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In Focus

New Mexico Releases Medicaid Managed Care RFP

This week, our In Focus reviews the New Mexico Medicaid managed care request for proposals (RFP), released on September 30, 2022, by the New Mexico Human Services Department (HSD). The state will transition to a new program called Turquoise Care in 2024, which will build upon the current Centennial Care 2.0 program through a new Section 1115 waiver demonstration. Managed care organizations (MCOs) will provide physical health, behavioral health, and long-term care (LTC) services to approximately 800,000 Medicaid managed care members.


New Mexico plans to award Turquoise Care contracts to three MCOs. One of the selected MCOs will also be awarded a specialized foster care plan contract to provide services to Children in State Custody (CISC) on a statewide basis. CISC will be mandatorily enrolled and Native American CISC members will have the option to voluntarily enroll.

Turquoise Care will introduce new practices aimed at improving quality based on population health outcomes. The program will focus on three goals:

  • Goal 1: Build a New Mexico health care delivery system where every Medicaid member has a dedicated health care team that is accessible for both preventive and emergency care that supports the whole person – their physical, behavioral, and social drivers of health.
  • Goal 2: Strengthen the New Mexico health care delivery system through the expansion and implementation of innovative payment reforms and value-based initiatives.
  • Goal 3: Identify groups that have been historically and intentionally disenfranchised and address health disparities through strategic program changes to enable an equitable chance at living healthy lives. The target populations will be:
    • Prenatal, postpartum, and members parenting children, including children in state custody
    • Seniors and members with long-term services and supports (LTSS) needs
    • Members with behavioral health conditions
    • Native American members
    • Justice-involved individuals

Other changes for Turquoise Care include:

  • 90 percent Medical Loss Ratio (MLR) aimed at improving quality of care
  • Expanded MCO reporting and monetary penalties for non-compliance
  • Minimum reimbursement rate for contract providers at or above the state plan approved fee schedule
  • More stringent provider network requirements
  • A single centralized vendor to process applications
  • Enhanced MCO staffing requirements, including qualifications, staffing levels, and training
  • Focus on social determinants of health

New Mexico will submit the Section 1115 demonstration waiver for Turquoise Health to the Centers for Medicare & Medicaid Services (CMS) for approval by December 2022. HSD will update the model contract to reflect the requirements related to the waiver renewal upon its approval.

During this procurement, the state will also be developing and implementing a new Medicaid Management Information System (MMIS).


Approximately 83 percent of the Medicaid population is in managed care.

Populations exempt from mandatory managed care enrollment are:

  • Native American members not in need of LTC
  • Individuals with Intellectual Disabilities (ICF-IID) in Intermediate Care Facilities
  • Individuals enrolled in Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLIMB), or Qualified Individuals program
  • Individuals covered only under the Medicaid Family Planning program
  • Individuals enrolled in the Program of All-Inclusive Care for the Elderly (PACE)
  • Individuals covered pursuant to Emergency Medical Services for Non-Citizens (EMSNC)

Members in the Developmental Disabilities 1915(c) Waiver and in the Medically Fragile 1915(c) Waiver will continue to receive home and community-based services (HCBS) through that waiver but are required to enroll with an MCO for all non-HCBS.


Proposals are due December 2, 2022. Contracts will run from January 1, 2024, through December 31, 2026, with optional one-year renewals, not to exceed eight years total.

Current Market

New Mexico had 811,732 Medicaid managed care as of August 2022, served by Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, and Centene/Western Sky. The state also had an additional 163,361 fee-for-service members.


The evaluation process will consist of three phases: review of mandatory requirements, review and scoring of the technical proposals, and review and scoring of the CISC technical proposals.

