MB-10451 - USA (New Mexico) - Medicaid Financial and Actuarial Support Professional Services - Deadline October 12,2026

(1) Vendor needs to provide Medicaid financial and actuarial support professional services.• The selected offerors will assist with developing risk–based managed care rates, conducting financial analyses, and providing expert guidance on Medicaid finances, reporting requirements, federal waivers, policies, regulations, and programs.• Developing, setting, and certifying actuarially sound capitation rates for all Medicaid managed care organization cohorts.• Providing actuarial and financial modelling related to managed care rate development.• Supporting financial monitoring, reconciliations, and risk mitigation mechanisms.• Ensuring actuarial methodologies and rate certifications comply with 42 CFR §§ 438.4–438.7 and other applicable federal Medicaid managed care regulations.• Providing budget neutrality modelling and financial analysis related to managed care expenditures.• Modelling service utilization patterns (including medication utilization) and developing medical and administrative cost profiles.• Reviewing financial statements to identify issues affecting cost trends or rate development.• Applying adjustments for federal/state regulatory changes, program modifications, benefit changes, coverage expansions/reductions, and directed payment programs.• Developing non–benefit components, including administrative load, taxes and assessments, underwriting gain limitations, and risk margins.• Developing and maintaining a multi–year Medicaid financial forecast model.• Projecting enrolment and expenditure trends by eligibility category.• Preparing fiscal impact analyses for proposed legislation and program changes.• Supporting HCA in responding to inquiries from other state agencies, the legislative finance committee, and other stakeholders, as needed.(2) A pre–bid conference will be held on September 17, 2026.(3) All question must be submitted no later than September 18, 2026.(4) A contract period will be for one year.