{ "_schema": { "version": "1.0", "last_verified": "2026-09-22", "owner": "hand-maintained; docs/market-entry-coverage-spec.md section 4.3", "research_method": "Web search on 2026-09-20 returning each page's own statements; direct fetch of every external domain was blocked by the session proxy, so procurement portal, MES modernization and work-requirement status stayed pending. A 2026-09-22 pass from the desktop fetched pages and checked each portal URL live to fill those three fields where a source supports them; a field no source supports stays pending. Official state, federal and NASPO pages are high confidence; secondary summaries are medium.", "jurisdictions": 56, "pending_fields_note": "procurement_portal_url, mes_modernization and work_requirements_status are null on every row unless a source is named. Fill one state at a time with a source URL and a retrieved date, then remove the field from pending and bump verified.", "expansion_source": { "label": "KFF: Status of State Medicaid Expansion Decisions (read 2026-09-20; 41 states including DC adopted, 10 not adopted)", "url": "https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/" }, "govramp_source": { "label": "GovRAMP participating governments (read 2026-09-20; 73 entities across 33 states as of August 2026)", "url": "https://govramp.org/participating-governments/" }, "fill_log": [ { "date": "2026-09-22", "method": "Research pass with page fetches and live URL checks from the desktop; every filled field carries its source and retrieved date; unsourced fields stay in pending.", "filled": { "procurement_portal_url": 10, "mes_modernization": 0, "work_requirements_status": 1 } }, { "date": "2026-09-22", "method": "Research pass with page fetches and live URL checks from the desktop; every filled field carries its source and retrieved date; unsourced fields stay in pending.", "filled": { "procurement_portal_url": 52, "mes_modernization": 53, "work_requirements_status": 56 } }, { "date": "2026-09-22", "method": "Research pass with page fetches and live URL checks from the desktop; every filled field carries its source and retrieved date; unsourced fields stay in pending.", "filled": { "procurement_portal_url": 53, "mes_modernization": 53, "work_requirements_status": 56 } } ] }, "federal_funding_rules": [ { "id": "ffp_ddi_90", "name": "90 percent federal match for design, development, installation or enhancement", "citation": "42 CFR 433.15(b)(3); 42 CFR 433.112", "summary": "FFP at 90 percent is available for the design, development, installation or enhancement of a mechanized claims processing and information retrieval system only when CMS approves the APD before the state spends the funds. CMS approves the system described in the APD when it is likely to provide more efficient, economical and effective administration of the state plan and the conditions in 433.112(b)(1) through (22) are met.", "conditions_examples": [ "Meets the system requirements, standards and conditions, and performance standards in Part 11 of the State Medicaid Manual", "HHS receives a royalty-free, non-exclusive, irrevocable license to software and documentation built with 90 percent FFP", "Information in the system is safeguarded under 42 CFR Part 431 Subpart F", "Modularity, alignment to the Medicaid Information Technology Architecture, industry standards, reuse, reporting and interoperability conditions (see 433.112(b) for the full list of 22)" ], "what_it_means_for_a_vendor": "A state can buy a module with 90 cents of every dollar coming from CMS, but only inside an approved APD. The vendor's product has to fit the state's modular architecture, license terms and certification plan, or the state loses the match.", "sources": [ { "label": "eCFR 42 CFR 433.112", "url": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-C/section-433.112", "retrieved": "2026-09-20" }, { "label": "eCFR 42 CFR Part 433 Subpart C", "url": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-C", "retrieved": "2026-09-20" }, { "label": "CMS MES certification repository: conditions for enhanced funding", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high" }, { "id": "ffp_operations_75", "name": "75 percent federal match for operations", "citation": "42 CFR 433.15(b)(4); 42 CFR 433.116", "summary": "CMS approves 75 percent FFP for system operations when the conditions of 433.112(b)(1) through (22) are met at the time of approval, the system has been operating continuously during the period claimed, and it provides both patient and provider profiles for program management and utilization review.", "conditions_examples": [], "what_it_means_for_a_vendor": "Operations and maintenance revenue on a certified module carries a 75 percent match. Losing certification puts the state back to the regular administrative match, which is why states write certification outcomes into vendor contracts.", "sources": [ { "label": "eCFR 42 CFR 433.116", "url": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-C/section-433.116", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high" }, { "id": "apd_prior_approval", "name": "Advance Planning Document prior approval and contract thresholds", "citation": "45 CFR Part 95 Subpart F; 45 CFR 95.611", "summary": "States plan and get approval for ADP acquisitions through Planning APDs, Implementation APDs and annual or as-needed APD Updates. Prior approval is required when a state plans to acquire ADP equipment or services with FFP at the regular matching rate and total acquisition costs of $5,000,000 or more. Contracts must be submitted before execution when they are anticipated to exceed $6,000,000 (competitive) or $1,000,000 (noncompetitive) for software application development, and $20,000,000 (competitive) or $1,000,000 (noncompetitive) for hardware and COTS software, unless the state uses an exemption or an Acquisition Checklist.", "thresholds": [ { "label": "Prior approval, regular match, total acquisition cost", "value": 5000000, "currency": "USD" }, { "label": "Contract submission, software application development, competitive", "value": 6000000, "currency": "USD" }, { "label": "Contract submission, software application development, noncompetitive", "value": 1000000, "currency": "USD" }, { "label": "Contract submission, hardware and COTS, competitive", "value": 20000000, "currency": "USD" }, { "label": "Contract submission, hardware and COTS, noncompetitive", "value": 1000000, "currency": "USD" } ], "what_it_means_for_a_vendor": "A state RFP above these lines has an APD behind it and CMS has seen the plan. A noncompetitive award above $1 million needs CMS's sign-off on the contract, which is why sole-source state deals stall.", "sources": [ { "label": "eCFR 45 CFR 95.611", "url": "https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-95/subpart-F/subject-group-ECFR8ea7e78ba47a262/section-95.611", "retrieved": "2026-09-20" }, { "label": "LII 45 CFR 95.611", "url": "https://www.law.cornell.edu/cfr/text/45/95.611", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high" } ], "certification": { "smc": { "id": "smc", "name": "Streamlined Modular Certification (SMC)", "citation": "State Medicaid Director Letter 22-001 (2022-04-14)", "summary": "SMDL 22-001 sunset the Medicaid Enterprise Certification Toolkit and the Medicaid Eligibility and Enrollment Toolkit and replaced them with SMC for all MES projects initiated after publication. CMS cut required state-submitted artifacts from 29 to 7 and moved to outcomes: CMS-required outcomes tied to statute and regulation, state-specific outcomes for the state's own priorities, and metrics that show the outcomes hold continuously. The SMC guidance defines the review stages (operational readiness review and certification review) and the intake form used for every MES module including MMIS, E&E and EVV.", "sources": [ { "label": "Medicaid.gov: SMDL 22-001 announcement", "url": "https://www.medicaid.gov/federal-policy-guidance/2022-04-14/134796", "retrieved": "2026-09-20" }, { "label": "SMC certification guidance (PDF)", "url": "https://www.medicaid.gov/sites/default/files/2022-04/smc-certification-guidance.pdf", "retrieved": "2026-09-20" }, { "label": "Medicaid.gov: Streamlined Modular Certification", "url": "https://www.medicaid.gov/medicaid/data-systems/streamlined-modular-certification", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high" }, "mes_modules": { "id": "mes_modules", "name": "Medicaid Enterprise System modules", "summary": "The MES is the sum of the discrete IT systems or services a Medicaid agency uses to manage, monitor and administer the program. Functions include beneficiary eligibility and enrollment, care management, provider enrollment and payment, benefits management, data analytics and reporting, health information exchange, and fraud and abuse detection. The CMS certification repository organizes required outcomes and metrics by module.", "modules": [ "Claims processing (MMIS core)", "Provider management", "Eligibility and enrollment (E&E)", "Pharmacy benefit management", "Electronic Visit Verification (EVV)", "Data analytics and reporting (including T-MSIS)", "Care management", "Financial management", "Health information exchange" ], "sources": [ { "label": "CMS MES Certification Repository", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/", "retrieved": "2026-09-20" }, { "label": "Medicaid.gov: Streamlining Medicaid Enterprise Systems templates", "url": "https://www.medicaid.gov/medicaid/data-systems/streamlining-medicaid-enterprise-systems-templates", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "module list cross-checked against the repository's current module index" ] }, "t_msis": { "id": "t_msis", "name": "T-MSIS reporting", "citation": "Social Security Act section 1903(r)(1); SHO 18-008; SHO 25-002", "summary": "States submit Medicaid and CHIP data to the Transformed Medicaid Statistical Information System monthly. Compliance is a condition of FFP for state automated data systems under section 1903(r)(1). CMS runs business-rule reviews on each monthly submission and expects continuous data quality work.", "sources": [ { "label": "Medicaid.gov: T-MSIS", "url": "https://www.medicaid.gov/medicaid/data-systems/medicaid-and-chip-business-information-solution/transformed-medicaid-statistical-information-system-t-msis", "retrieved": "2026-09-20" }, { "label": "SHO 18-008", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/sho18008.pdf", "retrieved": "2026-09-20" }, { "label": "SHO 25-002", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/sho25002.pdf", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high" }, "mars_e": { "id": "mars_e", "name": "MARS-E for eligibility and enrollment systems", "summary": "Required for a state's Medicaid and CHIP E&E systems to keep their Authority to Connect with CMS; recommended but not required for MMIS. Full record in authorization-paths.json (id mars_e).", "authorization_path_id": "mars_e", "verified": "2026-09-20", "confidence": "high" } }, "cooperative_purchasing": [ { "id": "naspo_valuepoint_cloud_software_2026", "name": "NASPO ValuePoint Cloud and Software Solutions (2026 to 2036)", "administrator": "NASPO ValuePoint; lead state Utah", "summary": "The lead state of Utah awarded competitively solicited master agreements to 58 suppliers for cloud and software solutions and services. Master agreements are effective 2026-09-16; as of 2026-09-10, 54 of 58 were fully executed. The legacy Cloud Solutions portfolio (2016 to 2026; PaaS, IaaS and SaaS categories) expires 2026-09-15. A state, territory, political subdivision or other eligible entity buys under a Participating Addendum approved by its Chief Procurement Official; each addendum says which entities in the state may use it.", "eligible_buyers": "All 50 states, DC, the territories, their political subdivisions, institutions of higher education and other eligible entities, subject to a Participating Addendum and local law", "how_a_vendor_uses_it": "Hold a master agreement, or partner with a supplier that holds one (several are resellers or distributors), then confirm the target state has signed a Participating Addendum.", "sources": [ { "label": "NASPO ValuePoint: Cloud and Software Solutions portfolio", "url": "https://www.naspovaluepoint.org/portfolios/cloud-and-software-solutions/", "retrieved": "2026-09-20" }, { "label": "NASPO ValuePoint: Cloud Solutions 2016 to 2026 portfolio", "url": "https://www.naspovaluepoint.org/portfolios/cloud-solutions-2016-2026/", "retrieved": "2026-09-20" }, { "label": "NASPO ValuePoint announces supplier awards for cloud and software solutions", "url": "https://www.naspovaluepoint.org/news/naspo-valuepoint-announces-supplier-contract-awards-for-cloud-and-software-solutions/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "count of executed Participating Addenda by state" ] }, { "id": "gsa_cooperative_purchasing", "name": "GSA Cooperative Purchasing Program", "administrator": "GSA Federal Acquisition Service", "summary": "State, local, regional and tribal governments and their instrumentalities (including institutions of higher education) may buy IT, law enforcement and security products, services and solutions through GSA Multiple Award Schedule contracts, under 40 U.S.C. 502(c). Related programs: Disaster Purchasing, the 1122 Program and Public Health Emergency purchasing.", "eligible_buyers": "State or local government as defined in 40 U.S.C. 502(c)(3)", "how_a_vendor_uses_it": "Hold a MAS contract with cooperative purchasing accepted on the eligible SINs (the IT category), then sell to the state directly under MAS terms.", "sources": [ { "label": "GSA: Cooperative Purchasing", "url": "https://www.gsa.gov/buy-through-us/purchasing-programs/programs-for-state-and-local-governments/cooperative-purchasing-program", "retrieved": "2026-09-20" }, { "label": "GSA: programs for state and local governments", "url": "https://www.gsa.gov/buy-through-us/purchasing-programs/programs-for-state-and-local-governments", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] } ], "demand_signals": [ { "id": "cms_0057_f", "name": "CMS Interoperability and Prior Authorization final rule (CMS-0057-F)", "summary": "Impacted payers include state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans and CHIP managed care entities, Medicare Advantage organizations and QHP issuers on the federally facilitated exchanges. Operational provisions took effect 2026-01-01; API development and enhancement requirements are due by 2027-01-01. Payers must also publicly report prior authorization metrics.", "dates": [ { "date": "2026-01-01", "event": "Operational provisions in effect." }, { "date": "2027-01-01", "event": "API requirements due." } ], "what_it_means_for_a_vendor": "Every state Medicaid program and its MCOs is building or buying FHIR prior authorization, provider access and payer-to-payer APIs on a 2027 clock. That is a live requirement with a date, not a forecast.", "sources": [ { "label": "CMS: Interoperability and Prior Authorization final rule (CMS-0057-F)", "url": "https://www.cms.gov/initiatives/burden-reduction/overview/interoperability/policies-regulations/cms-interoperability-prior-authorization-final-rule-cms-0057-f", "retrieved": "2026-09-20" }, { "label": "CMS: Prior Authorization API FAQ", "url": "https://www.cms.gov/initiatives/burden-reduction/overview/interoperability/frequently-asked-questions/prior-authorization-api", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high" }, { "id": "hr1_2025_medicaid", "name": "Medicaid provisions of H.R. 1 (2025 reconciliation law)", "summary": "Expansion adults ages 19 to 64 must report 80 hours a month of community engagement (work, community service, half-time enrollment) or an exception. States must implement by 2026-12-31, or earlier through 1115 waivers. Eligibility redeterminations for expansion adults move to every six months; sources place the first affected renewals at renewals scheduled on or after 2026-12-31 (some summaries say starting 2027-01-01). CMS issued initial guidance 2025-12-08 and HHS implementation guidance was due 2026-06-01. Nebraska was the first state to implement the work requirement, on 2026-05-01.", "dates": [ { "date": "2025-12-08", "event": "CMS initial guidance on community engagement requirements." }, { "date": "2026-06-01", "event": "HHS implementation guidance due to states." }, { "date": "2026-12-31", "event": "States must implement community engagement requirements." } ], "what_it_means_for_a_vendor": "Eligibility and enrollment systems in 41 expansion jurisdictions need work-verification, exemption handling and six-month renewal logic on a 2026 clock. That is the largest state E&E change since the ACA, and it runs through the APD and SMC process above.", "sources": [ { "label": "Center for American Progress: implementation timeline of the One Big Beautiful Bill Act", "url": "https://www.americanprogress.org/article/the-implementation-timeline-of-the-one-big-beautiful-bill-act/", "retrieved": "2026-09-20" }, { "label": "Center for Health Care Strategies: a summary of federal Medicaid work requirements", "url": "https://www.chcs.org/resource/a-summary-of-national-medicaid-work-requirements/", "retrieved": "2026-09-20" }, { "label": "AMA: changes to Medicaid, the ACA and other key provisions of the One Big Beautiful Bill Act", "url": "https://www.ama-assn.org/health-care-advocacy/federal-advocacy/changes-medicaid-aca-and-other-key-provisions-one-big", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "exact statutory date for the first six-month redetermination", "state-by-state implementation dates" ] } ], "agencies": [ { "code": "AL", "state": "Alabama", "agency": "Alabama Medicaid Agency", "program_name": "Alabama Medicaid", "url": "https://medicaid.alabama.gov/", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.alabamabuys.gov/page.aspx/en/rfp/request_browse_public", "mes_modernization": "The Alabama MES Modernization Program (AMMP) is replacing the legacy AMMIS, a fiscal agent interChange system implemented in 2008 and kept under a 2020 takeover contract of up to seven years, with a modular MES (Concept of Operations v5.2.1, 2023-03-15). Module RFPs posted in 2023 and 2024 include MEVV (2023-10-25) and AAC-01 (RFP 062 24000000082). No 2025 or 2026 award notice was found in this pass. As of 2023-10-25.", "work_requirements_status": "Has not adopted expansion and is not one of the three non-expansion states (Georgia, Tennessee, Wisconsin) KFF lists as subject through 1115 programs; KFF counts 44 jurisdictions subject to the requirement from 2027-01-01. As of 2026-09-09.", "sources": [ { "label": "Alabama Medicaid Agency", "url": "https://medicaid.alabama.