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 obtaining information about Ohio's Medicaid program. The selected vendor must demonstrate experience in Medicaid and/or commercial health care, managed care enrollment brokering, 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:

- Developing a consumer support system
- Providing web portals for MCOs and providers
- Resolving Just Cause requests
- Establishing connections to ODM’s technology systems
- Ensuring compliance with ISO guidelines for information security
- Conducting necessary system testing
- Performing data analytics
- Producing monthly reports
- Providing decision support tools
- Ensuring accessibility of enrollment information
- Offering choice counseling
- Completing Consumer Contact Records (CCR)
- Managing auto assignment processes
- Interfacing with OMES and OBES for demographic data
- Allowing alternative enrollment processes for special populations such as MyCare Ohio and children in custody
- Building a central repository of all Ohio Medicaid providers
- Maintaining an online provider complaint form
- Providing customer service agents to assist callers with inquiries related to Medicaid programs, benefits, and enrollment processes.

Period of Performance
The contract period is expected to run from contract award through June 30, 2027, with the possibility of two renewal periods through June 2031, contingent upon satisfactory performance.

Place of Performance
Services will be performed primarily in Ohio, specifically at a location agreed upon by ODM within the Columbus metropolitan area.

Bidder Requirements
Offerors must meet several qualifications including:

- Three years of experience in enrolling individuals into health care plans
- Two years of experience operating a call center with a capacity of at least 200,000 calls per month
- Independence from any Managed Care Organization (MCO)
- Submission of a selected Ohio certified Minority Business Enterprise (MBE) subcontractor equating to at least 15% of the total contract amount per state fiscal year
- Compliance with personal confidential information requirements.