New Mexico Turquoise Care RFP

HMA Roundup


Colorado Releases Medicaid, CHIP Enrollment Broker Services RFP. The Colorado Department of Health Care Policy and Financing released on September 28, 2022, a request for proposals (RFP) for an enrollment broker to serve the state’s Medicaid and Children’s Health Insurance Program (CHIP). The contract begins on June 30, 2023, after a six-month startup period, and runs for one-year with up to five annual renewal options. The current incumbent is Maximus Health Services. Read More


Louisiana to Begin Auto Assignment of Medicaid Beneficiaries into Managed Care Plans. The Louisiana Department of Health announced on September 30, 2022, that it will begin the auto-assignment of Medicaid beneficiaries into one of six Medicaid managed care plans awarded contracts in a recent procurement, with notifications going out to members in November. Five of the plans are incumbents. Enrollees can change their auto-assignment between November 8 and December 29, with the change effective when the new contracts begin on January 1, 2023. After that, changes can still be made up until March 31, 2023. Read More


Maine Looks to Renew NEMT Waiver, Release RFP. The Maine Department of Health and Human Services announced on October 4, 2022, its intent to release a request for proposals (RFP) for its Medicaid non-emergency medical transportation (NEMT) broker service. News of the RFP was included in an amendment submitted to federal regulators to renew the state’s NEMT waiver for five years. Proposed changes include use of a single capitated rate per region instead of allowing bidders to select from a range of rates as well as revising performance measures. The public comment period is open until November 4. Read More


Massachusetts to Receive $14 Million in PBM Settlement. Massachusetts announced on September 29, 2022, that it will receive $14.2 million in a settlement concerning Medicaid pharmacy benefit management (PBM) overcharges. The case involved claims that Centene’s PBM operation had overcharged MassHealth for prescription drugs and services. Read More


Minnesota Awards Medicaid Managed Care Contracts Covering Individuals Outside Twin Cities, Elderly, Disabled. The Minnesota Department of Human Services awarded on October 5, 2022, Medicaid managed care contracts covering more than 600,000 individuals effective January 1, 2023, including families and children outside the Twin Cities area and both the elderly and individuals with disabilities statewide. Plans awarded in the 80-county area for the state’s Families and Children Medical Assistance (MA) and MinnesotaCare Basic Health and for the Minnesota Senior Health Options (MSHO)/Minnesota Senior Care Plus (MSC+) programs were Blue Plus, HealthPartners, Itasca Medical Care, Medica, PrimeWest Health, South Country Health Alliance, UCare, and United Healthcare Community Plan of Minnesota. Plans awarded for the Special Needs BasicCare (SNBC) program were HealthPartners, Hennepin Health, Medica, PrimeWest Health, South Country Health Alliance, UCare, and United Healthcare Community Plan of Minnesota. Implementation is set for January 1, 2023. Read More


Nebraska Seeks Funds to Cover Aduhelm, Reduce Waiting List for Individuals With Development Disabilities. KPVI/ The Omaha World-Herald reported on October 2, 2022, that the Nebraska Department of Health and Human Services projects the state will need $16 million annually to cover the costs of Alzheimer’s drug Aduhelm for Medicaid beneficiaries. In a biennial budget request to the Governor, DHHS also requested $11.9 million to serve 250 wait listed individuals with developmental disabilities. Overall, DHHS is seeking $2.5 billion annually for the state Medicaid program.


Nevada to Begin Medicaid Redeterminations Month After PHE Is Lifted. The Nevada Department of Health and Human Services announced on September 26, 2022, that it will begin conducting Medicaid eligibility redeterminations the month after the public health emergency (PHE) is lifted. Managed care organizations and dental benefits administrators can use text messages to engage members as long as they have opted into text.

