{ "schema": "precapture.client-intelligence.v1", "generated_at": "2026-10-28T16:30:00Z", "coverage_note": "Verified public-source intelligence. Facts and Precapture analysis are labeled separately.", "states": [ { "code": "AZ", "name": "Arizona", "program": "ALTCS E/PD", "heat": 5, "stage": "evaluation", "next_event": "Oral presentations scheduled October 26–November 10, 2026; contract award planned for January 2027", "freshness": "2026-09-26" }, { "code": "IL", "name": "Illinois", "program": "HealthChoice Illinois", "heat": 5, "stage": "award implementation, plan transition and sanction remediation", "next_event": "HFS says current HealthChoice Illinois contracts expire December 31, 2026. BidBuy 26-478HFS-MEDPR-B-49167 records a June 8, 2026 notice of award. Meridian enrollment hold remains pending HFS/EQRO remediation; Humana enrollment is open for January 1 coverage", "freshness": "2026-10-16" }, { "code": "IN", "name": "Indiana", "program": "HIP / PathWays / Hoosier Care Connect / Hoosier Healthwise", "heat": 5, "stage": "RFP withdrawn", "next_event": "Withdrawn for IC § 12-15-5-17.5(c)(2). Reissue expected most likely by November 9, 2026. January 1, 2029 go-live unchanged. The October 11, 2026 package cutoff is superseded.", "freshness": "2026-10-27" }, { "code": "AR", "name": "Arkansas", "program": "ARHOME expansion coverage", "heat": 4, "stage": "market exit and transition", "next_event": "Open enrollment October 15–December 15, 2026 for Centene members moving to Arkansas Blue Cross Blue Shield coverage", "freshness": "2026-10-06" }, { "code": "DC", "name": "District of Columbia", "program": "DC Medicaid managed care", "heat": 4, "stage": "market exit", "next_event": "Elevance transition and continuity planning", "freshness": "2026-09-17" }, { "code": "FL", "name": "Florida", "program": "Children's Medical Services Health Plan", "heat": 4, "stage": "transition", "next_event": "Molina assumes statewide CMS Plan operations October 1, 2026", "freshness": "2026-09-25" }, { "code": "ID", "name": "Idaho", "program": "Comprehensive Medicaid managed care", "heat": 4, "stage": "pre-RFP shaping", "next_event": "Procurement blackout begins December 1, 2026", "freshness": "2026-09-17" }, { "code": "LA", "name": "Louisiana", "program": "Healthy Louisiana", "heat": 5, "stage": "market exit and transition", "next_event": "Healthy Blue notices by October 1; plan selection October 15–November 16, 2026", "freshness": "2026-09-18" }, { "code": "TX", "name": "Texas", "program": "Medicaid and CHIP Dental Services", "heat": 4, "stage": "STAR & CHIP award pending; dental RFP forecast", "next_event": "Solicitation forecast for Q1 SFY 2027", "freshness": "2026-09-18" }, { "code": "MI", "name": "Michigan", "program": "MI Coordinated Health", "heat": 3, "stage": "duals expansion", "next_event": "Statewide HIDE-SNP expansion planned for 2027", "freshness": "2026-09-17" }, { "code": "NM", "name": "New Mexico", "program": "Turquoise Care financial and actuarial support", "heat": 4, "stage": "solicitation closed; evaluation and award watch", "next_event": "Finalist selection was estimated for October 19, oral presentations for October 22, and contract award for November 10, 2026", "freshness": "2026-10-19" }, { "code": "NH", "name": "New Hampshire", "program": "Medicaid Care Management external quality review", "heat": 4, "stage": "solicitation closed; award watch", "next_event": "Proposal window closed October 14, 2026 at noon; official award timing is not stated", "freshness": "2026-10-14" }, { "code": "OR", "name": "Oregon", "program": "Coordinated Care Organizations", "heat": 3, "stage": "forecast", "next_event": "RFP release reported for fall 2027", "freshness": "2026-04-22" }, { "code": "WI", "name": "Wisconsin", "program": "Family Care / Family Care Partnership", "heat": 3, "stage": "implementation", "next_event": "New and expanding plan execution in regions 2 and 7", "freshness": "2026-09-17" }, { "code": "CA", "name": "California", "program": "Medi-Cal commercial managed care", "heat": 2, "stage": "procurement delayed", "next_event": "Next procurement no sooner than 2029", "freshness": "2026-10-11" }, { "code": "NC", "name": "North Carolina", "program": "NC Medicaid Managed Care", "heat": 2, "stage": "watch", "next_event": "Procurement watch; state directs vendors to official IPS", "freshness": "2026-09-17" }, { "code": "RI", "name": "Rhode Island", "program": "FIDE-SNP and Medicaid Managed Care Services", "heat": 5, "stage": "open FIDE-SNP solicitation", "next_event": "QLV27007040 proposals are due November 4, 2026 at 11:00 AM EST. Vendor Q&A ran from October 2, 2026 at 11:15 AM EDT through October 16, 2026 at 2:00 PM EDT. A non-mandatory pre-bid conference was October 15, 2026 at 10:00 AM EST. The initial contract period begins January 1, 2028.", "freshness": "2026-10-28" } ], "items": [ { "id": "nm-2026-medicaid-actuarial-support-rfp", "published_at": "2026-09-11", "updated_at": "2026-10-19", "state": "NM", "category": "procurement", "headline": "New Mexico closes Medicaid actuarial-support solicitation and enters evaluation", "summary": "New Mexico Health Care Authority RFP 27-630-8000-0009 seeks one or more independent contractors for Medicaid actuarial, rate-setting and financial consulting services, including managed-care capitation rates, risk adjustment, financial reconciliation and Section 1115 modeling. Proposals were due October 12, 2026. The solicitation marks finalist selection on October 19, oral presentations on October 22, contract award on November 10 and protest deadline on November 25 as estimated dates. Amendment 1 says the procurement may produce one, multiple or no awards and adds conflict-of-interest restrictions involving New Mexico Medicaid managed-care organizations.", "implication": "This is an oversight and rate-setting support procurement, not a health-plan award. The selected adviser or advisers will influence the analytic framework used for Turquoise Care rates, risk adjustment, financial oversight and future managed-care procurement support, making the official award and any protest the next material watch points.