Professional Services for Medicaid Financial and Actuarial Support

The New Mexico Health Care Authority (HCA), Medical Assistance Division, is soliciting proposals under RFP 27-630-8000-0009 for professional actuarial and financial consulting services to support the Turquoise Care Medicaid Managed Care Program. The selected contractor will be responsible for developing, setting, and certifying actuarially sound risk-based capitation rates for all Medicaid Managed Care Organization cohorts, providing Section 1115 budget neutrality modeling, and conducting financial analyses to improve program efficiency and health outcomes. Key deliverables include annual capitation rate certification packages compliant with 42 CFR Part 438 and CMS guidelines, risk score calculation files, and risk corridor evaluation reports. All work must adhere to Applicable Actuarial Standards of Practice and American Academy of Actuaries qualifications. Proposals must be submitted electronically via the designated portal by October 12, 2026. Mandatory submission requirements include a signed Letter of Transmittal, a Campaign Contribution Disclosure Form, a Certification Regarding Lobbying, and a Suspension and Debarment Requirement Form; failure to provide these will result in disqualification. Evaluation is based on the total cost of implementation and organizational experience, verified through at least three organizational references. The contract is subject to state and federal regulations, including HIPAA and HITECH Act requirements for safeguarding protected health information. Payment is issued within thirty days of service acceptance, provided invoices are submitted no later than fifteen days after the end of the fiscal year.