New Jersey

New Jersey Senate Committee Advances Bill to Require Medicaid Coverage of Behavioral Health Services Provided in Schools. The New Jersey Senate Democrats announced on September 29, 2022, that legislation requiring Medicaid to reimburse providers for behavioral health services provided to eligible students in schools was unanimously passed by the Senate Education Committee. Previously, federal policy prohibited Medicaid reimbursement of certain school health services. Read More

New York

New York Medicaid Fraud, Waste Reduction Efforts Yield Results. Spectrum News reported on October 3, 2022, that the New York Medicaid program’s efforts to prevent waste and fraud resulted in nearly $3.2 billion recoveries and savings in 2021, according to acting state Medicaid inspector general Frank Walsh. Unnecessary cost avoidance accounted for $2.4 billion of the total, while provider audits and investigations accounted for $714 million. Read More

Molina Healthcare Completes Acquisition of AgeWell. Molina Healthcare announced on October 3, 2022, that is had completed the acquisition of AgeWell New York’s Medicaid managed long term care business. As of September 2022, AgeWell New York’s MLTC business served about 13,000 members. Read More

North Carolina

North Carolina Delays Implementation of Behavioral Health IDD Tailored Plans to April 2023. The North Carolina Department of Health and Human Services announced on September 29, 2022, that it has further delayed the implementation of Behavioral Health and Intellectual/Developmental Disabilities (IDD) Tailored Plans until April 1, 2023. Implementation was originally scheduled for July 2022 and then delayed to December 1, 2022. Tailored plans will be offered by the state’s Local Management Entity-Managed Care Organizations (LME-MCOs). Certain features of the tailored plans, including integrated care management and certain home and community-based services, will be effective in December. Read More

North Dakota

North Dakota Leads Country in Rate of Physicians Accepting New Medicaid Patients, Analysis Finds. The State Health Access Data Assistance Center reported on August 25, 2022, that North Dakota had the highest rate of physicians who accepted new Medicaid patients at 98.8 percent between 2014 and 2017, according to an analysis of health records survey data. New Jersey had the lowest at 42.2 percent. Read More


Ohio Governor Looks to Expand Medicaid Eligibility for Pregnant Women to 300 Percent of Poverty. Ohio Governor Mike DeWine announced on September 30 2022, hopes to work with the state legislature to expand the Medicaid income-eligibility limit for pregnant women from 200 percent of poverty to 300 percent as part of a maternal and child health care initiative. DeWine also plans to expand Medicaid eligibility to children adopted through private agencies, as well as launch quality standards to improve birth outcomes at hospitals and birthing centers.


Oklahoma Implements 25 Percent Rate Increase for Developmental Disability, HCBS Providers. The Oklahoman reported on October 4, 2022, that the Oklahoma Department of Health and Human Services has implemented a 25 percent rate increase for Medicaid providers serving individuals with intellectual and developmental disabilities and home and community-based services (HCBS) providers for seniors. The change, which is aimed at eliminating the state’s 13-year waiting list for developmental disability services, raises hourly wages to $12. More than 4,600 individuals with developmental disabilities are on the waiting list. Read More

Oklahoma to Cover Hospice Services for Medicaid Expansion Adults. The Oklahoma Health Care Authority announced on September 29, 2022, that Medicaid will cover hospice services for adults in the expansion population residing in long-term care facilities, effective October 1. Under the new policy, if Medicare is the primary insurer, the state Medicaid agency will only reimburse hospice providers for coinsurance and deductibles. Read More


HCSC Names Anne Rote President of Medicaid Division. Becker’s Payer Issues reported on October 4, 2022, that Health Care Service Corp. (HCSC) named Anne Rote president of its Medicaid division. HCSC is the parent company of Blue Cross Blue Shield of Texas, Illinois, New Mexico and Montana. Rote previously served stints at Molina Healthcare, United/Optum, and Aetna. Read More

Medicare Advantage Plans Are Criticized for Ending Nursing Home Coverage. Kaiser Health News reported on October 4, 2022, that Medicare Advantage (MA) plans are ending members’ coverage for nursing home and rehabilitation services before they are healthy enough to go home, according to health care providers and nursing home representatives. MA must cover the same benefits as Medicare but have leeway when deciding how much nursing home care is necessary. Read More

