Medicaid Hotline & Enrollment Broker RFP

Background
The Ohio Department of Medicaid (ODM) is seeking a vendor to operate and manage the Ohio Medicaid Consumer Hotline and provide enrollment broker services. This initiative aims to assist individuals on Medicaid and the general public in accessing information about Ohio’s Medicaid program. The selected vendor must demonstrate experience in Medicaid, managed care enrollment, customer service, call center management, and information technology for call center operations.

Work Details
The selected vendor will be responsible for providing managed care enrollment broker services, which include:

1) Developing a consumer support system for pre- and post-enrollment assistance;
2) Providing a web portal for MCOs for Just Cause requests and complaint resolution;
3) Creating a web portal for providers to submit complaints regarding MCOs;
4) Resolving Just Cause requests and collecting details of grievances;
5) Establishing a direct connection to ODM’s technology systems;
6) Meeting ISO guidelines for information security;
7) Completing necessary system testing and providing results to ODM;
8) Ensuring accurate data used in reporting and analytics;
9) Producing monthly summary reports;
10) Providing decision support tools for consumers regarding plan benefits;
11) Ensuring accessibility of enrollment materials for individuals with limited English proficiency or visual impairments;
12) Offering unbiased choice counseling during enrollment; and
13) Completing Consumer Contact Records (CCRs) for each individual during the selection process.

Period of Performance
The contract period is expected to run from contract award through June 30, 2027, with the possibility of two renewal contracts extending through June 2031.

Place of Performance
The services will be performed primarily in Ohio, specifically targeting the Medicaid population across the state.