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "New Mexico HCA open RFPs index", "url": "https://www.hca.nm.gov/lookingforinformation/open-rfps/", "primary": true }, { "title": "New Mexico HCA RFP 27-630-8000-0009 — Medicaid Financial and Actuarial Support", "url": "https://www.hca.nm.gov/wp-content/uploads/RFP-27-630-8000-0009_Professional-Services-for-Medicaid-Financial-and-Actuarial-Support.pdf", "primary": true }, { "title": "New Mexico HCA Amendment 1 — RFP 27-630-8000-0009", "url": "https://hca.nm.gov/wp-content/uploads/Amendment-1-RFP-27-630-8000-0009.pdf", "primary": true } ], "verification_tier": 2 }, { "id": "aetna-2026-medicaid-oncology-pa-bundles", "published_at": "2026-09-17", "effective_at": "2026-09-01", "state": "US", "category": "performance", "headline": "Aetna expands bundled oncology prior authorization across eligible Medicaid markets", "summary": "CVS Health says Aetna expanded bundled prior authorization across all cancer types for eligible Medicaid members whose providers use the Eviti portal in Oklahoma, Illinois, Maryland, New Jersey, Virginia, Florida, Kentucky and West Virginia. Aetna reports an effective date of September 1; Healthcare Dive reported availability beginning September 2. Both sources describe combined oncology, radiation and related imaging requests and approximately one-quarter initial uptake.", "implication": "The program gives Aetna a concrete provider-burden and access proof point in active Illinois and Florida markets, but procurement evaluators should distinguish the announced workflow from independently validated turnaround-time, denial and treatment-start outcomes.", "implication_label": "Precapture analysis", "confidence": 0.96, "sources": [ { "title": "Aetna expands oncology prior authorization bundles", "url": "https://www.cvshealth.com/news/company-news/aetna-expands-bundled-oncology-prior-authorizations.html", "primary": true }, { "title": "CVS Aetna streamlines cancer prior authorizations", "url": "https://www.healthcaredive.com/news/cvs-aetna-cancer-prior-authorization-bundles-expansion/830700/", "primary": false } ], "verification_tier": 2 }, { "id": "nh-2026-eqro-rfp", "published_at": "2026-09-15", "updated_at": "2026-10-14", "state": "NH", "category": "procurement", "headline": "New Hampshire closes Medicaid external-quality-review solicitation", "summary": "New Hampshire DHHS sought one or more external quality review organizations to assess quality, timeliness and access for Medicaid beneficiaries enrolled in statewide Medicaid Care Management. The official procurement page lists the solicitation close as October 14, 2026 at noon and lists official Q&A and Addendum 1 dated October 6. The page does not state an award date or identify an awardee.", "implication": "The procurement has moved past the proposal deadline into an award watch. Because this is an oversight-services procurement rather than an MCO health-plan award, the eventual selection should be tracked for its likely role in quality and access scrutiny without treating it as plan selection.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "New Hampshire DHHS RFP-2027-DPQI-02-EQRO procurement page", "url": "https://www.dhhs.nh.gov/news-and-media/rfp-2027-dpqi-02-eqro-external-quality-review-organization", "primary": true }, { "title": "New Hampshire DHHS RFP-2027-DPQI-02-EQRO solicitation", "url": "https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/inline-documents/sonh/rfp-2027-dpqi-02-eqro.pdf", "primary": true } ], "deadline_at": "2026-10-14T12:00:00-04:00", "verification_tier": 2 }, { "id": "tx-2026-dental-procurement", "published_at": null, "updated_at": "2026-10-09", "state": "TX", "category": "procurement", "headline": "Texas identifies RFP HHS0017108 for its Q1 SFY 2027 Medicaid dental procurement", "summary": "HHSC’s procurement forecast, labeled Last Updated October 9, 2026, identifies RFP HHS0017108 for statewide Medicaid and CHIP managed-care dental services and retains a Q1 SFY 2027 estimated posting date. HHSC’s managed-care timeline anticipates award in Q4 SFY 2027 and operations in Q4 SFY 2028. The original publication date is not established by these sources.", "implication": "Dental is the clearest near-term Texas opening while STAR/CHIP and STAR Kids award schedules remain important watch points.", "implication_label": "Precapture analysis", "confidence": 0.97, "sources": [ { "title": "Texas HHS Procurement Forecast — source updated October 9, 2026", "url": "https://apps.hhs.texas.gov/procurement-calendar/procurement-forecast.pdf", "primary": true, "publication_date_status": "unknown", "published_at": null, "source_updated_at": "2026-10-09", "date_provenance": { "kind": "document_explicit_update_label", "quote": "Last Updated 10/9/2026", "locator": "PDF page 1", "retrieved_at": "2026-10-12T14:12:59Z", "document_sha256": "907f2dca5a47487acdfd7be6969a4acaaa532e8c91cecba77611a40df595737e", "note": "PDF creation/modification and HTTP Last-Modified are not original publication evidence." } }, { "title": "Texas HHSC Procurement Opportunities", "url": "https://www.hhs.texas.gov/business/contracting-hhs/procurement-opportunities", "primary": true, "publication_date_status": "unknown", "published_at": null, "source_updated_at": null, "date_provenance": { "kind": "no_explicit_publication_or_update_label", "retrieved_at": "2026-10-12T14:12:59Z", "locator": "Medicaid Managed Care Procurement Timelines / Medicaid and CHIP Dental Services" } } ], "verification_tier": 2, "date_reconciliation_history": [ { "recorded_at": "2026-10-12T14:12:59Z", "previous_published_at": "2026-09-17", "previous_updated_at": "2026-09-18", "disposition": "superseded_unverified_publication_date; source_update_is_not_publication" } ], "publication_date_status": "unknown" }, { "id": "tx-2026-firstcare-rightcare-exit", "published_at": null, "effective_at": "2026-09-01", "state": "TX", "category": "market_movement", "headline": "FirstCare and RightCare Scott & White leave Texas Medicaid managed care", "summary": "Texas HHS says FirstCare and RightCare Scott & White Health Plans left the Texas Medicaid managed-care program on August 31, 2026. A separate official provider notice says their STAR participation ended for Lubbock, MRSA West and MRSA Central, with affected members moving to Wellpoint or Superior and providers required to use the receiving plan's payer code for service dates beginning September 1. Texas also says affected CHIP members were automatically enrolled in Superior beginning September 1.", "implication": "The completed exits concentrate affected STAR and CHIP enrollment among remaining plans and create measurable continuity, authorization, billing and provider-network execution risk in the impacted service areas.