Medicaid Financial and Actuarial Support Professional Services

The selected vendor will provide Medicaid financial and actuarial support services, including development, setting, and certification of actuarially sound, risk-based managed care capitation rates for all Medicaid managed care organization cohorts. Services will include financial analysis, actuarial and financial modeling, financial monitoring, reconciliations, risk mitigation support, and guidance on Medicaid finances, reporting requirements, federal waivers, policies, regulations, and programs.

The vendor will ensure that actuarial methodologies and rate certifications comply with 42 CFR §§ 438.4–438.7 and other applicable federal Medicaid managed care regulations. Responsibilities will include budget neutrality modeling; analysis of managed care expenditures; modeling service and medication utilization; developing medical and administrative cost profiles; reviewing financial statements; and applying adjustments for regulatory changes, program modifications, benefit changes, coverage expansions or reductions, and directed payment programs.

Additional work will include developing non-benefit components such as administrative loads, taxes and assessments, underwriting gain limitations, and risk margins; maintaining a multi-year Medicaid financial forecast model; projecting enrollment and expenditure trends by eligibility category; preparing fiscal impact analyses for proposed legislation and program changes; and supporting responses to inquiries from state agencies, the legislative finance committee, and other stakeholders. The contract period will be one year. A pre-bid conference is scheduled for September 17, 2026, and questions must be submitted by September 18, 2026.