Less Than 6 Percent of Wealthy Individuals Enroll in Medicaid LTSS, Study Says. Forbes reported on October 4, 2022, that fewer than six percent of high-income individuals over age 65 enroll in Medicaid long-term services and supports (LTSS), according to a paper from Rich Johnson at the Urban Institute. The study also estimated that more than one-third of the lowest income individuals over age 65 use Medicaid LTSS. Read More

CMS Implements ACE Kids Act for Children with Complex Medical Needs. Senator Chuck Grassley (R-IA) announced on October 3, 2022, that the Centers for Medicare & Medicaid Services (CMS) implemented the Advancing Care for Exceptional (ACE) Kids Act, which is aimed at improving specialized care coordination for children with complex medical conditions. The bill was passed in April 2019 and had an implementation deadline of October 1, 2022. Read More

Federal Grants Topping $346 Million Awarded to Address Healthcare Staffing Shortages. Modern Healthcare reported on October 3, 2022, that the U.S. Health and Human Services (HHS) and Labor departments are awarding more than $346 million in grants to help address the health care workforce shortage by training nurses, community workers, and public health professionals. HHS plans to award $225.5 million to 83 recipients through the Community Health Worker Training Program and $40.7 million to 29 recipients through the Public Health Scholarship Program. The Labor Department is awarding $80 million to support programs that expand the pipeline of trained nurses with an emphasis on those from historically marginalized and underrepresented communities. Read More

Center for Medicare & Medicaid Innovation Is Developing Reimbursement Model for Palliative Care. Hospice News reported on October 3, 2022, that the Center for Medicare & Medicaid Innovation (CMMI) is developing a reimbursement model for palliative care. The model will include aspects of CMMI’s Medicare Care Choices Model demonstration, which ended in December 2021 and performed well on cost savings and patient satisfaction. Read More

Biden Is Expected to Sign Bill Extending Rural Hospital Payment Programs. Fierce Healthcare reported on September 30, 2022, that President Biden is expected to sign a short-term budget bill passed by Congress, which would extend two rural hospital programs through December 16 – the hospital payment adjustment for certain low-volume hospitals and the Medicare-Dependent Hospital program. The short-term bill also gives provider groups a window to head off a four percent mandatory cut under the PAYGO law and a 4.5 percent cut to Medicare payments. Read More

5 Percent of Children Were Uninsured From 2016-20, Report Finds. Health Payer Intelligence reported on September 30, 2022, that five percent of children aged 17 and younger were uninsured between 2016 and 2020, according to a report from the State Health Access Data Assistance Center, funded by the Robert Wood Johnson Foundation. Among racial and ethnic groups, the uninsured rate was highest for American Indian and Alaska Native children at 14.1 percent. Data is for 50 states and the District of Columbia from U.S. Census Bureau estimates. Read More

CMS Offers States Grants to Develop Health Homes for Children With Complex Conditions. The Centers for Medicare & Medicaid Services (CMS) announced on September 30, 2022, that it will award grants to states for activities related to the development of health homes aimed at improving care coordination for children with medically complex conditions. The initiative would allow states to expand coverage of coordination of care, including efforts by out-of-state providers. Read More

CMS Projects Medicare Advantage Premiums to Fall Nearly 8 Percent in 2023. The Centers for Medicare & Medicaid Services (CMS) announced on September 29, 2022, that the projected average monthly premium for 2023 Medicare Advantage Plans will be $18, down eight percent from $19.52 in 2022. The average basic monthly premium for standard Part D coverage is projected to decrease nearly two percent from $32.08 to $31.50. Read More

Federal Judge Rules HHS Must Restore Full 340B Drug Payments for Remainder of 2022. Modern Healthcare reported on September 29, 2022, that the U.S. Department of Health and Human Services (HHS) must restore full 340B drug payments for the remainder of 2022, according to a federal judge’s ruling. The ruling follows a Supreme Court order from June that HHS must compensate providers for lower 340B payments received in prior years. Read More