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Alabama Department of Finance, Purchasing Division (opened)", "url": "https://procurement.alabama.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Alabama Medicaid, AMMIS Concept of Operations v5.2.1 (PDF opened)", "url": "https://medicaid.alabama.gov/documents/2.0_Newsroom/2.4_Procurement/2.4_Active_Procurements/2.4_PL07_MMIS_Concept_Operations_v5.2.1_1-4-24.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Alabama Medicaid, AMMP MEVV3 RFP dated 2023-10-25 (search snippet)", "url": "https://medicaid.alabama.gov/documents/2.0_Newsroom/2.4_Procurement/2.4_Active_Procurements/2.4_AMMP_MEVV3_RFP_10-25-23.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Alabama Medicaid, RFP 062 24000000082 AAC-01, names Gainwell as fiscal agent (search snippet)", "url": "https://medicaid.alabama.gov/documents/2.0_Newsroom/2.4_Procurement/2.4.1_Consolidated/2.4.1.7_2024/2.4.1.7_AAC-01_RFP.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF: Tracking Implementation of the 2025 Reconciliation Law, Medicaid Work Requirements (overview, page dated 2026-09-09)", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF: Medicaid Work Requirements tracker, 1115 waivers and early implementation (page dated 2026-09-09)", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-1115-waivers/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Alabama Buys (public solicitations)" }, { "code": "AK", "state": "Alaska", "agency": "Department of Health, Division of Health Care Services", "program_name": "Alaska Medicaid", "url": "https://health.alaska.gov/en/division-of-health-care-services/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://aws.state.ak.us/OnlinePublicNotices/", "mes_modernization": "Conduent, the MMIS vendor since 2007, announced on 2025-01-15 a $92 million contract to continue operating and to modernize the Alaska MMIS (vendor release). The state's RFP 2023-1600-0138 MMIS Support Services was issued 2023-02-02 and closed 2023-07-24; the notice names no awardee. A separate RFP 2025-1600-0188 for eligibility system modernization was issued 2025-03-24 with proposals due 2025-05-27. As of 2025-03-24.", "work_requirements_status": "The Department of Health states the federal implementation date for the work and community engagement rules is 2027-01-01 and that Alaska has requested additional implementation time; if approved, the Division of Public Assistance will notify recipients of a new effective date. As of 2026-09-22.", "sources": [ { "label": "Alaska Division of Health Care Services", "url": "https://health.alaska.gov/en/division-of-health-care-services/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Alaska DOT&PF Procurement and Contracting page (opened)", "url": "https://dot.alaska.gov/procurement/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Alaska Online Public Notices (curl 200; fetch tool 403)", "url": "https://aws.state.ak.us/OnlinePublicNotices/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Conduent news release, Alaska $92 million MMIS contract, 2025-01-15 (vendor release, medium confidence)", "url": "https://www.news.conduent.com/news/alaska-awards-92-million-contract-to-conduent-to-enhance-medicaid-program-delivery-systems", "retrieved": "2026-09-22" }, { "label": "MES modernization: Alaska Online Public Notices, RFP 2023-1600-0138 MMIS Support Services (opened)", "url": "https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=209799", "retrieved": "2026-09-22" }, { "label": "MES modernization: Alaska Online Public Notices, RFP 2025-1600-0188 Eligibility Modernization Milestone 2 (opened)", "url": "https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=218954", "retrieved": "2026-09-22" }, { "label": "Work requirements: Alaska Department of Health, Medicaid Work Requirements (H.R. 1) page (opened)", "url": "https://health.alaska.gov/en/education/medicaid-work-and-community-engagement-requirements/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Alaska Online Public Notices" }, { "code": "AZ", "state": "Arizona", "agency": "Arizona Health Care Cost Containment System (AHCCCS)", "program_name": "AHCCCS", "url": "https://www.azahcccs.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "GovRAMP (formal state program page)", "procurement_portal_url": "https://app.az.gov/page.aspx/en/rfp/request_browse_public", "mes_modernization": "AHCCCS MES Modernization update dated 2026-02-05: PMMIS mainframe refactor testing in a new Azure cloud environment began in 2026-02 with AHCCCS technical staff; an EDI translator upgrade was expected in use 2026-03; program integrity components launch 2026-03-31 and 2026-06-28; a new customer service system starts 2026-04. NTT Data was awarded the PMMIS modular roadmap contract (YH22-0009) on 2021-11-05. As of 2026-02-05.", "work_requirements_status": "AHCCCS states H.R. 1 requires implementation by 2026-12-31 and that from 2027-01 certain expansion adults must work, study, volunteer or meet another qualifying activity (page undated). AHCCCS and partners launched KeepMyAHCCCS.com ahead of the 2027-01-01 start (snippet, 2026-09). As of 2026-09-10.", "sources": [ { "label": "AHCCCS", "url": "https://www.azahcccs.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Arizona Department of Transportation, Procurement page (opened)", "url": "https://azdot.gov/business/procurement", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Arizona State Procurement Office, How to do business with the State (search snippet; page returned 403)", "url": "https://spo.az.gov/suppliers/how-do-business-state-arizona", "retrieved": "2026-09-22" }, { "label": "MES modernization: AHCCCS, MES Modernization Program update, 2026-02-05 (opened)", "url": "https://azahcccs.gov/shared/News/GeneralNews/MES_Modernization_Update.html", "retrieved": "2026-09-22" }, { "label": "MES modernization: AHCCCS, mainframe modernization contract award to NTT Data, 2021-11-05 (opened)", "url": "https://www.azahcccs.gov/shared/News/GeneralNews/MainframeModernizationContractAward.html", "retrieved": "2026-09-22" }, { "label": "Work requirements: AHCCCS, H.R. 1 Overview: Changes Are Coming to Medicaid (opened)", "url": "https://www.azahcccs.gov/AHCCCS/Initiatives/HR1/", "retrieved": "2026-09-22" }, { "label": "Work requirements: Arizona Public Health Association, new AHCCCS tool for work requirements, 2026-09-10 (search snippet, medium confidence)", "url": "https://azpha.org/2026/09/10/help-spread-the-word-new-ahcccs-tool-helps-members-prepare-for-medicaid-work-requirements/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "Arizona Procurement Portal (APP)" }, { "code": "AR", "state": "Arkansas", "agency": "Department of Human Services, Division of Medical Services", "program_name": "Arkansas Medicaid", "url": "https://humanservices.arkansas.gov/divisions-shared-services/medical-services/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://sas.arkansas.gov/procurement/bid-opportunities/", "mes_modernization": "The current Arkansas MMIS went live 2017-11-01, replacing a mainframe system more than 30 years old (DHS announcement dated 2017-10-16, read on a Healthcare Journal of Arkansas repost). Gainwell is the fiscal agent operating the MMIS provider portal (AFMC page, search snippet). No state page on a further MES modernization procurement was found in this pass; the DHS news page returned 403 to fetch tools. As of 2017-10-16.", "work_requirements_status": "Arkansas soft-launched its ARHOME work requirement on 2026-07-01 with automated checks and no penalties in 2026; enforcement begins 2027-01-01 with 30 days to show compliance before suspension. The Governor's 2026-06-26 release says this replaces the Pathway to Prosperity waiver request. As of 2026-06-26.", "sources": [ { "label": "Arkansas DHS Division of Medical Services", "url": "https://humanservices.arkansas.gov/divisions-shared-services/medical-services/", "retrieved": "2026-09-20" }, { "label": "MES modernization: Healthcare Journal of Arkansas repost of DHS announcement, 2017-10-16 (trade press, medium confidence)", "url": "https://healthcarejournalar.com/news/dhs-to-launch%C2%A0new-medicaid-management-information-system-nov-1", "retrieved": "2026-09-22" }, { "label": "MES modernization: Arkansas DHS news post (403 to fetch tools; title from search results)", "url": "https://humanservices.arkansas.gov/news/dhs-set-to-launch-new-medicaid-management-information-system-nov-1/", "retrieved": "2026-09-22" }, { "label": "MES modernization: AFMC, Arkansas MMIS services page, Gainwell as fiscal agent (search snippet)", "url": "https://medicaid.afmc.org/services/arkansas-medicaid-management-information-system", "retrieved": "2026-09-22" }, { "label": "Work requirements: Arkansas Governor, Welfare to Work Requirement Rollout Begins July 1, 2026-06-26 (opened)", "url": "https://governor.arkansas.gov/news_post/welfare-to-work-requirement-rollout-begins-july-1/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Arkansas.gov service listing, State Bid Current Solicitations (opened)", "url": "https://portal.arkansas.gov/service/state-bid-current-soliciatations/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Arkansas Shared Administrative Services, Bid Opportunities (opened by fetch tool; curl 403)", "url": "https://sas.arkansas.gov/procurement/bid-opportunities/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Arkansas Shared Administrative Services, Vendor Registration and Resources, Ariba launch 2026-07-11 (opened)", "url": "https://sas.arkansas.gov/procurement/vendor-registration-resources/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Arkansas Shared Administrative Services, Procurement page, new eProcurement system Ariba (opened)", "url": "https://sas.arkansas.gov/procurement/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Arkansas Office of State Procurement bid opportunities (SAP Ariba Business Network)" }, { "code": "CA", "state": "California", "agency": "Department of Health Care Services (DHCS)", "program_name": "Medi-Cal", "url": "https://www.dhcs.ca.