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "Texas HHS EVV impacts: Baylor Scott & White and FirstCare end Medicaid managed-care participation", "url": "https://www.hhs.texas.gov/provider-news/2026/08/21/evv-impacts-baylor-scott-white-firstcare-mcos-end-participation-texas-medicaid-managed-care", "primary": true, "publication_date_status": "unknown", "published_at": null }, { "title": "Texas HHS information for providers on health-plan changes", "url": "https://www.hhs.texas.gov/providers/medicaid-business-resources/information-providers-health-plan-changes", "primary": true, "publication_date_status": "unknown", "published_at": null } ], "verification_tier": 2, "publication_date_status": "unknown" }, { "id": "ca-2026-procurement-delay", "published_at": "2026-09-17", "updated_at": "2026-10-11", "state": "CA", "category": "procurement", "headline": "California postpones commercial Medi-Cal plan procurement until at least 2029", "summary": "DHCS says the next competitive commercial Medi-Cal managed-care procurement will begin no sooner than 2029, with new contracts effective no sooner than 2031. DHCS now says current plan contracts have been extended from January 1, 2027 through December 31, 2027 under its annual renewal process.", "implication": "Incumbents gain runway while challengers should shift near-term positioning toward CalAIM execution, partnerships and annual-renewal performance.", "implication_label": "Precapture analysis", "confidence": 0.96, "sources": [ { "title": "Medi-Cal Commercial Managed Care Plan Procurement Update", "url": "https://www.dhcs.ca.gov/services/medi-cal-commercial-managed-care-plan-procurement-update/", "primary": true }, { "title": "Medi-Cal Managed Care Boilerplate Contracts", "url": "https://www.dhcs.ca.gov/providers-partners/medi-cal-managed-care-boilerplate-contracts/", "primary": true } ], "verification_tier": 2 }, { "id": "la-2026-healthy-blue-exit", "published_at": "2026-09-01", "updated_at": "2026-09-18", "effective_at": "2026-12-31", "state": "LA", "category": "market_movement", "headline": "Louisiana advances financing and continuity plan for Healthy Blue exit", "summary": "Louisiana LDH says Healthy Blue's Medicaid managed-care contract will end December 31, 2026, affecting more than 290,000 members. Members may select Aetna Better Health, AmeriHealth Caritas Louisiana, Humana Healthy Horizons or Louisiana Healthcare Connections from October 15 through November 16; members who do not choose will be assigned before January 1, 2027. On September 17, LDH presented proposed 2027 contract extensions under which the four remaining plans would collectively receive a cited contract amount (amount for subscribers), subject to legislative approval. The state said plan performance may influence some automatic assignments and receiving plans must honor previously authorized services and prescriptions for the first 60 days of 2027.", "implication": "The transition now has explicit financing, continuity and performance-based enrollment stakes. The four remaining plans gain membership opportunity but face near-term network-matching, authorization, pharmacy, member-service and auto-assignment execution exposure; stronger measured performance may also affect enrollment allocation.", "implication_label": "Precapture analysis", "confidence": 0.98, "sources": [ { "title": "Louisiana Department of Health Healthy Blue transition announcement", "url": "https://ldh.la.gov/news/healthy-blue-coverage", "primary": true }, { "title": "Louisiana Joint Legislative Committee on the Budget meeting file — September 17, 2026", "url": "https://jlcb.legis.la.gov/Docs/2026/JLCB%20Meeting%20File%20091726.pdf", "primary": true }, { "title": "Medicaid exits mean Louisiana will pay remaining plans more", "url": "https://lailluminator.com/2026/09/18/louisiana-prepares-to-pay-more-to-its-remaining-private-medicaid-plans/", "primary": false } ], "verification_tier": 2 }, { "id": "cms-may-2026-enrollment", "published_at": "2026-08-28", "state": "US", "category": "policy", "headline": "CMS reports 73.5 million Medicaid and CHIP enrollees for May 2026", "summary": "CMS reported 66,388,522 Medicaid enrollees and 7,137,750 CHIP enrollees across reporting states and DC for May 2026.", "implication": "Current state-level enrollment should anchor market-size estimates and transition capacity assumptions rather than stale annual totals.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "May 2026 Medicaid & CHIP Enrollment Data Highlights", "url": "https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights", "primary": true }, { "title": "May 2026 Medicaid/CHIP Eligibility Operations & Enrollment Snapshot", "url": "https://www.medicaid.gov/resources-for-states/downloads/eligib-oper-and-enrol-snap-may2026.pdf", "primary": true } ], "verification_tier": 2 }, { "id": "id-2026-managed-care-blackout", "published_at": "2026-08-19", "state": "ID", "category": "procurement", "headline": "Idaho sets December 1 blackout before comprehensive managed-care RFP", "summary": "Idaho DHW and Idaho Capital Sun report that the comprehensive managed-care transition is delayed to 2030 and that a procurement blackout begins December 1, 2026. DHW separately says it expects the RFP later in 2027.", "implication": "The remaining pre-blackout period is a defined market-shaping window for Idaho-specific rural access, workforce, LTSS, claims-readiness and provider-experience