Medicaid, Medicare Enrollment Exceeds 142 Million in June 2022, CMS Reports. The Centers for Medicare & Medicaid Services announced on September 29, 2022, that Medicaid and Children’s Health Insurance Program (CHIP) enrollment exceeded 89 million in June 2022, an increase of 0.5 percent since May 2022. Medicare enrollment was nearly 65 million, an increase of 0.2 percent. More than 12 million individuals were eligible for both Medicare and Medicaid. Read More

Tricare PBM to Drop Nearly 15,000 Pharmacies From Network. Health Payer Specialist reported on September 28, 2022, that pharmacy benefit manager Cigna/Express Scripts will drop nearly 15,000 pharmacies from the U.S. Defense Department’s Tricare network effective next month. The Tricare PBM contract, which was awarded to Cigna/Express Scripts last year, runs 15 months with seven one-year renewal options. Tricare is expected to announce awards for its medical care plans in November. Read More

Medicaid NEMT Fraud Investigations Result in Convictions, Settlements. The U.S. Government Accountability Office (GAO) announced on September 28, 2022, that state Medicaid fraud investigations resulted in nearly 200 criminal convictions, civil settlements, and judgments against non-emergency medical transportation providers (NEMT) from 2015 through 2020, according to a GAO report. The fraud included NEMT providers billing for trips that were not provided or using unauthorized drivers or vehicles. The report also found that most states utilize a combination of managed care, third party brokers, and in-house approaches to administer NEMT benefits. Read More

Medicare Telehealth Usage Increased 10-Fold During Pandemic, GAO Reports. The U.S. Government Accountability Office (GAO) reported on September 26, 2022, that the use of Medicare telehealth services increased from 5 million between April and December 2019 to 53 million between April and December 2020. Overall Medicare usage was down over the same period. GAO recommends additional oversight and education for beneficiaries on privacy and security risks. Read More

Industry News

UnitedHealth/Optum Completes Merger with Change Healthcare. UnitedHealth/Optum announced on October 3, 2022, the completion of its merger with Change Healthcare. The merger was cleared by the U.S. Department of Justice in September 2022. Read More

Ensign Group Acquires Skilled Nursing Facilities in AZ, SC. The Ensign Group announced on October 3, 2022, that it has acquired the operations of Oak Harbor Healthcare and Oak View Health and Rehabilitation, two skilled nursing facilities in South Carolina with 322 beds combined. The Ensign Group also acquired the real estate and operations of Fountain Hills Post Acute, a skilled nursing facility based in Arizona. The acquisitions were effective on October 1. Read More

Ensign Group May Soon Become Largest Nursing Home Provider in U.S. Skilled Nursing News reported on October 3, 2022, that the Ensign Group could surpass Genesis HealthCare as the largest nursing home provider in the U.S., according to Stifel analyst Tao Qiu. As a result of recent acquisitions, Ensign operates 268 health care entities across 13 states. Read More

Spero Health Acquires My Turning Point. Spero Health announced on October 3, 2022, the acquisition of My Turning Point, an addiction treatment provider with four locations in Kentucky. Spero Health currently operates 85 outpatient addiction treatment locations across six states. Read More

Addus HomeCare Acquires Apple Home Healthcare. Addus HomeCare announced on October 3, 2022, the acquisition of Chicago-based Apple Home Healthcare, a provider of home health services for patients recovering from acute illnesses and procedures. Apple Home Healthcare serves approximately 450 patients in the Chicago area and has annual revenues of about $10 million. The acquisition was effective on October 1. Read More

Enhabit Home Health & Hospice Acquires Caring Hearts Hospice. Enhabit Home Health & Hospice announced on October 3, 2022, its acquisition of Caring Hearts Hospice, a Texas-based hospice agency with four locations. The acquisition was effective on October 1. Read More

