5 million Hoosiers across four programs: Hoosier Healthwise (serving approximately 589,000 low-income children and pregnant women), Healthy Indiana Plan (approximately 487,000 adults aged 19-64), Hoosier Care Connect (approximately 80,000 individuals under age 60 who are blind, disabled, wards, or foster children), and Indiana PathWays for Aging (approximately 115,000 seniors aged 60+). The pre-proposal conference was scheduled for September 10, 2026, with written questions due September 11, 2026, and responses provided by October 2, 2026. Proposal submissions were due November 6, 2026. The contract term is four years with two optional one-year renewals available, for a potential total of six years. Proposal discussions, oral presentations, and Best and Final Offers are anticipated in May 2027, with Award Recommendation in July 2027.

Respondents must demonstrate current MCO service in at least one state and at least five years of prior MCO experience, and must be Indiana-licensed health maintenance organizations achieving NCQA accreditation by contract start or no later than the end of the second full calendar year of operation. Total estimated base capitation across all programs exceeds $4.9 billion for the initial rating period, with state fiscal year 2027 capitation rates ranging from $305.42 per member per month (PMPM) for Hoosier Healthwise to $3,468.29 PMPM for PathWays for Aging. Evaluation criteria total 90 points (91 with bonus), including Management Assessment and Quality (75 points), Oral Presentations (5 points), Buy Indiana Initiative (5 points), and Indiana Veteran Owned Small Businesses (5 points with 1 bonus point). Contractors must maintain minimum Risk Based Capital ratios of 300 percent per NAIC standards, obtain fidelity bond and professional liability insurance, and purchase commercial reinsurance with attachment points not exceeding $2 million. Compliance performance is tied to a pay-for-outcomes program withholding 1.85-2.25 percent of capitation payments annually from 2029-2034, with estimated recovery of 60-70 percent based on performance against HEDIS and outcome measures.