evidence.", "implication_label": "Precapture analysis", "confidence": 0.98, "sources": [ { "title": "The Future of Idaho Medicaid is Managed Care", "url": "https://healthandwelfare.idaho.gov/managedcare", "primary": true }, { "title": "Idaho lawmakers hope to ensure timely doctor payments, treatment approvals in Medicaid transition", "url": "https://idahocapitalsun.com/2026/09/25/idaho-lawmakers-hope-to-ensure-timely-doctor-payments-treatment-approvals-in-medicaid-transition/", "primary": false } ], "verification_tier": 2 }, { "id": "il-2026-meridian-hcbs-sanction", "published_at": "2026-08-14", "effective_at": "2026-08-22", "state": "IL", "category": "performance", "headline": "Illinois imposes a monetary sanction on Meridian (amount for subscribers), corrective-action plan and enrollment hold", "summary": "Illinois HFS sanctioned Meridian Health Plan (monetary sanction, amount for subscribers) for multiple HealthChoice Illinois contract failures involving HCBS waiver service planning, authorizations, appeals and care-coordinator training. HFS imposed an enrollment hold effective August 22, 2026, suspending automatic assignments and new enrollment until the department, in consultation with its EQRO, determines that deficiencies are resolved. The state enrollment site says current members may remain enrolled and waiver-service members qualify for a special enrollment period while the hold remains in place.", "implication": "The active hold creates near-term enrollment and reputation pressure for Meridian while making HCBS remediation, appeal accuracy, service-plan documentation and state/EQRO validation measurable competitive issues during Illinois contract implementation.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "Illinois HFS Meridian sanction notice and corrective action plan — August 14, 2026", "url": "https://hfs.illinois.gov/content/dam/soi/en/web/hfs/medicalproviders/cc/sanctions/2026/meridianhcihcbcbss08142026.pdf", "primary": true }, { "title": "Illinois Client Enrollment Services — Meridian Health Plan sanction", "url": "https://enrollhfs.illinois.gov/en/news", "primary": true } ], "verification_tier": 2 }, { "id": "elv-2026-dc-exit", "published_at": "2026-08-13", "state": "DC", "category": "market_movement", "headline": "Elevance agrees to exit the District's Medicaid market", "summary": "Elevance leadership said the company mutually agreed with the District to exit DC Medicaid and expects additional targeted exits over 12–18 months where it does not see a path to sustainable performance.", "implication": "Competitors should distinguish broad Medicaid commitment from state-level portfolio discipline and watch for continuity, rebid and replacement opportunities in marginal markets.", "implication_label": "Precapture analysis", "confidence": 0.94, "sources": [ { "title": "Elevance Health 2026 Q2 Earnings Call", "url": "https://ir.elevancehealth.com/events-and-presentations/event-details/2026/Elevance-Health-2026-Q2-Earnings-Call/default.aspx", "primary": true }, { "title": "Medicaid Managed Care: The Big Five in Q2 2026", "url": "https://ccf.georgetown.edu/2026/08/13/medicaid-managed-care-the-big-five-in-q2-2026/", "primary": false } ], "verification_tier": 2 }, { "id": "cnc-2026-arhome-exit", "published_at": "2026-08-13", "updated_at": "2026-10-06", "state": "AR", "category": "market_movement", "headline": "Arkansas sets enrollment path for Centene's ARHOME exit", "summary": "Arkansas DHS says Centene, also known in the market as Ambetter, QCA and QualChoice, will leave ARHOME at the end of 2026. Affected members may select an Arkansas Blue Cross Blue Shield plan from October 15 through December 15, 2026; members who do not select a plan will be automatically placed into a Blue Cross plan without a coverage lapse and will have 30 days to change that assignment.", "implication": "The exit now has a defined member-transition window. Enrollment communications, automatic assignment, continuity and Blue Cross readiness are the immediate execution tests.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "Arkansas DHS ARHOME Open Enrollment", "url": "https://humanservices.arkansas.gov/divisions-shared-services/medical-services/healthcare-programs/arhome/arhome-open-enrollment/", "primary": true }, { "title": "Medicaid Managed Care: The Big Five in Q2 2026", "url": "https://ccf.georgetown.edu/2026/08/13/medicaid-managed-care-the-big-five-in-q2-2026/", "primary": false } ], "verification_tier": 2 }, { "id": "az-2026-altcs-epd-rfp", "published_at": "2026-08-04", "updated_at": "2026-09-26", "state": "AZ", "category": "procurement", "headline": "Arizona posts official list of ALTCS E/PD offers received", "summary": "AHCCCS's official YH27-0001 bidders’ library posted a List of Offers Received, as verified September 26. Solicitation Amendment 3, dated September 9, had replaced Exhibit F2 for contract citations and past-performance submissions, incorporated a second round of answers, and required a signed amendment with each response. Proposals were due September 24, 2026 at 3:00 p.m. Arizona time. The official schedule sets oral presentations for October 26 through November 10, with contract award planned for January 2027 and contract operations beginning October 1, 2027.", "implication": "The posted offeror list confirms that the competition has moved into evaluation. The next scheduled checkpoints are oral presentations and the planned January award.