MO HealthNet Managed Care Program

The Missouri Department of Social Services is soliciting proposals for managed care organizations to deliver comprehensive health services under the MO HealthNet Managed Care Program, with proposals due September 2, 2026. The program operates under a competitive RFP process with multiple contract awards anticipated across geographic regions and population groups throughout Missouri.

The scope encompasses acute care, behavioral health, dental, and long-term care services for MO HealthNet-eligible members across four regional divisions: Western, Eastern, Central, and Southwestern. Eligible populations include Parents and Caretakers under MO HealthNet for Families, MO HealthNet for Children across multiple poverty and funding categories, and the Adult Expansion Group (individuals aged 19–64 at less than 138% of federal poverty level). Estimated monthly enrollment varies by region and fiscal year, with the Adult Expansion Group ranging from approximately 54,527 to 111,279 members across regions. Vendors must establish and document provider networks including Federally Qualified Health Centers, Rural Health Clinics, Community Mental Health Centers, safety-net hospitals, family planning providers, and STI providers with executed contracts or letters of intent. The program includes specialized transportation eligibility determined through a Department of Mental Health decision tree covering substance use treatment, medication-related visits, and psychosocial rehabilitation services.

Contract terms are typically two to three years with renewal options. SFY 2028 capitation rates are established on a per-member-per-month basis, with specialty plan pricing at $847.03 for Category of Aid 4 and $9,588.80 for Category of Aid 4 – General Relief Only across all four regions. Funding combines state general revenue and federal Medicaid matching funds under Title XIX. Awardees must comply with HIPAA Business Associate Agreement requirements, federal nondiscrimination statutes (Title VI, Title VII, Title IX, Section 504, ADA), 2 CFR Part 200 (Uniform Administrative Requirements), the Byrd Anti-Lobbying Amendment, Drug Free Workplace Act, and state Medicaid regulations governing network adequacy, utilization management, quality assurance, and member services. The incumbent status of current managed care organizations is not identified.