Medicaid Estate Recovery Program (MERP)

The Texas Health and Human Services Commission (HHSC) is seeking a contractor to manage its Medicaid Estate Recovery Program (MERP), a critical service designed to recover costs of Medicaid long-term care benefits paid on behalf of deceased Medicaid recipients. The Request for Proposals (RFP) solicits a contractor capable of processing approximately 900,000 records monthly, with an average of 2,306 new cases opened each month and 21 cases recovered monthly. Key deliverables include comprehensive estate recovery processes, financial management, and strict compliance with Medicaid regulations while maintaining confidentiality. Minimum qualifications require five years of business experience or demonstrated expertise in Medicaid subrogation services. The evaluation criteria will weight Qualifications and Experience at 30%, Project Work Plan at 25%, Reporting and Data Exchange at 30%, and Cost at 15%. Critical procurement dates include a virtual pre-proposal conference on January 7, 2025, a question submission deadline of January 8, 2025, and proposal submissions due January 30, 2025, at 10:30 AM Central Time. The initial contract term spans three years, with options for two additional one-year renewals and a potential extension year, with an anticipated start date of September 1, 2025.

The procurement includes a mandatory Historically Underutilized Business (HUB) Subcontracting Plan, indicating a commitment to supporting diverse business participation. Vendors must maintain specified insurance coverage and comply with comprehensive data security and privacy requirements through a Data Use Agreement. The contractor will need to integrate with existing state infrastructure, including an automated interface with Texas Vital Statistics for death records. Historical compensation for similar contracts has been approximately $960,000 per fiscal year, though HHSC reserves the right to adjust amounts based on state funding availability. Proposals can be submitted either via USB drives delivered to HHSC's procurement office or through the HHS Online Bid Room system. In the most recent fiscal year (2024), the program processed 222 hardship waivers and closed 2,414 cases without recovery, suggesting a complex operational environment. Respondents must be prepared to handle sensitive financial recovery processes while adhering to strict state guidelines and maintaining comprehensive reporting mechanisms.