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "AHCCCS YH27-0001 ALTCS E/PD Bidders’ Library", "url": "https://www.azahcccs.gov/PlansProviders/HealthPlans/YH27-0001.html", "primary": true }, { "title": "AHCCCS YH27-0001 Solicitation Amendment 3", "url": "https://www.azahcccs.gov/Resources/Downloads/Solicitations/Open/RFPs/YH27-0001/YH27-0001_SolicitationAmend3.pdf", "primary": true } ], "deadline_at": "2026-09-24T15:00:00-07:00", "verification_tier": 2 }, { "id": "pa-2026-healthchoices-physical-health-rfi", "published_at": "2026-10-06", "state": "PA", "category": "procurement", "headline": "Pennsylvania issues HealthChoices Physical Health RFI 26-RFI-20476", "summary": "The Pennsylvania eMarketplace advertisement for solicitation 26-RFI-20476 lists the title HealthChoices for Physical Health Services, a solicitation start date of October 6, 2026, and a due date of November 20, 2026 at 12:00 p.m. The advertisement is issued by the Department of Human Services Bureau of Procurement and Contract Management and asks for input toward a future HealthChoices Physical Health RFA and improvements to the mandatory managed care program. FindMyBids and ContractRadar list the same solicitation number, title, October 6 posting, and November 20 deadline.", "implication": "This RFI is a pre-solicitation signal for a later RFA. It is not an award and it is not a contract proposal deadline. Responses are due November 20, 2026. The official advertisement is the controlling record.", "implication_label": "Precapture analysis", "confidence": 0.98, "deadline_at": "2026-11-20T12:00:00-05:00", "verification_tier": 2, "sources": [ { "title": "Pennsylvania eMarketplace solicitation 26-RFI-20476", "url": "https://www.emarketplace.state.pa.us/Solicitations.aspx?SID=26-RFI-20476", "primary": true }, { "title": "FindMyBids listing for 26-RFI-20476", "url": "https://findmybids.com/bids/pa:26-RFI-20476", "primary": false }, { "title": "ContractRadar listing for 26-RFI-20476", "url": "https://contractradar.io/posts/01742a0b-7f9b-4c2b-8921-46db72e9eef3", "primary": false } ] }, { "id": "ga-2026-families-cmo-protest", "published_at": "2026-04-23", "state": "GA", "category": "procurement", "headline": "Georgia Families solicitation 41900-DCH0000133 remains in protest", "summary": "The Georgia Department of Community Health's April 23, 2026 Georgia Families update says solicitation 41900-DCH0000133 is in the protest phase and a notice of award has not been issued. The same update extends the current contracts for Amerigroup, CareSource, and Peach State through June 30, 2027. The December 26, 2024 notice of intent to award names CareSource, Humana, Molina, and UnitedHealthcare as the apparent successful health plans, and names UnitedHealthcare for the Georgia Families 360 contract.", "implication": "The notice of award is still unissued, so the apparent successful plans are not a completed award. The June 30, 2027 date is an extension of the current Amerigroup, CareSource, and Peach State contracts.", "implication_label": "Precapture analysis", "confidence": 0.98, "verification_tier": 2, "sources": [ { "title": "Georgia Families latest news", "url": "https://medicaid.georgia.gov/programs/all-programs/georgia-families/georgia-families-latest-news", "primary": true }, { "title": "Georgia Procurement Registry event 41900-DCH0000133", "url": "https://ssl.doas.state.ga.us/gpr/eventDetails?eSourceNumber=41900-DCH0000133&sourceSystemType=ps", "primary": true } ] }, { "id": "pa-2026-chc-waiver", "published_at": "2026-07-01", "state": "PA", "category": "policy", "headline": "Pennsylvania’s updated Community HealthChoices waiver takes effect", "summary": "Pennsylvania and the Rehabilitation & Community Providers Association report that CMS approved the Community HealthChoices Section 1915(c) waiver amendment effective July 1, 2026.", "implication": "CHC contractors must align HCBS oversight, participant protections, authorizations and grievance operations with the renewed authorities and agreement.", "implication_label": "Precapture analysis", "confidence": 0.98, "sources": [ { "title": "Community HealthChoices Supporting Documents", "url": "https://www.pa.gov/agencies/dhs/resources/medicaid/chc/chc-supporting-documents", "primary": true }, { "title": "CMS Approves CHC Waiver Amendment", "url": "https://www.paproviders.org/cms-approves-chc-waiver-amendment", "primary": false } ], "verification_tier": 2 }, { "id": "il-2026-healthchoice-awards", "published_at": "2026-06-09", "state": "IL", "category": "award", "headline": "Illinois opens Humana enrollment and sets MLTSS plan transitions", "summary": "Illinois formally awarded new HealthChoice Illinois contracts to Aetna, Blue Cross Blue Shield, Humana, Meridian, Molina and CountyCare. The state's official enrollment site says eligible clients may choose Humana for HealthChoice Illinois or MLTSS beginning October 16, 2026, with coverage effective January 1, 2027 and a special enrollment period through March 31, 2027 for otherwise locked-in clients. The same official page says CountyCare and Blue Cross Blue Shield will leave MLTSS after December 31, 2026, and affected MLTSS members must choose a new plan by that date for January 1 coverage.", "implication": "The award has entered member-choice and transition execution. Humana now has a defined enrollment runway, while the MLTSS changes create near-term member communication, plan selection, continuity and receiving-plan capacity tests.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "Illinois HFS procurement", "url": "https://hfs.illinois.gov/info/procurement.html", "primary": true }, { "title": "Illinois awards new Medicaid contracts", "url": "https://www.healthcaredive.com/news/illinois-medicaid-awards-healthchoice-contracts-humana/822278/", "primary": false }, { "title": "Illinois Client Enrollment Services — Humana and MLTSS transition news", "url": "https://enrollhfs.illinois.gov/en/news", "primary": true } ], "verification_tier": 2, "updated_at": "2026-10-16" }, { "id": "cnc-2026-leadership", "published_at": "2026-04-06", "state": "US", "category": "leadership", "headline": "Centene reorganizes leadership around Medicaid and local-market execution", "summary": "Centene announced Daniel Finke and Michael Carson as group presidents in a structure separating Medicaid/Marketplace responsibilities from Medicare/Specialty responsibilities. Centene's April announcement called Finke Group President, Markets and Commercial; a May SEC filing described the role as Group President, Medicaid and Marketplace.", "implication": "The structure sharpens Medicaid and local-market accountability while importing senior Aetna operating experience.