Medicaid Rate Analysis and Reimbursement Services

The Wyoming Department of Administration and Information, General Services Division is requesting proposals for Medicaid rate analysis and reimbursement services on behalf of the Wyoming Department of Health, Division of Healthcare Financing under RFP 0036-N, with proposals due October 5, 2026 at 2:00 p.m. Mountain Time and questions due September 14, 2026.

The scope is comprehensive technical assistance in establishing and analyzing Medicaid reimbursement rates across multiple provider types: ambulance services, care management, disproportionate share hospitals, durable medical equipment, federally qualified health centers, home and community-based services waivers, inpatient and outpatient hospital services, physician and professional services, rural health clinics, and psychiatric residential treatment facilities. Deliverables include rate files, upper payment limit demonstrations, disproportionate share hospital calculations, audit reports for healthcare facilities, research and policy compliance support, external quality review activities for the Care Management Entity, and on-request analytical support for Medicaid initiatives. The contract is structured as a single-contractor engagement.

Proposers must demonstrate at least five years of experience in Medicaid rate setting and analysis across multiple provider types and payment methodologies, along with research and policy compliance capabilities. Responses must include completed mandatory requirements spreadsheets, current financial statements, professional certifications or accreditations, staffing plans with estimated hours by discipline, and detailed quality assurance and project management plans. Cyber liability insurance with minimum limits of $2 million per occurrence and $2 million general aggregate is required. Contractor proposals are binding for 180 days.

The initial contract term is one year with an option to extend for up to five years total subject to mutual approval. Work commencement is anticipated April 1, 2027, with award expected in November 2026. Wyoming Medicaid serves approximately 104,296 eligible individuals annually with approximately 22,256 enrolled service providers. The incumbent contractor has provided these services for twenty years. All submissions must be made through the Public Purchase online bidding system in PDF, Excel, or Microsoft Office format.