An Advocate’s Guide to Medicaid Managed Care Procurement

2022 is a big year for Medicaid managed care procurements.  Procurements are already underway in California, Iowa, and Nebraska with awards scheduled to be announced in August. New Mexico is scheduled to launch its procurement in September, and three more states — Florida, Georgia, and Texas — are expected to issue Requests for Proposals (RFPs) later this year.  In these procurements, they will choose which managed care organizations (MCOs) will enroll about 14 million Medicaid beneficiaries in these seven states. During procurement (or re-procurement or re-contracting, as the process is sometimes called) state Medicaid agencies can also make many other important changes to the MCOs’ contracts which can significantly affect outcomes for children and families. This makes procurement a unique opportunity for child and maternal health advocates to push for targeted improvements in whatever specific way is necessary for their state’s Medicaid managed care program.

In our newest Advocate’s Guide “A Guide for Health Care Advocates: Medicaid Managed Care Procurement,” we give a general overview of the procurement process with the stipulation that procurement processes, like Medicaid programs, vary by state. We then offer examples of how procurement can be used to strengthen managed care performance for children and families. For example, procurement gives the state a chance to strengthen its contracts with MCOs to make improvements to their program (e.g., improving access and reducing racial and ethnic disparities). We also supply a checklist that advocates can use to begin leveraging their state’s Medicaid MCO procurement process to benefit children and families that includes, and expands upon, the following action steps:

  • Figure out what problems you want the procurement to fix: Procurement might not be the best fix for every problem, and it will likely be important to prioritize if the list is long.
  • How can you know what the problems are? Transparency in Medicaid managed care is notoriously lacking, especially on the individual MCO level. A good place to start is the Annual Technical Report prepared by the External Quality Review Organization (EQRO) that each state Medicaid agency is required to post on its website. (If you’re looking for more background on MCOs or action steps for improving transparency of MCO performance, our Advocate’s Guide to Transparency is the resource for you!)
  • Find providers who want to fix the problems and collaborate with them: Many providers and their state trade associations have formal and informal channels to state policymakers and they can be important and motivated allies.
  • Figure out where in the process you and other stakeholders can intervene: The formal procurement process is likely to include at least one opportunity for public comment.
  • Find an interested reporter (or get one interested): Journalists are essential to the transparency of the process. Procurement is more likely to produce favorable results if all involved parties know the public is watching.
  • Ask for support from state health care foundations: State health care foundations can offer financial, analytical, communications, and various other kinds of support to advocacy efforts.
  • Mine procurement postings for information about the bidders: Although some states make more information available than others, this can be a valuable resource!

Medicaid is complicated, Medicaid managed care is even more complicated, and adding each state’s different procurement process doesn’t simplify the matter. This Guide is not intended to answer every question advocates might have. In fact, it might add a few to their list. How well have the incumbent MCOs in their state performed for children and families? How should the state’s current risk contract be improved to increase access to EPSDT services or to reduce racial and ethnic disparities? These are highly state-specific questions, and the Guide provides a starting point for advocates to find state-specific answers.

Medicaid managed care procurements only come around every so often—three, five, sometimes more years pass between re-procurements. Even though they are an intermittent opportunity, they hold great potential to advance child and maternal health advocacy goals, and we hope this Guide will be a helpful resource whenever the time comes in your state.

A Guide for Health Care Advocates: Medicaid Managed Care Procurement