Medicaid Actuarial and Financial Support Services
New Mexico > Human Services Department > Health Care Authority > Medical Assistance Division
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Submission Instructions
Description
The New Mexico Health Care Authority's Medical Assistance Division is seeking one or more contractors to provide actuarial and financial consulting services for New Mexico's Medicaid program, including support for the Turquoise Care managed care program. The scope includes developing risk-based managed care rates, conducting financial analyses, and providing expert guidance on Medicaid finances, reporting requirements, federal waivers, policies, regulations, and programs. Services are intended to support Medicaid innovation, improve access to care and health outcomes, and increase program efficiency and effectiveness statewide. Additional services include developing, updating, and certifying actuarially sound capitation rates; constructing cohorts and rate cells; analyzing utilization, costs, risk adjustment, directed payments, taxes, assessments, administrative loads, and underwriting gain; and supporting compliance with applicable federal requirements and actuarial standards. The work also includes financial reconciliations, risk corridor and high-cost risk pool analysis, third-party liability analysis, medical loss ratio and monetary penalty reviews, value-based purchasing financial modeling, Section 1115 budget neutrality and waiver financial modeling, Medicaid forecasting, legislative fiscal impact analysis, stakeholder presentations, and transition of models and documentation. The resulting contract may be awarded to one or more contractors for up to four years, beginning on or before January 1, 2027, with optional extensions. Offerors may not be New Mexico Medicaid providers, managed care organizations, certain Medicaid-related subcontractors, or entities with specified conflicting relationships.
Classification Codes
Smart Codes
Specifications
Timeline
Join TeamsRequirements
- Performance Bond
- Minimum 3 references
- Within the last 5 years
- Client point of contact required for each reference
Documents
| Title | Date Posted |
|---|---|
| rfp0911267 | Sep 11, 2026 01:20 PM |
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