Indiana Medicaid Managed Care Organizations

The Indiana Family and Social Services Administration's Office of Medicaid Policy and Planning is soliciting 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, with proposals due November 6, 2026, and a pre-proposal conference on September 10, 2026. Respondents must demonstrate current MCO service in at least one state and at least five years of prior MCO experience, with a mandatory Buy Indiana Initiative preference offering 5 points and an Indiana Veteran Owned Small Business subcontracting goal of 3 percent (5 points plus 1 bonus point available).

Contractors 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. For PathWays for Aging (serving ~115,000 beneficiaries aged 60+), contractors must obtain NCQA accreditation including the LTSS Distinction and execute a State Medicaid Agency Contract to operate a Dual Eligible SNP effective January 1, 2029. 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. 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 and co-insurance responsibility capped at 20 percent.

Contract value encompasses four programs with state fiscal year 2027 capitation rates: Hoosier Healthwise serves approximately 589,000 low-income children and pregnant women with composite PMPM rates of $305.42 (for-profit) and $304.23 (not-for-profit); Healthy Indiana Plan covers approximately 487,000 adults aged 19–64 with HIP capitation rates ranging from $228.72 to $1,936.56 PMPM plus maternity case rates; Hoosier Care Connect serves approximately 80,000 individuals under age 60 who are blind, disabled, wards, or foster children with composite rates of $1,448.47 PMPM; and PathWays for Aging covers approximately 115,000 seniors aged 60+ with composite rates of $3,468.29 PMPM. Total estimated base capitation across all programs exceeds $4.9 billion for the initial rating period. The contract term is four years with two optional one-year renewals available at the state's discretion, for a potential total of six years.

Evaluation criteria total 90 points (91 with bonus): 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). Contractors are subject to readiness review per 42 CFR 438.66(d)(2) prior to implementation, with assessments across Operations/Administration, Service Delivery, Financial Management, and Systems Management. 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.

Written questions are due September 11, 2026, with responses by October 2; a second round closes October 9, with responses by October 23. Proposal discussions, oral presentations, and Best and Final Offers are anticipated in May 2027, with Award Recommendation in July 2027.