Actuarial Analysis & Consulting

The Illinois Department of Healthcare and Family Services is soliciting proposals for actuarial analysis and consulting services that support Medicaid managed care rate development, with offers due October 22, 2026, a date that passed as of October 28, 2026. The solicitation carries a 4% Business Enterprise Program (BEP) utilization goal for subcontracting with minority-, women-, and disabled-owned businesses. Vendors must submit a completed BEP utilization plan, and a BEP waiver request accompanying the bid is required to render it responsive.

The vendor will review, advise on, and develop actuarially sound rates for Managed Care Organizations serving HealthChoice Illinois, YouthCare, and the Medicare-Medicaid Alignment Initiative, which cover approximately 3.2 million lives (82% of Illinois Medicaid enrollees). Annual rate development spans 54 rate cells in each of five state regions (270 total rate cells), with potential mid-year amendments and semi-annual risk adjustment applications. Required deliverables include annual rate certifications due December 31, waiver reporting due July 31, Medical Loss Ratio and risk pool reconciliation reports, weekly and monthly status reports, and a Transition Plan due within one year of execution. Missed mandatory deliverables place fees at risk. Offerors must demonstrate at least seven years of Title XIX actuarial rate development and state Medicaid agency consultation, performed as prime contractor. The vendor must establish a secured data environment for large claims data volumes, maintain on-call availability during business hours, and make an estimated three on-site trips per contract year at vendor expense. Hosted data must remain within the contiguous United States, encrypted with FIPS 140-compliant AES at a minimum 256-bit key length, and breaches must be reported to the Agency's Chief Privacy Officer within 24 hours. Required SOC 1 and SOC 2 reports follow a set schedule, and the solicitation includes a HIPAA Business Associate Agreement, which names Milliman, Inc. as the business associate.

The initial term is ten years from the date of last signature. Pricing consists of fixed hourly rates by labor category. Rates for Contract Years 1–5 remain firm and unchanged, and rates for Contract Years 6–10 are capped at 4% above Period 1 rates with no further increases. No expenses are allowed, and taxes are excluded unless the vendor provides proof of state tax liability. Offers must remain firm for 180 days from opening. Services must be performed in the United States unless otherwise disclosed.

Evaluation consists of three independently scored components: technical requirements (1,000 points), commitment to diversity (200 points), and pricing (240 points), for a total of 1,440 points. Offerors must achieve at least 840 combined technical and diversity points to advance to price evaluation.

Questions were due October 9, 2026, and a non-mandatory pre-submission conference is held via Webex. Offers are submitted electronically through BidBuy. Bid Amendment #1 clarifies that the Project Portfolio described in Section F.3.4.1 must demonstrate the seven-year experience required under Section F.3.4, and it changes the cross-reference in Section F.3.4.1.1 from Section F.2.1 to Section F.3.4.