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "Centene Announces New Executive Leadership Structure", "url": "https://investors.centene.com/2026-04-06-Centene-Announces-New-Executive-Leadership-Structure", "primary": true }, { "title": "Centene Corporation Form 8-K, May 12, 2026", "url": "https://www.sec.gov/Archives/edgar/data/1071739/000107173926000117/cnc-20260512.htm", "primary": true } ], "verification_tier": 2 }, { "id": "la-2026-uhc-closeout", "published_at": "2026-03-31", "state": "LA", "category": "market_movement", "headline": "Louisiana closes UnitedHealthcare Medicaid contract and reassigns members", "summary": "Louisiana closed UnitedHealthcare’s Medicaid contract on March 31, 2026 and reassigned nearly 280,000 members among remaining Healthy Louisiana plans.", "implication": "The exit creates an immediate share and service-transition opportunity for remaining plans while placing continuity and member-transfer execution under scrutiny.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "Louisiana LDH UnitedHealthcare closeout", "url": "https://ldh.la.gov/news/united-healthcare-closeout", "primary": true }, { "title": "UnitedHealth Group Q2 2026 results", "url": "https://www.unitedhealthgroup.com/content/dam/UHG/PDF/investors/2026/unh-reports-second-quarter-2026-results.pdf", "primary": true } ], "verification_tier": 2 }, { "id": "wi-2026-family-care-expansion", "published_at": "2026-03-01", "state": "WI", "category": "market_movement", "headline": "Wisconsin begins enrollment for new and expanding Family Care plans", "summary": "After a procurement protest was withdrawn, Wisconsin moved forward with Family Care and Partnership awards in regions 2 and 7. Anthem entered Family Care in both regions, while Inclusa, iCare and Molina/My Choice Wisconsin expanded in specified markets.", "implication": "Competition has shifted from award to network, certification, member-choice and transition execution.", "implication_label": "Precapture analysis", "confidence": 0.98, "sources": [ { "title": "Wisconsin Family Care Request for Proposal", "url": "https://www.dhs.wisconsin.gov/familycare/rfp.htm", "primary": true }, { "title": "Family Care, Family Care Partnership, and PACE: What’s New", "url": "https://www.dhs.wisconsin.gov/es/node/2899", "primary": true } ], "verification_tier": 2 }, { "id": "in-2026-mce-procurement", "published_at": "2026-10-27", "state": "IN", "category": "procurement", "headline": "Indiana withdraws Medicaid RFP 27-88343", "summary": "The IDOA current business opportunities page states that FSSA-OMPP is withdrawing RFP 27-88343, Indiana Medicaid Managed Care Organizations, for compliance with IC § 12-15-5-17.5(c)(2). FSSA-OMPP anticipates reissuing the RFP in substantially the same form, most likely by November 9, 2026. The January 1, 2029 go-live is unchanged.", "implication": "The November 6, 2026 proposal date is not a live deadline while this solicitation is withdrawn. The October 11, 2026 controlling-package cutoff is superseded. Watch the IDOA index for the reissued solicitation.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "Indiana IDOA current business opportunities", "url": "https://www.in.gov/idoa/procurement/current-business-opportunities/", "primary": true }, { "title": "Indiana IDOA RFP 27-88343 solicitation file", "url": "https://www.in.gov/idoa/proc/solicitations/files/005030000088343.zip", "primary": true } ], "updated_at": "2026-10-27", "verification_tier": 2 }, { "id": "cms-2026-sdp-change", "published_at": "2026-02-02", "state": "US", "category": "policy", "headline": "CMS updates state-directed payment policy under Public Law 119-21", "summary": "CMS released preliminary guidance reducing payment limits for specified state-directed payments and describing temporary grandfathering for certain arrangements across all states and DC.", "implication": "Plans and states face renewed rate-development and provider-financing complexity; procurement models should stress-test directed-payment assumptions and implementation timing.", "implication_label": "Precapture analysis", "confidence": 0.98, "sources": [ { "title": "State Directed Payments", "url": "https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments", "primary": true }, { "title": "New CMS Guidance on H.R. 1’s Restrictions of State Directed Payments", "url": "https://ccf.georgetown.edu/2026/02/04/new-cms-guidance-on-h-r-1s-restrictions-of-state-directed-payments/", "primary": false } ], "verification_tier": 2 }, { "id": "macpac-procurement-practices", "published_at": "2022-04-07", "state": "US", "category": "stakeholder_signal", "headline": "MACPAC documented procurement-capacity and policy-goal challenges in 2022", "summary": "In April 2022, MACPAC reported that states use managed-care purchasing to advance program goals while complex procurements can strain staff responsible for ongoing operations. This is archival context, not a newly occurring 2026 event.", "implication": "Credible bids should reduce state implementation burden and show measurable alignment to policy goals, not only offer program features.", "implication_label": "Precapture analysis", "confidence": 0.92, "sources": [ { "title": "Understanding Medicaid Managed Care Procurement Practices Across States", "url": "https://www.macpac.gov/publication/understanding-medicaid-managed-care-procurement-practices-across-states/", "primary": true }, { "title": "April 2022 Public Meeting", "url": "https://www.macpac.gov/meeting/april-2022-macpac-public-meeting/", "primary": true } ], "verification_tier": 2 }, { "id": "sc-2026-managed-care-carvein", "published_at": "2026-01-01", "state": "SC", "category": "policy", "headline": "South Carolina adds member populations to managed care for medical services", "summary": "SCDHHS moved medical services for additional Healthy Connections members into managed care effective January 1, 2026, while waiver services remain fee-for-service.", "implication": "Plans need strong managed-care/waiver coordination, transition, authorization, encounter and provider-communication capabilities.", "implication_label": "Precapture analysis", "confidence": 0.98, "sources": [ { "title": "South