Medicaid managed care rate setting/program admin

The West Virginia Department of Human Services, Bureau for Medical Services is requesting proposals for Medicaid managed care rate setting, program administration, and actuarial services under Centralized Request for Proposals (CRFP) 0511 BMS2700000001, with proposals due September 9, 2026 at 1:30 p.m. ET. The vendor question deadline is July 30, 2026. This is a hard-dollar Medicaid state procurement, not a county-level solicitation, though a parallel federal-funds addendum permits county and local entities to participate under separate evaluation.

The scope encompasses nine service categories: lead actuary services (5,000 hours annually), staff actuary services (20,000 hours annually), technical support staff (5,000 hours annually), clerical support staff (5,000 hours annually), managed care program oversight services (fixed annual amount), managed care oversight ad hoc services (5,000 hours annually), actuarial services ad hoc services (5,000 hours annually), financial services (fixed annual amount), and optional rate setting services (fixed annual amount). Subcontracting is permitted for actuarial services only; all other functions must be performed directly by the prime contractor. Vendors must submit a conflict mitigation plan addressing potential organizational conflicts of interest if the same contractor performs both Medical Loss Ratio audits and rate-setting functions. Service level agreement penalties of $500 per day apply for failure to deliver within specified timeframes. Medicaid managed care rate certifications must be submitted 90 days prior to rate effective dates.

The contract runs for a base year plus five optional renewal years. Pricing is structured as hourly rates for staffing services and all-inclusive fixed annual amounts for oversight and financial services, with actual utilization not capped at estimated hours. Contract services are compensiced monthly in arrears, with ad hoc services paid on approved Statements of Work. Reporting obligations are extensive and include quarterly quality submissions, monthly provider directory updates, monthly encounter data, annual financial statements, Medical Loss Ratio reports, and compliance attestations across multiple categories specified in Exhibit C.

Proposals must be submitted in writing to the Department of Administration Purchasing Division, 2019 Washington Street East, Charleston, West Virginia 25305. Online submissions are prohibited. Vendors must acknowledge receipt of all addenda (Addendum 1 and Addendum 2 have been issued) on the Addendum Acknowledgement Form. No pre-bid meeting will be held.