When is the submission deadline?

Submissions are due November 6, 2026. Questions must be submitted by October 23, 2026.

What is the budget for this RFP?

Settle estimates the budget at $500,000 – $2,000,000. The issuer has not published an official figure.

It was issued by New York State Office of the Medicaid Inspector General. The work is located in Albany, New York, United States.

Home Health Care Medicare Maximization Services (Due November 6, 2026)

SUMMARY

The New York State Office of the Medicaid Inspector General is seeking a contractor to perform Medicare maximization services for dual eligible recipients receiving home health care services paid by Medicaid.

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DESCRIPTION

The contractor will support the Office of the Medicaid Inspector General's efforts to maximize Medicare coverage for dual eligible Medicare and Medicaid recipients who receive home health services paid by Medicaid. Responsibilities include data analysis, case selection, Medicare appeals processing, provider coordination, audit and recovery support, reporting, and provider education. The program involves approximately 1,700 fee-for-service recipient cases selected annually for Medicare appeal, with potential expansion into Medicaid Managed Care populations. The contract term is three years with two optional one-year renewals.

KEY REQUIREMENTS

Must have at least five years of relevant experience in Medicare maximization, healthcare recovery, or audit operations
Must have a Program Director with at least five years of experience overseeing complex healthcare initiatives
Must have a Program Manager with at least five years of experience managing complex healthcare operations
Must provide licensed medical professionals experienced in home health medical record review
Must provide at least one attorney licensed in New York State
Must attest that all work will be performed within the United States
Must maintain SOC 1 and SOC 2 reports annually
Must maintain commercial general liability insurance with a limit of at least $5,000,000
Must maintain cyber liability insurance with a limit of at least $10,000,000
Must maintain errors and omissions liability insurance with a limit of at least $5,000,000

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TIMELINE

Release of RFP: October 16th, 2026

Written questions due: October 23rd, 2026

Official response to questions: October 30th, 2026

Proposals due: November 6th, 2026

Selection of contractor: December 30th, 2026

Contract commencement: July 1st, 2027

Issuing Agency

New York State Office of the Medicaid Inspector General

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CONTACTS

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Home Health Care Medicare Maximization Services