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://caleprocure.ca.gov/pages/index.aspx", "mes_modernization": "DHCS states it is developing an RFP for a Fiscal Intermediary Maintenance and Operations (FI-M&O) contractor for CA-MMIS, preceded by RFI 23-072 (DHCS page, search snippet; the page is script-rendered and returned no text to fetch tools). Gainwell, formerly DXC, has been the CA-MMIS fiscal intermediary since 2020-10-01 (Medi-Cal NewsFlash, snippet). No FI-M&O RFP release date was found in this pass. As of 2026-09-22.", "work_requirements_status": "DHCS's 2026-05 proposed trailer bill fact sheet: the H.R. 1 work and community engagement requirement for the MAGI new adult group applies no sooner than 2027-01-01, DHCS must comply by 2027-01-01, counties must notify members by 2026-08-31, and the federal notice deadline is 2026-07-01. As of 2026-05.", "sources": [ { "label": "California DHCS", "url": "https://www.dhcs.ca.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Cal eProcure (state-procurement.json, verified 2026-09-20)", "url": "https://caleprocure.ca.gov/pages/index.aspx", "retrieved": "2026-09-20" }, { "label": "MES modernization: DHCS, Request for Information 23-072 page, FI-M&O RFP in development (search snippet; page script-rendered)", "url": "https://www.dhcs.ca.gov/providers-partners/procurement-and-contracting-division/request-for-information-23-072/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Medi-Cal NewsFlash, fiscal intermediary name change to Gainwell effective 2020-10-01 (search snippet)", "url": "https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30715.aspx", "retrieved": "2026-09-22" }, { "label": "Work requirements: DHCS, H.R. 1 proposed trailer bill fact sheet, 2026-05 (PDF opened)", "url": "https://www.dhcs.ca.gov/fa/wp-content/uploads/2026/05/HR1-DHCS-Fact-Sheet-2026.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Cal eProcure" }, { "code": "CO", "state": "Colorado", "agency": "Department of Health Care Policy and Financing (HCPF)", "program_name": "Health First Colorado", "url": "https://hcpf.colorado.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://vss.state.co.us/", "mes_modernization": "HCPF is moving the interChange MMIS (Gainwell, live 2017-03) to eight modules. Optum took over the provider call center 2025-05-01; EDI moves from Gainwell to Cotiviti (formerly Edifecs) in phases from 2025 with full transition scheduled for late summer 2026; care and case management moves to AssureCare and EVV to Sandata. Gainwell keeps core MMIS, claims editing, TPL and interoperability under a 2025 contract. As of 2026-09-22.", "work_requirements_status": "HCPF's H.R. 1 timeline: work (community engagement) requirements, six-month eligibility checks and retroactive coverage changes take effect 2027-01; member notices go out in 2026-09 and 2026-11; the first cohort is renewed or terminated by end of 2027-03. HCPF says dates are subject to change. As of 2026-09-22.", "sources": [ { "label": "Colorado HCPF", "url": "https://hcpf.colorado.gov/", "retrieved": "2026-09-20" }, { "label": "Health First Colorado", "url": "https://www.healthfirstcolorado.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: ColoradoVSS home page (opened)", "url": "https://vss.state.co.us/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: ColoradoVSS, Accessing and Viewing Solicitations FAQs (opened)", "url": "https://vss.state.co.us/vendor-topics/solicitations/faqs/accessing-and-viewing-solicitations-faqs", "retrieved": "2026-09-22" }, { "label": "MES modernization: Colorado HCPF, MMIS transition page (opened via curl)", "url": "https://hcpf.colorado.gov/mmis-procurement", "retrieved": "2026-09-22" }, { "label": "MES modernization: Colorado HCPF, CMES executed contracts list (opened via curl)", "url": "https://hcpf.colorado.gov/cmes-contracts", "retrieved": "2026-09-22" }, { "label": "Work requirements: Colorado HCPF, H.R. 1 Timeline (opened via curl)", "url": "https://hcpf.colorado.gov/hr1-timeline", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "ColoradoVSS (Colorado Vendor Self Service)" }, { "code": "CT", "state": "Connecticut", "agency": "Department of Social Services", "program_name": "HUSKY Health", "url": "https://portal.ct.gov/husky", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://portal.ct.gov/das/ctsource/bidboard", "mes_modernization": "CT METS, the DSS program replacing the MMIS and other Medicaid enterprise systems with a modular MES (page updated 2026-02-05), lists awarded modules: enterprise care and case management, system integration platform, enterprise data warehouse and analytics, data governance and IV&V; vendors include Deloitte, Optum, CSG Government Solutions, NTT DATA and KPMG. Gainwell still processes claims on the interChange MMIS. As of 2026-02-05.", "work_requirements_status": "DSS states that effective 2027-01-01 adults 19 to 64 must complete at least 80 hours per month of work or community engagement, or meet an income or exemption test, to remain eligible for Medicaid (page dated 2025-07-03). As of 2025-07-03.", "sources": [ { "label": "Connecticut HUSKY Health", "url": "https://portal.ct.gov/husky", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Connecticut DAS, CTsource State Contracting Portal page (opened)", "url": "https://portal.ct.gov/das/procurement-programs-and-services/ctsource", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Connecticut DAS, CTsource Bid Board (opened)", "url": "https://portal.ct.gov/das/ctsource/bidboard", "retrieved": "2026-09-22" }, { "label": "MES modernization: Connecticut DSS, CT METS program page, updated 2026-02-05 (opened)", "url": "https://portal.ct.gov/dss/ct-mets", "retrieved": "2026-09-22" }, { "label": "MES modernization: ctdssmap.com provider manual, claims processed by Gainwell for DSS (search snippet)", "url": "https://www.ctdssmap.com/ctportal/portals/0/staticcontent/publications/companion_guide.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: Connecticut DSS, What will change with DSS benefits following federal H.R. 1, 2025-07-03 (opened)", "url": "https://portal.ct.gov/dss/knowledge-base/articles/general-information/federal-updates-hr1?language=en_US", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "CTsource Bid Board" }, { "code": "DE", "state": "Delaware", "agency": "Department of Health and Social Services, Division of Medicaid and Medical Assistance", "program_name": "Delaware Medicaid", "url": "https://dhss.delaware.gov/dmma/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://mymarketplace.delaware.gov/", "mes_modernization": null, "work_requirements_status": "DHSS's Medicaid ENGAGE page: federal work and community engagement requirements for the adult expansion group begin 2027-01-01 (at least $580 a month in earnings or 80 hours a month of qualifying activity), and six-month renewals for that group also start 2027-01-01. Page undated. As of 2026-09-22.", "sources": [ { "label": "Delaware DMMA", "url": "https://dhss.delaware.gov/dmma/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: MyMarketplace Delaware home page (opened)", "url": "https://mymarketplace.delaware.gov/", "retrieved": "2026-09-22" }, { "label": "Work requirements: Delaware DHSS DMMA, Medicaid ENGAGE page (opened)", "url": "https://dhss.delaware.gov/dmma/home/medicaid-engage/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [ "mes_modernization" ], "procurement_portal_name": "MyMarketplace Delaware" }, { "code": "DC", "state": "District of Columbia", "agency": "Department of Health Care Finance (DHCF)", "program_name": "DC Medicaid", "url": "https://dhcf.dc.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://contracts.ocp.dc.gov/solicitations/search", "mes_modernization": "DHCF testimony of 2026-01-29: after a competitive procurement Gainwell was selected as the new MMIS fiscal agent, replacing Conduent (fiscal agent since 2009-12), with go-live 2026-03-01 and operations from 2026-03-02. The contract is an estimated $85.9 million for a two-year base implementation period plus three option years of operations and maintenance at about $28 million a year, using a COTS product. As of 2026-01-29.", "work_requirements_status": "DHCF states that beginning 2027-01-01 childless adults in the expansion group must meet community engagement requirements; it held a planning workshop in 2025-11 and expects to use existing system developers including DCAS (testimony 2026-01-29). The DHCF web page repeats the 2027-01-01 start. As of 2026-01-29.", "sources": [ { "label": "DC DHCF", "url": "https://dhcf.dc.