Federal False Claims Lawsuit Against Elevance Health to Proceed, Judge Rules. Modern Healthcare reported on October 4, 2022, that a federal false claims lawsuit claiming Elevance Health improperly collected more than $100 million in Medicare Advantage payments must proceed, according to a ruling from U.S. District Court Judge Andrew Carter. Elevance had submitted a motion to dismiss the lawsuit, which was filed by the Justice Department. Read More

Health Management Associates Acquires The Focus Group. Health Management Associates (HMA) announced on September 30, 2022, an agreement to acquire The Focus Group, a healthcare strategy firm focusing on policy, payment, and delivery. Managing directors David Kulick and Alex Rich will continue to lead the firm under the name The Focus Group, an HMA Company. Read More

Consumer Direct Holdings to Be Publicly Traded After Merger With DTRT Health. Self-directed, personal home care provider Consumer Direct Holdings (CDH) announced on September 29, 2022, an agreement to merge with DTRT Health Acquisition Corp., a publicly traded special purpose acquisition company. The combined company, which is expected to traded on Nasdaq, will be called Consumer Direct Care Network and will be led by current CDH chief executive Ben Bledsoe. Read More

RFP Calendar

HMA News & Events

Medicaid Data
Medicaid Enrollment:

  • Florida Medicaid Managed Care Enrollment is Up 5.3%, Jun-22 Data
  • Florida Medicaid Managed Care Enrollment is Up 7.4%, Aug-22 Data
  • Hawaii Medicaid Managed Care Enrollment is Up 2.8%, Jun-22 Data
  • Illinois Medicaid Managed Care Enrollment is Up 1.9%, Jun-22 Data
  • Illinois Dual Demo Enrollment is Down 5.2%, Jun-22 Data
  • Indiana Medicaid Managed Care Enrollment Is Up 3.4%, Mar-22 Data
  • Missouri Medicaid Managed Care Enrollment is Up 12.8%, Jun-22 Data
  • Rhode Island Dual Demo Enrollment is Down 1.5%, Feb-22 Data

Public Documents: 

Medicaid RFPs, RFIs, and Contracts:

  • Colorado Medicaid, CHIP Enrollment Brokers Services RFP, Sep-22
  • Hawaii Fiscal Audit Services for 1915(c) Home and Community-Based Services RFP, Sep-22
  • New Hampshire Electronic Asset Verification System RFP, Sep-22
  • New Mexico Turquoise Care Managed Care RFP, Sep-22
  • Ohio Clinical Utilization Management and Prior Authorization Vendor RFP, Sep-22
  • Washington HITECH Implementation Advanced Planning Document, 2021-22

Medicaid Program Reports, Data, and Updates:

  • Georgia Medicaid HIT Implementation Advanced Planning Document, Feb-22
  • Nevada Medicaid COVID-19 Public Health Emergency Unwinding Plan, Sep-22
  • Pennsylvania Community HealthChoices MCO External Quality Review, 2019-21
  • Pennsylvania Community HealthChoices Rate Certification and Databooks, CY 2018-23
  • Texas HHSC Medicaid Rate Setting Reports, FY 2022
  • Texas HHSC Medicaid Rate Setting Reports, FY 2023
  • Texas HITECH Implementation Advanced Planning Documents, Jun-22
  • West Virginia Medicaid HITECH Implementation Advance Planning Documents and Approval, 2018-2022

A subscription to HMA Information Services puts a world of Medicaid information at your fingertips, dramatically simplifying market research for strategic planning in healthcare services. An HMAIS subscription includes:

  • State-by-state overviews and analysis of latest data for enrollment, market share, financial performance, utilization metrics and RFPs
  • Downloadable ready-to-use charts and graphs
  • Excel data packages
  • RFP calendar

If you’re interested in becoming an HMAIS subscriber, contact Carl Mercurio.

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Weekly Roundup