MO HealthNet Managed Care Program

The Missouri Department of Social Services is requesting proposals for the MO HealthNet Managed Care Program to provide statewide managed care medical services across four designated regions (Central, Eastern, Southwestern, and Western), with proposals due September 2, 2026 at 2:00 PM Central Time. A pre-proposal teleconference is scheduled for July 21, 2026 at 9:00 AM Central Time.

The scope encompasses both a General Plan and a Specialty Plan providing comprehensive managed care to eligible Medicaid and CHIP populations including parents, caretakers, children, pregnant women, adult expansion groups, foster care children, and adoption subsidy recipients. Proposers must demonstrate a minimum of five years' experience in publicly funded Medicaid or CHIP managed care contracts, with ten years preferred. Health plans must obtain a certificate of authority from the Department of Commerce and Insurance by the contract award date or February 1, 2027, whichever is later. The RFP requires physical presence in Missouri with key personnel including a Health Plan Administrator or CEO, Chief Financial Officer, Medical Director, and Program Integrity Manager located in-state. All services and functions must be performed in the United States with no data storage or transmission outside U.S. borders.

The contract period runs one year from award through renewal options. Specialty Plan capitation rates are standardized across all four regions at $847.03 per member per month for Category of Aid 4 and $9,588.80 per member per month for Category of Aid 4 – GR Only. The three current contracts (CS220777001 through CS220777003) serve as incumbents. Readiness reviews are anticipated January 1 through March 30, 2027.

Health plans must implement member incentive programs with at least 15 percent eligible member participation and provider incentive programs with at least 10 percent provider participation. Value-based purchasing strategies, alternative payment models, Healthy Birth Weight Incentive, and Prenatal Care Adequacy Index Incentive programs with specified bonus structures are required. Vendor questions are due at least ten calendar days prior to the proposal deadline. Amendment 01 modified sections 1.9 through 1.9.3 of the original RFP. Contact: Kristina Cramer, Buyer, (573) 751-1695 or Kristina.Cramer@oa.mo.gov. Proposals must be submitted through MissouriBUYS. Federal approval is required prior to commitment of federal financing share funds.