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: DC Office of Contracting and Procurement, OCP Solicitations page (opened)", "url": "https://ocp.dc.gov/service/ocp-solicitations", "retrieved": "2026-09-22" }, { "label": "Procurement portal: DC Contracts and Procurement Transparency Portal (opened; body script-rendered)", "url": "https://contracts.ocp.dc.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: DC DHCF, Performance Oversight Hearing testimony, 2026-01-29 (PDF opened)", "url": "https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/release_content/attachments/DHCF%202026%20Performance%20Testimony%201.29.26.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: DC DHCF, Federal Changes to Medicaid page (opened, undated)", "url": "https://dhcf.dc.gov/page/federal-changes-medicaid", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "Contracts and Procurement Transparency Portal (OCP)" }, { "code": "FL", "state": "Florida", "agency": "Agency for Health Care Administration (AHCA)", "program_name": "Florida Medicaid", "url": "https://ahca.myflorida.com/", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://vendor.myfloridamarketplace.com/search/bids", "mes_modernization": "AHCA's FX page states the FX project, in its current form, is now closing and remaining FX contracts and obligations are being closed out (page undated). The FX Program IAPDU of 2025-05 states Gainwell continues existing Core operations until a replacement goes live (snippet). Consistent with the record on file: Core Systems Module termination decided 2025-02-25; RFI 014-24/25 closed 2025-04-01. As of 2026-09-22.", "work_requirements_status": "Not applicable. Florida has not adopted Medicaid expansion; the Florida Policy Institute (2026-02-13) states the H.R. 1 work reporting requirement applies only to expansion states and cannot be waived onto non-expansion populations such as Florida's. No AHCA notice was found in this pass. As of 2026-02-13.", "sources": [ { "label": "Florida AHCA", "url": "https://ahca.myflorida.com/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: MyFloridaMarketPlace Vendor Information Portal / Vendor Bid System (state-procurement.json, verified 2026-09-20)", "url": "https://vendor.myfloridamarketplace.com/search/bids", "retrieved": "2026-09-20" }, { "label": "MES modernization: Florida AHCA, Florida Health Care Connections (FX) page (opened)", "url": "https://ahca.myflorida.com/medicaid/florida-health-care-connections-fx.html", "retrieved": "2026-09-22" }, { "label": "MES modernization: Florida AHCA, FX Program IAPDU May 2025 (search snippet)", "url": "https://ahca.myflorida.com/content/download/26818/file/FX%20Program%20IAPDU%20May%202025.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: Florida Policy Institute, Medicaid work reporting requirements in Florida, 2026-02-13 (opened, medium confidence)", "url": "https://www.floridapolicy.org/posts/medicaid-work-reporting-requirements-in-florida-still-do-not-make-sense", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "MyFloridaMarketPlace Vendor Information Portal / Vendor Bid System" }, { "code": "GA", "state": "Georgia", "agency": "Department of Community Health (DCH)", "program_name": "Georgia Medicaid", "url": "https://medicaid.georgia.gov/", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://ssl.doas.state.ga.us/gpr/", "mes_modernization": "MEST replaces the legacy GAMMIS (in operation since 2010-11-01) with independent modules, largely through NASPO ValuePoint. Georgia led the NASPO third party liability RFP (GPR event 41900-DCH0000120, opened 2020-10-02, status awarded) and the pharmacy benefit services RFP 41900-DCH0000136, with a notice of intent to award to five suppliers on 2025-10-20 and a state down-select to follow. As of 2025-10-20.", "work_requirements_status": "Pathways to Coverage eligibility changes to the H.R. 1 community engagement rules on 2027-01-01; current members see the change at their 2027 renewal. DCH issued a public notice on 2026-07-09 for a state plan amendment on the community engagement requirement (advocacy report, medium). As of 2026-07-28.", "sources": [ { "label": "Georgia Medicaid", "url": "https://medicaid.georgia.gov/", "retrieved": "2026-09-20" }, { "label": "Georgia DCH", "url": "https://dch.georgia.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Georgia DOAS, Bids and Contracts page identifying the GPR", "url": "https://doas.ga.gov/state-purchasing/bids-and-contracts", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Georgia Procurement Registry home (curl, HTTP 200)", "url": "https://ssl.doas.state.ga.us/gpr/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: GPR event 41900-DCH0000120 page opened without credentials (curl)", "url": "https://ssl.doas.state.ga.us/gpr/eventDetails?eSourceNumber=41900-DCH0000120&sourceSystemType=ps", "retrieved": "2026-09-22" }, { "label": "MES modernization: Georgia DCH, Medicaid Enterprise System Transformation (MEST) program page", "url": "https://medicaid.georgia.gov/programs/all-programs/mest", "retrieved": "2026-09-22" }, { "label": "MES modernization: Georgia DCH, Medicaid Management Information System (GAMMIS) page, operations began 2010-11-01", "url": "https://dch.georgia.gov/divisionsoffices/office-information-technology/medicaid-management-information-system-mmis", "retrieved": "2026-09-22" }, { "label": "MES modernization: Georgia DCH, Notice of Intent to Award, Pharmacy Benefit Services (NASPO ValuePoint), 2025-10-20", "url": "https://dch.georgia.gov/announcement/2025-10-20/notice-intent-award-pharmacy-benefit-services-procurement", "retrieved": "2026-09-22" }, { "label": "Work requirements: Georgia Pathways to Coverage, H.R. 1 Changes to Pathways", "url": "https://pathways.georgia.gov/hr-1-changes-pathways", "retrieved": "2026-09-22" }, { "label": "Work requirements: Georgians for a Healthy Future, comments to DCH on the Medicaid community engagement SPA notice, 2026-07-28 (medium)", "url": "https://healthyfuturega.org/2026/07/28/medicaid-work-requirement-comment/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "Georgia Procurement Registry (GPR)" }, { "code": "HI", "state": "Hawaii", "agency": "Department of Human Services, Med-QUEST Division", "program_name": "Med-QUEST", "url": "https://medquest.hawaii.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://hands.ehawaii.gov/hands/", "mes_modernization": "Hawaii is replacing its MMIS in modules. HOKU, the provider enrollment module built by CNSI under RFP YH18-0033, went live 2020-08-03 as the first module. A joint NTT Data roadmap with Arizona AHCCCS (2023-03-22) recommended replacing the shared mainframe MES. Med-QUEST issued RFI-MQD-2025-001 on 2024-08-09 for IT staffing to support the MES Modernization Project, responses due 2024-09-05. As of 2024-08-09.", "work_requirements_status": "Med-QUEST says H.R. 1 work or volunteer requirements start 2027-01-01 for adults 19 to 64 who are not blind, disabled or pregnant; members need take no action now. The Star-Advertiser (2026-08-20) reports an attestation form in the Med-QUEST system in October 2026 and six-month eligibility checks. As of 2026-08-20.", "sources": [ { "label": "Hawaii Med-QUEST", "url": "https://medquest.hawaii.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Hawaii State Procurement Office, HANDS program page", "url": "https://spo.hawaii.gov/for-state-county-personnel/programs/procurement/hands/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Hawaii State Procurement Office home page listing HANDS (Awards & Notices)", "url": "https://spo.hawaii.gov/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: HANDS opportunities page (curl, HTTP 200)", "url": "https://hands.ehawaii.gov/hands/opportunities", "retrieved": "2026-09-22" }, { "label": "MES modernization: Med-QUEST, HOKU Provider Enrollment System page", "url": "https://medquest.hawaii.gov/en/plans-providers/Provider-Management-System-Upgrade.html", "retrieved": "2026-09-22" }, { "label": "MES modernization: Arizona AHCCCS, MES Modernization Roadmap notice, 2023-03-22", "url": "https://www.azahcccs.gov/shared/News/GeneralNews/MESroadmap.html", "retrieved": "2026-09-22" }, { "label": "MES modernization: Med-QUEST, RFI-MQD-2025-001 Medicaid Enterprise Systems Staffing Services (PDF)", "url": "https://medquest.hawaii.gov/content/dam/medquest/docs/mes/RFI%20MES%20Staffing%20Services.