Request for Information for Innovative Medicaid Enterprise Systems (MES) Solutions

Request for Information

Medicaid programs and the systems that support them are rapidly changing. In the decade since passage of the Affordable Care Act, State Medicaid Agencies have needed to consider a wide array of new ideas, tools, and constraints in order to deliver quality care to members, most notably:

  • Value Based Payments (VBP)
  • Block Grant Funding Models
  • Medicaid Information Technology Architecture Updates
  • Budget and Resource Pressures, including those created by the COVID-19 response
  • Emerging uses of Social Determinants and Population Health Data
  • Health Information Exchanges
  • Office of the National Coordinatorfor Health Information Technology (ONC) Standards
  • Fast Healthcare Interoperability Resources (FHIR)Standards
  • Centers for Medicare & Medicaid Services (CMS) Data & Systems Group transition to Outcomes Based Certification (OBC)

In order to efficiently and effectively respond to these developments, Medicaid Enterprise Systems (MES) strategies must reflect long-term planning that includes both traditional and emerging solutions. To accomplish this, the New York State Department of Health ("DOH" or "Department") is engaged in a multi-year effort to create a Medicaid Enterprise Systems Roadmap.

When complete, the Roadmap will clearly lay out the Department's path forward for Design, Development, and Implementation (DDI) of Medicaid Enterprise Systems, including procurement of Medicaid Management Information Systems (MMIS), Medicaid Eligibility and Enrollment (E&E) modules, and supporting services. It will also provide required analysis consistent with CFR § 95.610 - Submission of advance planning documents.

The Department has previously gathered feedback on its vision for the New York State of Health (NYSOH) insurance system. Through this Request for Information ("RFI") for Innovative Medicaid Enterprise Systems Solutions, the Department seeks information on other Medicaid Enterprise solutions that may be used for Medicaid Enterprise Systems Roadmap planning.

Portions of the information gathered through this RFI may be shared with the Centers for Medicare & Medicaid Services (CMS), with contractors working with the Department on developing its MES Roadmap, and with other states. NYSDOH recognizes that responders may be hesitant to reveal solutions in or nearing development and unknown to the general public. Therefore, responders should clearly and specifically identify any portion of the response that a responder believes constitutes proprietary information entitled to confidential handling as an exception to the Freedom of Information Law. Please refer to Section 9.2 below for more information.

Schedule of Events

Release the RFI April 29, 2021
Deadline to Submit Questions May 13, 2021 by 5:00 p.m. ET
Answers to Questions On or about: May 28, 2021
RFI Response Due Date June 14, 2021 by 5:00 p.m. ET
Anticipated Responder Interview Period begins July 14, 2021

DOH Contact Information

  • Michael Lewandowski
    New York State Department of Health
    Office of Health Insurance Programs
    One Commerce Plaza Room 1450
    99 Washington Ave
    Albany NY 12210
    Telephone: 518-473-4657