Hawaii releases new Medicaid Managed Care RFP

The Hawaii Department of Human Services (DHS) issued its new QUEST Integration Medicaid Managed Care RFP on Tuesday. The Request for Proposals is seeking up to 5 health plans to provide Medicaid services statewide, though the RFP notes that health plans may propose providing services on one or more islands.

The latest RFP comes after DHS announced it was rescinding the Medicaid managed care contract awards previously announced in January due to the “evolving needs of the community” during the COVID-19 crisis.

 

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Prior to the cancellation, the transition to the new contracts — which pared five plans to two on the neighboring islands — was turbulent. After rescinding the original contract awards, Med-QUEST stated it was too early to determine if the number of health plans would be limited for the neighbor islands in the new RFP. This question was a key component of the new Request for Information released in July 2020.

Under the new RFP, it appears DHS is looking to rely on statewide health plans.

“DHS prefers that the Health Plan provides services statewide; however, the Health Plan may propose to provide services on one (1) or more islands. If the Health Plan’s proposal results in an island(s) not having the choice of two (2) Health Plans, then DHS may allow the other Health Plans an opportunity to change to operate on this island(s). If no Health Plan chooses to change, then DHS may cancel this RFP,” reads the document.

The new RFP also details DHS’s plan to implement the Hawaii Ohana Nui Project Expansion (HOPE) program, which aims to support whole person care, invest in primary care, and focus on prevention. The HOPE program also looks to reform and align payment to providers, and support community-driven initiatives to improve population health.

“We consider the health plans valuable partners to help deliver better health outcomes by focusing on primary care and preventive care, addressing the complex health needs of individuals, and supporting members and their families who are facing multiple social risk factors that ultimately affect their health, such as houselessness,” said Judy Mohr Peterson, administrator of the Med-QUEST Division, in a prepared statement. “We’re also realigning our financial incentives to address the health and social needs of our members and exploring community-driven initiatives to improve the overall health of our members.”

Proposals are due February 15, 2021, with contracts expected to be awarded on March 15. The RFP’s timeline lists an approximate contract execution date of April 30th, with services to members beginning July 1, 2021.

“The ongoing health, social, and economic effects of the COVID-19 pandemic are taking a toll on Hawaii’s most vulnerable and at-risk populations.  We appreciate the understanding, cooperation, and flexibility of our contracted health plans to help us all get through this challenging time,” said Mohr Peterson.

“We must do even more to make sure people receive the care they need in a cost-effective manner,” she said. “We look forward to partnering with the health plans in the new contract period to ensure we can continue to be responsive to the changing needs of the community, while also managing healthcare costs.”

Links to the full 565-page RFP and its appendices are available here.