Carolina Health & Managed Care Plans", "url": "https://www.scdhhs.gov/partners/health-managed-care-plans", "primary": true }, { "title": "Select Health provider alert — Medicaid carve-in for waiver and nursing-facility populations", "url": "https://www.selecthealthofsc.com/content/dam/first-choice/selecthealthofsc/pdf/provider/newsletters-and-updates/2026/022626-provider-alert-medicaid-carve-in-waiver.pdf.coredownload.inline.pdf", "primary": false } ], "verification_tier": 2 }, { "id": "nv-2026-caresource-entry", "published_at": "2026-01-01", "state": "NV", "category": "market_movement", "headline": "CareSource begins statewide Nevada Medicaid operations", "summary": "CareSource began operating Nevada Medicaid statewide on January 1, 2026, including rural counties and Clark and Washoe counties.", "implication": "Nevada gives CareSource a western beachhead and intensifies competition with four national plans in the statewide model.", "implication_label": "Precapture analysis", "confidence": 0.96, "sources": [ { "title": "CareSource awarded Nevada Medicaid managed care contract", "url": "https://www.caresource.com/newsroom/press-releases/caresource-awarded-nevada-medicaid-managed-care-contract/", "primary": true }, { "title": "Nevada Medicaid MCO information", "url": "https://www.medicaid.nv.gov/providers/enrollees/MCOinfo", "primary": true } ], "verification_tier": 2 }, { "id": "fl-2025-cms-molina", "published_at": "2025-11-10", "updated_at": "2026-09-25", "state": "FL", "category": "award", "headline": "Florida sets eight-month continuity protection for October 1 CMS Plan transition to Molina", "summary": "Florida AHCA confirms that Molina Healthcare of Florida will assume statewide Children's Medical Services Plan operations from Sunshine Health on October 1, 2026. In a September 25 provider alert, AHCA said Molina's continuity-of-care period may extend through May 31, 2027: services authorized by Sunshine and documented courses of treatment in effect on October 1 remain covered until the authorization, treatment course or continuity period ends, or a new care plan and services are authorized, whichever occurs first. Members may continue seeing current providers during that period, and Molina must reimburse non-participating providers at their prior rate unless an alternative rate is agreed.", "implication": "The eight-month protection materially lowers immediate disruption risk but creates a measurable transition test for Molina across authorization migration, out-of-network reimbursement, care-plan conversion, provider support and complaint resolution for medically complex children.", "implication_label": "Precapture analysis", "confidence": 0.99, "sources": [ { "title": "Florida AHCA CMS Plan Transition", "url": "https://ahca.myflorida.com/medicaid/statewide-medicaid-managed-care/2025-2030-smmc-plans/cms-plan-transition.html", "primary": true }, { "title": "Florida Medicaid Health Care Alert — CMS Plan transition continuity of care, September 25, 2026", "url": "https://www.icontact-archive.com/archive?c=227375&f=11179&s=13873&m=879176&t=850d8a08f66cb5c2e1e49656573dbe0caeb447b39b9d192096e732cbe37425f5", "primary": true } ], "effective_at": "2026-10-01", "verification_tier": 2 }, { "id": "ri-2026-mco-amendment-21", "published_at": "2026-07-01", "state": "RI", "category": "procurement", "headline": "Rhode Island executes Amendment 21 to the three Medicaid managed-care contracts", "summary": "EOHHS executed Amendment 21 to the Medicaid Managed Care Services agreements with Neighborhood Health Plan of Rhode Island, UnitedHealthcare of New England, and Tufts Health Public Plans. Each standalone amendment was entered into on July 1, 2026, and each underlying agreement is dated March 1, 2017. Each full contract states the period March 1, 2017 to June 30, 2022 with seven one-year option periods. The Division of Purchases legacy bid search returned no solicitation rows.", "implication": "Amendment 21 keeps the three incumbent Medicaid Managed Care Services contracts in force under the March 1, 2017 agreements. The retrieved legacy bid search contains no solicitation rows. Questions, proposal, award, and go-live dates are absent from the documents PrecaptureBot retrieved on October 27, 2026.", "implication_label": "Precapture analysis", "confidence": 0.99, "verification_tier": 2, "sources": [ { "title": "Neighborhood Health Plan of Rhode Island Amendment 21", "url": "https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2026-08/NHPRI_Amend_21_StandAlone_Fully%20Executed_20260624.pdf", "primary": true }, { "title": "UnitedHealthcare of New England Amendment 21", "url": "https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2026-08/UHC_Amend_21_StandAlone_Fully%20Executed_20260624.pdf", "primary": true }, { "title": "Tufts Health Public Plans Amendment 21", "url": "https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2026-08/THPP_Amend_21_StandAlone_Signed_Fully%20Executed_20260626.pdf", "primary": true }, { "title": "Neighborhood Health Plan of Rhode Island Medicaid Managed Care Services contract", "url": "https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2026-08/NHPRI_Amend_21_executed_Fully%20Executed_20260624.pdf", "primary": true }, { "title": "UnitedHealthcare of New England Medicaid Managed Care Services contract", "url": "https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2026-08/UHC_Amend_21_Fully%20Executed_20260624.pdf", "primary": true }, { "title": "Tufts Health Public Plans Medicaid Managed Care Services contract", "url": "https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2026-08/THPP_Amend_21__Fully%20Executed_20260626.pdf", "primary": true }, { "title": "Rhode Island Division of Purchases legacy bid search", "url": "https://purchasing.ri.gov/bidding/BidSearch.aspx", "primary": true } ] }, { "id": "ri-2026-fide-snp-qlv27007040", "published_at": "2026-10-02", "updated_at": "2026-10-27", "state": "RI", "category": "procurement", "headline": "Rhode Island posts QLV27007040 for the FIDE-SNP program, proposals due November 4, 2026", "summary": "Ocean State Procures solicitation