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Med-QUEST, Solicitations and Contract page", "url": "https://medquest.hawaii.gov/en/resources/solicitations-contract.html", "retrieved": "2026-09-22" }, { "label": "Work requirements: Med-QUEST, Stay Well Stay Covered toolkit page on H.R. 1 requirements", "url": "https://medquest.hawaii.gov/en/members-applicants/already-covered/Stay_Well_Stay_Covered_Toolkit.html", "retrieved": "2026-09-22" }, { "label": "Work requirements: Honolulu Star-Advertiser, Kokua Line on Med-QUEST rules, 2026-08-20 (medium)", "url": "https://www.staradvertiser.com/2026/08/20/hawaii-news/kokua-line-how-can-i-keep-med-quest-under-new-rules/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "Hawaii Awards and Notices Data System (HANDS)" }, { "code": "ID", "state": "Idaho", "agency": "Department of Health and Welfare, Division of Medicaid", "program_name": "Idaho Medicaid", "url": "https://healthandwelfare.idaho.gov/services-programs/medicaid-health", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://purchasing.idaho.gov/", "mes_modernization": "Idaho DHW is replacing its MMIS, which Gainwell Technologies runs for claims processing, with a modular enterprise system. NTT DATA was named System Integrator Technical Advisory contractor (trade press, 2024-08-15) and CSG runs the enterprise PMO (vendor page, 2024-07-09). A 2026-04-30 Idaho Capital Sun report says a Medicaid contract awarded to Acentra Health is stalled by a Gainwell lawsuit filed 2025-08. As of 2026-04-30.", "work_requirements_status": "DHW announced on 2026-07-23 that Medicaid expansion work requirements start 2027-01-01: 80 hours a month, a three-month compliance period before new applicants are eligible, semiannual renewal checks and 13 exemption categories. House Bill 913, signed 2026-04-10, put the requirement in state law. As of 2026-07-23.", "sources": [ { "label": "Idaho DHW Medicaid", "url": "https://healthandwelfare.idaho.gov/services-programs/medicaid-health", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Idaho Division of Purchasing home page with Bid Opportunities link", "url": "https://purchasing.idaho.gov/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Idaho State Controller's Office, Luma Supplier Portal go-live page (IPRO, powered by Luma)", "url": "https://www.sco.idaho.gov/LivePages/luma-supplier-portal-go-live.aspx", "retrieved": "2026-09-22" }, { "label": "MES modernization: Idaho DHW, Information for Medicaid Providers (Gainwell Technologies runs the MMIS claims processing center)", "url": "https://healthandwelfare.idaho.gov/providers/idaho-medicaid-providers/information-medicaid-providers", "retrieved": "2026-09-22" }, { "label": "MES modernization: MeriTalk State and Local, Idaho selects NTT DATA for Medicaid system modernization, 2024-08-15 (medium)", "url": "https://www.meritalkslg.com/articles/idaho-selects-ntt-data-to-support-its-medicaid-system-modernization/", "retrieved": "2026-09-22" }, { "label": "MES modernization: CSG Government Solutions case study, procurement planning and PMO for Idaho MMIS modernization, 2024-07-09 (vendor, medium)", "url": "https://csgdelivers.com/case-study/mmis-modernization-in-idaho/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Idaho Capital Sun, Medicaid contract stalled after lawsuit, 2026-04-30 (search snippet, medium)", "url": "https://idahocapitalsun.com/2026/04/30/medicaid-contract-is-stalled-after-a-lawsuit-now-idaho-officials-are-delaying-privatization/", "retrieved": "2026-09-22" }, { "label": "Work requirements: Idaho DHW news release, work requirements for Medicaid expansion recipients, 2026-07-23", "url": "https://healthandwelfare.idaho.gov/news/idaho-department-health-and-welfare-announces-work-requirements-medicaid-expansion-recipients", "retrieved": "2026-09-22" }, { "label": "Work requirements: Ballotpedia News, Idaho governor signs House Bill 913, 2026-04-14 (medium)", "url": "https://news.ballotpedia.org/2026/04/14/idaho-governor-signs-medicaid-work-requirements-bill-requiring-three-months-of-compliance-before-enrollment/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "IPRO, powered by Luma (Idaho Division of Purchasing)" }, { "code": "IL", "state": "Illinois", "agency": "Department of Healthcare and Family Services (HFS)", "program_name": "Illinois Medicaid", "url": "https://hfs.illinois.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.bidbuy.illinois.gov/bso/", "mes_modernization": "IMPACT, the modular MMIS run by Acentra Health (formerly CNSI) and shared with Michigan, is operating. HFS holds a NASPO participating addendum (Montana lead state) with Acentra Health for maintenance and operations of the IMPACT Provider Enrollment module: initial term 2025-03-30 to 2025-05-31 at $1,236,359.47, with yearly extension options through 2028-05-31. No new MES solicitation is on the HFS procurement page. As of 2025-06-25.", "work_requirements_status": "HFS says work requirements take effect 2027-01-01 for ACA Adults 19 to 64; current enrollees show compliance at their first 2027 redetermination, starting in 2027-03. A paid public awareness campaign begins in 2026-09, followed by mailed notices, Manage My Case alerts and texts through 2027. As of 2026-09.", "sources": [ { "label": "Illinois HFS", "url": "https://hfs.illinois.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: BidBuy (state-procurement.json, verified 2026-09-20)", "url": "https://www.bidbuy.illinois.gov/bso/", "retrieved": "2026-09-20" }, { "label": "MES modernization: Illinois Comptroller, Contract Transparency Document, HFS and Acentra Health LLC, IMPACT Provider Enrollment module M&O (PDF)", "url": "https://illinoiscomptroller.gov/CTDDocs/478-2025-4100213116-E-06252025-824379367-G-NA-NA-ACENTRA%20HOLDINGS%20LLC-CTD.PDF", "retrieved": "2026-09-22" }, { "label": "MES modernization: Illinois HFS, IMPACT home page", "url": "https://hfs.illinois.gov/impact.html", "retrieved": "2026-09-22" }, { "label": "MES modernization: Illinois HFS, Procurement page (no MES solicitation listed)", "url": "https://hfs.illinois.gov/info/procurement.html", "retrieved": "2026-09-22" }, { "label": "Work requirements: Illinois HFS, FAQs: How will federal changes impact Medicaid", "url": "https://hfs.illinois.gov/info/fedresctr/faqshowwillfedchimpactmedicaid.html", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "BidBuy" }, { "code": "IN", "state": "Indiana", "agency": "Family and Social Services Administration, Office of Medicaid Policy and Planning", "program_name": "Indiana Medicaid", "url": "https://www.in.gov/medicaid/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "GovRAMP (formal state program page)", "procurement_portal_url": "https://www.in.gov/idoa/procurement/current-business-opportunities/", "mes_modernization": "Operating, with no modernization procurement found. Gainwell Technologies, contracted with Indiana since 1991, runs CoreMMIS, the state MMIS that went live in 2017-02 (FSSA stabilization updates dated 2017-02-14). No MES modernization solicitation appears on the IDOA current business opportunities page or the FSSA Medicaid partner pages in this pass. As of 2026-09-22.", "work_requirements_status": "FSSA will enforce HIP work requirements from 2027-01-01 for adults 19 to 64 who are not pregnant or Medicare eligible: 80 hours a month, with January 2027 applicants needing to meet the requirement for 2026-10 through 2026-12. Ten exemption categories are listed; the page cites no waiver. As of 2026-09-22.", "sources": [ { "label": "Indiana Medicaid", "url": "https://www.in.gov/medicaid/", "retrieved": "2026-09-20" }, { "label": "FSSA Office of Medicaid Policy and Planning", "url": "https://www.in.gov/fssa/ompp.html", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Indiana Department of Administration, Current Business Opportunities", "url": "https://www.in.gov/idoa/procurement/current-business-opportunities/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Indiana Medicaid, Medicaid Partners: Gainwell Technologies (contracted since 1991, runs CoreMMIS)", "url": "https://www.in.gov/medicaid/partners/medicaid-partners/gainwell-technologies/", "retrieved": "2026-09-22" }, { "label": "MES modernization: State of Indiana events, Update on CoreMMIS Stabilization, 2017-02-14", "url": "https://events.in.gov/event/update-on-coremmis-stabilization", "retrieved": "2026-09-22" }, { "label": "Work requirements: Indiana FSSA, HIP Work Requirements", "url": "https://www.in.gov/fssa/hip/hip-work-requirements/index", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "IDOA Current Business Opportunities (Indiana Department of Administration)" }, { "code": "IA", "state": "Iowa", "agency": "Iowa Department of Health and Human Services", "program_name": "Iowa Medicaid", "url": "https://hhs.iowa.gov/medicaid", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://bidopportunities.iowa.gov/", "mes_modernization": "The Medicaid Enterprise Modernization Effort (MEME) is replacing the legacy MMIS through modular procurements. PAPD Update 5 (2023-12-07) prioritizes a provider enrollment and data management module as the first major module, records an acquisition vendor engagement launched 2022-04-13 and an interoperability contract intent to award on 2022-04-04. No newer state status was found in this pass. As of 2023-12-07.", "work_requirements_status": "Iowa HHS says that by 2026-12-01 certain IHAWP members must complete 80 hours a month of qualifying activities to enroll or keep coverage, applied at renewals on or after 2027-02, with nine exclusion categories. Iowa HHS will notify affected members by letter or email in the coming months. As of 2026-09-22.", "sources": [ { "label": "Iowa HHS Medicaid", "url": "https://hhs.iowa.gov/medicaid", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Iowa DAS, State of Iowa Bid Opportunities", "url": "https://bidopportunities.iowa.