Medicaid eligibility operations services

The South Carolina Department of Health and Human Services (SCDHHS) is soliciting proposals for Medicaid Eligibility Operations Services through Request for Proposal (RFP) #5400021745. The procurement seeks a contractor to provide comprehensive data entry and outbound call center services for Medicaid applications and reviews, with core services including account management, implementation, information security, data entry, and call center operations. Contractors must key documents within five business days of receipt, maintain a 97 percent accuracy rate, and complete outbound calls within five to seven business days depending on application type. The contract requires maintaining operations within South Carolina, with a staffing model currently comprising approximately 32 Customer Service Agents. Evaluation criteria will weight Technical Approach/Implementation at 45 points, Qualifications and References at 30 points, and Total Cost of Ownership at 25 points. Key submission dates include a pre-proposal conference held on December 17, 2021, with questions due by that date, and proposals originally due on March 30, 2022, with an anticipated award date of July 26, 2022. Minimum qualifications mandate at least three years of experience providing Medicaid Eligibility operations services and an Implementation Manager with one year of specific Medicaid eligibility experience.

The solicitation does not explicitly indicate specific set-aside designations for disadvantaged businesses. The incumbent contractor is BlueCross BlueShield of South Carolina (Contract 4400015232), which will be extended to support transition to the successor vendor. The contract provides access to existing systems including OnBase, MMIS, MEDS, and MMS at no cost to the contractor. The total contract value includes a firm fixed price structure with a $750,000 modification pool available throughout the contract term, and the initial contract period spans three years with two optional one-year renewal periods, potentially extending the total contract duration to five years through August 4, 2027. Contractors must maintain comprehensive liability insurance with minimum limits of $1,000,000 per occurrence for general liability and $5,000,000 per occurrence for errors and omissions insurance. Historical data indicates the service manages approximately 1.2 million Medicaid benefit recipients, with monthly application volumes ranging from 7,946 to 20,875 applications historically processed by the current operations team.