QLV27007040 is titled Fully Integrated Dual Eligible Special Needs Plan Program (FIDE-SNP). The solicitation states that the Rhode Island Executive Office of Health and Human Services is seeking proposals and that questions go to the Division of Purchases eProcurement site. It states a start of October 02, 2026 at 11:00:00 AM EDT, an end of November 04, 2026 at 11:00:00 AM EST, vendor Q&A from October 02, 2026 at 11:15:00 AM EDT through October 16, 2026 at 2:00:00 PM EDT, a non-mandatory pre-bid conference on 10/15/2026 at 10:00 AM EST, and an initial contract period beginning January 1, 2028 for one year with up to five additional 12-month periods.", "implication": "Neighborhood Health Plan of Rhode Island is an incumbent on the Medicaid Managed Care Services contract. QLV27007040 is a separate EOHHS solicitation to qualify managed-care organizations for the FIDE-SNP program, so the November 4, 2026 proposal deadline is a timing item for this plan.", "implication_label": "Precapture analysis", "confidence": 0.99, "verification_tier": 2, "deadline_at": "2026-11-04T11:00:00-05:00", "sources": [ { "title": "Ocean State Procures solicitation document QLV27007040", "url": "https://webprocure.proactiscloud.com/MainBidBoard/solicitation_document.pdf?ac=2&bidid=146431", "primary": true }, { "title": "Ocean State Procures public bid board record for QLV27007040", "url": "https://webprocure.proactiscloud.com/wp-web-public/en/#/bidboard/bid/146431?customerid=120002&oid=120002", "primary": true } ] }, { "id": "il-2026-healthchoice-bidbuy-award", "published_at": "2026-06-08", "state": "IL", "category": "procurement", "headline": "Illinois BidBuy records a June 8, 2026 notice of award for HealthChoice Illinois", "summary": "BidBuy solicitation 26-478HFS-MEDPR-B-49167 is an HFS HealthChoice Illinois procurement. The page lists a bid opening date of November 13, 2025. The amendment list includes Addendum #1, Addendum #2, and a June 8, 2026 notice of award. A BidBuy No Bid warning on that list is not an addendum. The HFS procurement page states that current HealthChoice Illinois contracts expire on December 31, 2026.", "implication": "The BidBuy docket records a notice of award dated June 8, 2026. The HFS procurement page states that current HealthChoice Illinois contracts expire on December 31, 2026. The notice attachment was not retrieved, so a replacement contract end date remains unstated in this item.", "implication_label": "Precapture analysis", "confidence": 0.99, "verification_tier": 2, "sources": [ { "title": "Illinois BidBuy solicitation 26-478HFS-MEDPR-B-49167", "url": "https://www.bidbuy.illinois.gov/bso/external/bidDetail.sda?docId=26-478HFS-MEDPR-B-49167&external=true&parentUrl=close", "primary": true }, { "title": "Illinois HFS procurement", "url": "https://hfs.illinois.gov/info/procurement.html", "primary": true } ] }, { "id": "il-2026-september-mco-enrollment", "published_at": "2026-09-01", "state": "IL", "category": "market_movement", "headline": "Illinois reports September 1, 2026 managed-care enrollment by plan", "summary": "The HFS detailed managed-care enrollment report as of September 1, 2026 lists these plan totals: Aetna Better Health 331,185; BlueCross/Blue Shield of Illinois 679,512; CountyCare 374,872; Humana Health Plan 26,471; Meridian Health Plan 607,540; Molina Health Care 270,415; YouthCare 35,707. The report says YouthCare is administered by Meridian Health. The HealthChoice Illinois contact page lists Aetna Better Health of Illinois, Blue Cross Community Health Plan, CountyCare Health Plan for Cook County only, Meridian Health Plan, and Molina Healthcare.", "implication": "The September 1, 2026 report is the latest monthly enrollment file retrieved. CountyCare's total on that report is 374,872. YouthCare's total is 35,707 and the report says YouthCare is administered by Meridian Health.", "implication_label": "Precapture analysis", "confidence": 0.99, "verification_tier": 2, "sources": [ { "title": "Illinois HFS detailed managed care enrollment index", "url": "https://hfs.illinois.gov/info/factsfigures/detailedmanagedcareenrollment.html", "primary": true }, { "title": "Illinois HFS enrollment as of September 1, 2026", "url": "https://hfs.illinois.gov/content/dam/soi/en/web/hfs/info/factsfigures/detailedmanagedcare/092026dmce.pdf", "primary": true }, { "title": "Illinois HFS managed care contact list", "url": "https://hfs.illinois.gov/medicalclients/managedcare.html", "primary": true } ] } ], "positioning": [ { "entity": "Humana", "direction": "expanding", "evidence": "Enrollment opened October 16 for January 1 HealthChoice Illinois and MLTSS coverage", "state": "IL", "as_of": "2026-10-16" }, { "entity": "Molina Healthcare", "direction": "expanding", "evidence": "Selected for Florida's statewide CMS Health Plan", "state": "FL", "as_of": "2025-11-10" }, { "entity": "Elevance Health", "direction": "contracting", "evidence": "DC Medicaid exit and Louisiana Healthy Blue exit effective at year-end 2026", "state": "US", "as_of": "2026-09-01" }, { "entity": "UnitedHealthcare Community & State", "direction": "contracting", "evidence": "Louisiana contract closed and members reassigned", "state": "LA", "as_of": "2026-03-31" }, { "entity": "CareSource", "direction": "expanding", "evidence": "Began statewide Nevada Medicaid operations", "state": "NV", "as_of": "2026-01-01" }, { "entity": "Centene", "direction": "reorganizing", "evidence": "New Markets and Commercial leadership structure covers Medicaid", "state": "US", "as_of": "2026-04-06" } ], "content_updated_at": "2026-10-28T16:30:00Z", "monitoring": { "verification_run_at": "2026-10-29T11:02:11.415861Z", "coverage_status": "partial", "scope_count": 20, "verified_count": 3, "unknown_count": 17, "verified_states": [ "AZ", "IN", "NM" ], "unknown_states": [ "AR", "CA", "DC", "FL", "GA", "IA", "ID", "IL", "LA", "MI", "MS", "NC", "NH", "PA", "RI", "TX", "WI" ], "stale_states": [ "AR", "AZ", "DC", "FL", "GA", "IA", "ID", "LA", "MI", "MS", "NC", "PA", "RI", "WI" ], "content_sha256": "ea949dfb2fe7e87d70986fbc12dc8b4cb8b1303cd3bd1dc303bd10a1bbd94a11" } }