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Iowa HHS, Medicaid Enterprise Modernization Effort (MEME) page", "url": "https://hhs.iowa.gov/medicaid/about-medicaid/medicaid-projects/meme", "retrieved": "2026-09-22" }, { "label": "MES modernization: Iowa HHS, Planning Advance Planning Document Update 5, MEME Project, 2023-12-07 (PDF)", "url": "https://hhs.iowa.gov/media/10527/download", "retrieved": "2026-09-22" }, { "label": "MES modernization: Iowa HHS, Medicaid Projects page", "url": "https://hhs.iowa.gov/medicaid/about-medicaid/medicaid-projects", "retrieved": "2026-09-22" }, { "label": "Work requirements: Iowa HHS, IHAWP Community Engagement Requirements", "url": "https://hhs.iowa.gov/medicaid/plans-programs/iowa-health-wellness-plan/ihawp-community-engagement-requirements", "retrieved": "2026-09-22" }, { "label": "Work requirements: Iowa HHS, Iowa Health and Wellness Plan page", "url": "https://hhs.iowa.gov/medicaid/plans-programs/iowa-health-wellness-plan", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "State of Iowa Bid Opportunities (Iowa Department of Administrative Services)" }, { "code": "KS", "state": "Kansas", "agency": "Kansas Department of Health and Environment, Division of Health Care Finance (with KDADS)", "program_name": "KanCare", "url": "https://www.kancare.ks.gov/", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://supplier.sok.ks.gov/", "mes_modernization": "The Kansas Modular Medicaid System (KMMS) went live in 2022-04, replacing the legacy MMIS; Gainwell Technologies is the fiscal agent and KMMS contractor under a contract procured in 2015. KDHE's FY2026 budget request plans a contract extension for KMMS maintenance, support and enhancement, with staffing cost increases of $8,320,665 in 2025. No new MMIS reprocurement was found in this pass. As of 2026-09-22.", "work_requirements_status": "Not applicable per trackers: Kansas has not adopted Medicaid expansion, and KFF's tracker (updated 2026-09-09) names only Georgia, Tennessee and Wisconsin as non-expansion states with waiver programs subject to the requirement. No KDHE or KanCare notice on H.R. 1 work requirements was found. As of 2026-09-09.", "sources": [ { "label": "KanCare", "url": "https://www.kancare.ks.gov/", "retrieved": "2026-09-20" }, { "label": "KDHE KanCare and Medicaid", "url": "https://www.kdhe.ks.gov/183/KanCare-Medicaid", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Kansas Department of Administration, Bidding and Contracts page naming Bid Solicitations (eSupplier)", "url": "https://admin.ks.gov/offices/procurement-contracts/bidding--contracts", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Kansas eSupplier Portal public bid page (redirects to sign-in without cookies)", "url": "https://supplier.sok.ks.gov/psc/sokfsprdsup/SUPPLIER/ERP/c/SCP_PUBLIC_MENU_FL.SCP_PUB_BID_CMP_FL.GBL", "retrieved": "2026-09-22" }, { "label": "MES modernization: KDHE, FY2026 Agency Budget Request narrative (KMMS live 2022-04; Gainwell contract extension planned) (PDF)", "url": "https://budget.kansas.gov/wp-content/uploads/264265-KDHE-FY-2026-Budget-Narrative.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF, Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements, updated 2026-09-09 (medium)", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF, Status of State Medicaid Expansion Decisions, 2026-08-21 (medium)", "url": "https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/", "retrieved": "2026-09-22" }, { "label": "Work requirements: healthinsurance.org, Medicaid eligibility and enrollment in Kansas (search snippet, medium)", "url": "https://www.healthinsurance.org/medicaid/kansas/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Kansas eSupplier Portal (Office of Procurement and Contracts)" }, { "code": "KY", "state": "Kentucky", "agency": "Cabinet for Health and Family Services, Department for Medicaid Services", "program_name": "Kentucky Medicaid", "url": "https://www.chfs.ky.gov/agencies/dms/Pages/default.aspx", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://vss.ky.gov/", "mes_modernization": "Kentucky is modernizing its Medicaid Enterprise Management System (MEMS) in modules. A vendor case study (2024-07-09) reports final CMS certification of the Waiver Case Management and Partner Portal modules, completion of the Eligibility and Enrollment Services project and a move to streamlined modular certification. DMS lists the MMIS, PBM and EVV as vendor-contracted; no open MEMS solicitation was found. As of 2024-07-09.", "work_requirements_status": "Kentucky Medicaid says the work or community engagement requirement of 80 hours a month starts 2027-01-01 for expansion adults 19 to 64. Notices to current members began 2026-07-01, with further notices starting 120 days before each member's 2027 annual renewal. As of 2026-07-01.", "sources": [ { "label": "Kentucky Department for Medicaid Services", "url": "https://www.chfs.ky.gov/agencies/dms/Pages/default.aspx", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Kentucky Finance and Administration Cabinet, eProcurement page", "url": "https://finance.ky.gov/eProcurement/Pages/default.aspx", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Kentucky Vendor Self Service (curl, HTTP 200)", "url": "https://vss.ky.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: CSG Government Solutions case study, modular procurement support and IV&V for Kentucky's Medicaid enterprise, 2024-07-09 (vendor, medium)", "url": "https://csgdelivers.com/case-study/maximizing-the-value-of-modularity-for-kentuckys-medicaid-enterprise/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Kentucky DMS, Division of Information Systems page", "url": "https://www.chfs.ky.gov/agencies/dms/dis/Pages/default.aspx", "retrieved": "2026-09-22" }, { "label": "Work requirements: Kentucky Health Benefit Exchange, Changes Coming to Medicaid and Marketplace Coverage", "url": "https://khbe.ky.gov/Enrollment/Pages/MedicaidChanges.aspx", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Kentucky eProcurement, eMARS Vendor Self Service (VSS)" }, { "code": "LA", "state": "Louisiana", "agency": "Louisiana Department of Health, Bureau of Health Services Financing", "program_name": "Healthy Louisiana", "url": "https://ldh.la.gov/medicaid", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://wwwcfprd.doa.louisiana.gov/osp/lapac/Vendor/VndPubMain.cfm?tab=2", "mes_modernization": "LDH's Medicaid Enterprise Systems process FFS claims, managed care encounters, provider enrollment and program integrity. The FY2026-2031 strategic plan sets an objective to move to a cloud-based modular platform, starting with a cloud Decision Support System to replace the legacy mainframe and data warehouse. A legislative fiscal note records MES module purchasing through NASPO multi-state cooperative contracts. As of 2026-09-22.", "work_requirements_status": "LDH says work or community engagement requirements begin 2027-01-01 for members up for renewal and new applicants aged 19 to 64: 80 hours a month, $580 in monthly earnings, or at least half-time school. Members renewing in 2027-01 were mailed a notice in 2026-05 and get a renewal packet in 2026-11. As of 2026-09-22.", "sources": [ { "label": "Louisiana Department of Health Medicaid", "url": "https://ldh.la.gov/medicaid", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Louisiana Division of Administration, Office of State Procurement page linking LaPAC", "url": "https://www.doa.la.gov/doa/osp/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: LaPAC vendor public main page (curl, HTTP 200)", "url": "https://wwwcfprd.doa.louisiana.gov/osp/lapac/Vendor/VndPubMain.cfm?tab=2", "retrieved": "2026-09-22" }, { "label": "MES modernization: LDH, FY 2026-2031 Strategic Plan, Medical Vendor Administration, Activity 2 Medicaid Enterprise Systems (PDF)", "url": "https://ldh.la.gov/assets/docs/budget/Medicaid-FY2026-2031-5-YEAR-STRATEGIC-PLAN.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Louisiana Legislature fiscal document on Medicaid Enterprise Systems cooperative purchasing (PDF)", "url": "https://legis.la.gov/Legis/ViewDocument.aspx?d=1218203", "retrieved": "2026-09-22" }, { "label": "MES modernization: LDH news, RFP: Enterprise Architecture for LDH Medicaid Systems Modernization, 2015-05-06 (curl)", "url": "https://ldh.la.gov/news/3372", "retrieved": "2026-09-22" }, { "label": "Work requirements: LDH, Medicaid Work or Community Engagement Requirements (curl)", "url": "https://ldh.la.gov/medicaid/work-requirements", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "LaPAC" }, { "code": "ME", "state": "Maine", "agency": "Department of Health and Human Services, Office of MaineCare Services", "program_name": "MaineCare", "url": "https://www.maine.gov/dhhs/oms", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.maine.gov/dafs/bbm/procurementservices/vendors/rfps", "mes_modernization": "The Office of MaineCare Services is upgrading MIHMS, its claims processing system, and replacing the HealthPAS Online Portal with a new MaineCare Partner Portal. A 2026-03-16 bulletin announced a late September 2026 launch; a 2026-08-20 bulletin moved the launch to mid-October 2026 and pauses configuration changes from the end of August to the end of October 2026. The bulletins name no vendor. As of 2026-08-20.", "work_requirements_status": "Maine DHHS says MaineCare expansion adults 19 to 64 must meet work requirements starting 2027-01-01: $580 in monthly earnings or 80 hours of approved activities. OFI began member outreach in 2026-08 with letters, e-notices, texts and calls; partner materials are dated 2026-08-24. As of 2026-08-24.", "sources": [ { "label": "Maine Office of MaineCare Services", "url": "https://www.maine.gov/dhhs/oms", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Maine Division of Procurement Services, RFPs page with VSS notice", "url": "https://www.maine.gov/dafs/bbm/procurementservices/vendors/rfps", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Maine Division of Procurement Services, Vendor Self Service system