Medicaid and Children’s Health Insurance Program Dental Services

The Texas Health and Human Services Commission is requesting proposals for statewide Medicaid and Children's Health Insurance Program dental services under RFP No. HHS0017108, with proposals due December 7, 2026. The awardee must serve eligible Medicaid and CHIP beneficiaries across all Texas counties and establish HMO licensure from the Texas Department of Insurance within 60 days of contract effective date and URAC accreditation within six months of the Operations Phase start date.

This is a risk-based managed care contract requiring the contractor to establish and maintain a robust provider network of general dentists, pediatric dentists, and dental specialists across all designated dental reporting regions statewide. The contractor must arrange delivery of preventive, diagnostic, restorative, and emergency dental services to Medicaid members from birth through age 20 and CHIP members under age 19. The initial contract term runs from the effective date through June 29, 2034, with potential extensions subject to good faith negotiation, provided total operational term does not exceed eight years. The contractor bears all administrative costs, including claims processing, provider credentialing, member services, quality improvement, and fraud prevention.

Payment is structured on a capitation model with monthly per-member-per-month rates. Historical and projected caseload data indicates Medicaid dental enrollment of approximately 2.9 to 3.0 million members with per-member-per-month costs ranging from $30 to $32.67, and CHIP dental enrollment projected to reach 264,500 members by fiscal 2027 with per-member-per-month costs of $21.70 to $24.67. Anticipated program costs for Medicaid range from $86.4 million to $120 million annually; CHIP costs are projected at $77.1 million by fiscal 2027.

All respondents must submit a completed subcontracting plan and meet a VetHUB (Veteran Heroes United in Business) utilization goal of 26% for subcontracting opportunities, or attest to self-performing the contract. Respondents must provide written notification to a minimum of two certified VetHUB vendors per opportunity with at least seven working days for response. Respondents must also document current Texas Department of Insurance HMO Certificate of Authority status for all 254 counties or provide evidence of pending certification applications.

The evaluation framework consists of 16 technical questions (5 to 15 pages each) across four best value criteria, plus four scenario-based oral presentations scored on a 0–5 scale focusing on provider communication, MCO coordination, preventive care rate improvement, and network adequacy. The contract is contingent upon federal and state appropriations and Centers for Medicare and Medicaid Services approval.