RoBailey Consulting.pdf

This is a Pre-Proposal Network Opportunities Form submitted by RoBailey Consulting, LLC to the Indiana Family and Social Services Administration's Office of Medicaid Policy and Planning in response to Request for Proposal 27-88343 for Indiana Medicaid Managed Care Organizations. The RFP seeks proposals from managed care organizations to provide statewide risk-based Medicaid services across four programs—Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging—collectively serving approximately 1.5 million Hoosiers. A pre-proposal conference is scheduled for September 10, 2026, with written questions due September 11, 2026, and proposals due November 6, 2026. The contract term is four years with two optional one-year renewals available, potentially extending to six years total. Evaluation criteria total 91 points and include Adherence to Mandatory Requirements (Pass/Fail), 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). 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.

The total estimated base capitation across all programs exceeds $4.9 billion for the initial rating period, with fiscal year 2027 rates varying by program: Hoosier Healthwise serves approximately 589,000 beneficiaries with composite PMPM rates of $305.42 (for-profit) and $304.23 (not-for-profit); Healthy Indiana Plan covers approximately 487,000 adults with HIP capitation rates ranging from $228.72 to $1,936.56 PMPM; Hoosier Care Connect serves approximately 80,000 individuals with composite rates of $1,448.47 PMPM; and PathWays for Aging covers approximately 115,000 seniors with composite rates of $3,468.29 PMPM. 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. Administrative offices must be located within five miles of the Indiana Government Center in Indianapolis with key personnel residing in Indiana and performing the majority of work on-site. A mandatory Buy Indiana Initiative preference offers 5 points, and an Indiana Veteran Owned Small Business subcontracting goal of 3 percent is available for 5 points plus 1 bonus point. 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.