MO HealthNet Managed Care Program

The MO HealthNet Managed Care Program solicitation, issued by the Missouri Department of Social Services through the Division of Purchasing, seeks qualified health plans to deliver comprehensive managed care services under a capitation-based model for both General and Specialty Plan populations across the state. Proposals must be submitted electronically via MissouriBUYS by September 2, 2026, and must satisfy stringent mandatory requirements to be considered responsive. The contract encompasses a firm, fixed per member per month capitation rate structure, with distinct pricing for General Plan categories such as newborns, children, adults, and specific aid groups, and a significantly higher rate for the Specialty Plan catering to individuals with complex behavioral and physical health needs. The Specialty Plan requires integrated, trauma-informed care delivery, including specialized provider networks, clinical practice guidelines, and exclusive quality reporting metrics like OED, FUA, and APM-E, without risk adjustment or performance withhold provisions that apply to the General Plan. All proposals are evaluated on a 200-point system, heavily weighted toward technical merit—demonstrating organizational experience, leadership and workforce qualifications, methodology for care management, fraud prevention, provider network access, quality improvement, and administration—with additional points available for MBE/WBE participation and preferences for Missouri-based service-disabled veteran and blind/ sheltered workshop businesses. Contract compliance is rigorously enforced through a detailed framework rooted in Missouri state law and federal requirements, including full adherence to 2 CFR 200 for federal awards and strict financial controls mandating five-year record retention and EFT payment processing through MissouriBUYS. Contractors must provide a performance security deposit within 30 days of award, maintain a Special Investigations Unit with one full-time investigator per 100,000 members, and appoint a Compliance Officer reporting directly to senior leadership. The health plan must implement continuous quality improvement aligned with QISMC and CMS standards, conduct monthly screenings of federal exclusion lists, and submit quarterly fraud, waste, and abuse reports using state-approved forms. Essential documentation includes attachments detailing eligibility groups, actuarial models, federal funding rules, and pricing, as well as a comprehensive suite of exhibits covering experience, team qualifications, methodology, tax compliance, business registration, and workforce authorization. The contract, initially for one year, carries a potential for four one-year renewals at the state’s discretion, and contractors must be prepared to continue services for up to 90 days post-expiration if requested. All activities must comply with Missouri’s non-discrimination laws, and final payments