page (curl)", "url": "https://www.maine.gov/dafs/bbm/procurementservices/vendors/vendor-self-service-system", "retrieved": "2026-09-22" }, { "label": "MES modernization: Maine DHHS OMS provider bulletin, Action Needed: A New Online Portal is Coming September 2026, 2026-03-16 (curl)", "url": "https://www.maine.gov/dhhs/oms/providers/provider-bulletins/action-needed-new-online-portal-coming-september-2026-you-need-confirm-your-login", "retrieved": "2026-09-22" }, { "label": "MES modernization: Maine DHHS OMS provider bulletin, Reminder: Upcoming Pause in Configuration Changes, 2026-08-20 (curl)", "url": "https://www.maine.gov/dhhs/oms/providers/provider-bulletins/reminder-upcoming-pause-configuration-changes-2026-08-20", "retrieved": "2026-09-22" }, { "label": "Work requirements: Maine DHHS OFI, Work Requirements for MaineCare Expansion Adults", "url": "https://www.maine.gov/dhhs/ofi/health-care-assistance/work", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "Maine Division of Procurement Services RFP listing and Vendor Self Service (VSS)" }, { "code": "MD", "state": "Maryland", "agency": "Maryland Department of Health (Medicaid)", "program_name": "Maryland Medicaid (HealthChoice managed care)", "url": "https://health.maryland.gov/mmcp/pages/home.aspx", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://emma.maryland.gov/", "mes_modernization": "MDH runs a Medicaid Enterprise Systems Modular Transformation (MMT) program to replace the MMIS procured in 1992. NTT DATA was selected in 2021 to run the MMT program office, with full implementation expected in 2029 per the vendor release. Trade reporting says the MPRIME provider enrollment module replaces ePREP in 2026-10. No MDH page on program status was found in this pass. As of 2026-08.", "work_requirements_status": "Maryland Health Connection states that starting 2027-01-01 some Medicaid adults must meet work requirements and all Medicaid members renew every six months. No earlier implementation date or waiver notice was found on a state page in this pass. As of 2026-09-22.", "sources": [ { "label": "Maryland Department of Health Medicaid", "url": "https://health.maryland.gov/mmcp/pages/home.aspx", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Maryland Office of State Procurement home page, describes eMMA as the State of Maryland's eProcurement system where solicitations post public notices", "url": "https://procurement.maryland.gov/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: eMMA root URL, curl 200", "url": "https://emma.maryland.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Voyatek case study, Maryland MDH MMIS, dated 2022-04-27 (vendor; states the MMIS was procured in 1992)", "url": "https://www.voyatek.com/insights/case-study-maryland-department-of-health-medicaid-management-information-systems-mmis/", "retrieved": "2026-09-22" }, { "label": "MES modernization: BusinessWire, NTT DATA selected for MDH MMT program, 2021-11-15 (vendor release; search snippet, fetch returned 403)", "url": "https://www.businesswire.com/news/home/20211115005991/en", "retrieved": "2026-09-22" }, { "label": "MES modernization: Potomac Officers Club, NTT DATA and MDH MMT PMO, full implementation expected 2029 (trade; search snippet)", "url": "https://www.potomacofficersclub.com/ntt-data-to-help-maryland-health-department-modernize-medicaid-enterprise-system/", "retrieved": "2026-09-22" }, { "label": "MES modernization: MedRevenueCycle, Maryland MPRIME transition October 2026 (trade; search snippet)", "url": "https://www.medrevenuecycle.com/post/maryland-medicaid-provider-alert-the-mprime-transition-is-underway", "retrieved": "2026-09-22" }, { "label": "Work requirements: Maryland Health Connection, Changes Coming to Health Care in Maryland (opened with curl)", "url": "https://www.marylandhealthconnection.gov/whats-new/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "eMaryland Marketplace Advantage (eMMA)" }, { "code": "MA", "state": "Massachusetts", "agency": "Executive Office of Health and Human Services (MassHealth)", "program_name": "MassHealth", "url": "https://www.mass.gov/orgs/masshealth", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.commbuys.com/bso/", "mes_modernization": "Claims (MMIS): incumbent not yet read. A NewMMIS RFR listing exists; the incumbent's name did not appear on a MassHealth page in this pass. As of 2026-09-20.", "work_requirements_status": "MassHealth states that beginning 2027-01-01 the federal government will require some members to meet work and education requirements, and that affected members will be notified before changes take effect. A search snippet from the same site says notices began in 2026-08. As of 2026-08.", "sources": [ { "label": "MassHealth", "url": "https://www.mass.gov/orgs/masshealth", "retrieved": "2026-09-20" }, { "label": "Procurement portal: COMMBUYS (state-procurement.json, verified 2026-09-20)", "url": "https://www.commbuys.com/bso/", "retrieved": "2026-09-20" }, { "label": "Work requirements: Mass.gov, New work and education requirements for MassHealth members (opened with curl, page dated 2026-07-21)", "url": "https://www.mass.gov/info-details/new-work-and-education-requirements-for-masshealth-members", "retrieved": "2026-09-22" }, { "label": "Work requirements: Mass.gov, MassHealth Federal Updates and Impact (search snippet: notices began August 2026)", "url": "https://www.mass.gov/info-details/masshealth-federal-updates-and-impact", "retrieved": "2026-09-22" }, { "label": "MES modernization: Bid listing: NewMMIS RFR announcement (state-procurement.json module record)", "url": "https://bidbanana.thebidlab.com/bid/SIcU8CbdtYOB8OqPnQB0", "retrieved": "2026-09-20" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "COMMBUYS" }, { "code": "MI", "state": "Michigan", "agency": "Michigan Department of Health and Human Services (MDHHS)", "program_name": "Michigan Medicaid", "url": "https://www.michigan.gov/mdhhs/assistance-programs/medicaid", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.michigan.gov/budget/budget-offices/sigma/doing-business-with-the-state", "mes_modernization": "CHAMPS, Michigan's MMIS, runs under DTMB contract 071B6200168C with CNSI (now Acentra Health). Change Notice 27 extended the contract eight years and added $480,000,000, with a revised expiration of 2026-09-30. No re-procurement notice for CHAMPS was found in this pass; the HMA roundup of 2026-09-02 lists only an NEMT broker RFP for Michigan. As of 2026-09-02.", "work_requirements_status": "MDHHS announced on 2026-07-23 that beginning 2027-01 certain Healthy Michigan Plan members aged 19 to 64 must meet work requirements or qualify for an exemption, with most moving to six-month renewals. MDHHS testimony of 2026-04-28 gives the implementation date as 2027-01-01. As of 2026-07-23.", "sources": [ { "label": "MDHHS Medicaid", "url": "https://www.michigan.gov/mdhhs/assistance-programs/medicaid", "retrieved": "2026-09-20" }, { "label": "Procurement portal: SIGMA Vendor Self Service (state-procurement.json, verified 2026-09-20)", "url": "https://www.michigan.gov/budget/budget-offices/sigma/doing-business-with-the-state", "retrieved": "2026-09-20" }, { "label": "MES modernization: DTMB Change Notice 27 to Contract 071B6200168C, CHAMPS (official PDF, opened with curl; extension eight years, revised expiration 2026-09-30)", "url": "https://www.michigan.gov/-/media/Project/Websites/dtmb/Procurement/Contracts/Folder3/6200168CN26.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Acentra Health case study, Michigan MDHHS MMIS (vendor; CNSI became Acentra Health)", "url": "https://acentra.com/case-studies/michigan-department-of-health-and-human-services-mmis/", "retrieved": "2026-09-22" }, { "label": "MES modernization: HMA Weekly Roundup 2026-09-02 (trade; only a Michigan NEMT RFP listed)", "url": "https://www.healthmanagement.com/insights/weekly-roundup-v2/september-2-2026/", "retrieved": "2026-09-22" }, { "label": "Work requirements: MDHHS news release 2026-07-23, Healthy Michigan Plan changes under H.R. 1 (opened with curl)", "url": "https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2026/07/23/medicaid-work", "retrieved": "2026-09-22" }, { "label": "Work requirements: House Fiscal Agency, MDHHS testimony H.R. 1 Implementation: Medicaid Changes, 2026-04-28 (official PDF, opened with curl)", "url": "https://www.house.mi.gov/hfa/PDF/HealthandHumanServices/MedicaidandBehavioralHealth_Subcmte_Testimony_MDHHS_Medicaid_Changes_4-28-26.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "SIGMA Vendor Self Service" }, { "code": "MN", "state": "Minnesota", "agency": "Minnesota Department of Human Services", "program_name": "Medical Assistance (MA)", "url": "https://mn.gov/dhs/health-care/medical-assistance/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "GovRAMP (formal state program page)", "procurement_portal_url": "https://mn.gov/supplier", "mes_modernization": "DHS published a 2025 MES Modernization Strategy that swaps large system replacement for small end-to-end slices, and posted an RFx, Innovative strategy for MES modernization, on 2025-07-31 with responses due 2025-09-30 (bid listing). The DHS 2026 Supplemental Budget Book (2026-02) funds MMIS changes for H.R. 1 and an ASO shift but names no MMIS replacement procurement. As of 2026-02.", "work_requirements_status": "DHS states that effective 2027-01-01 Medical Assistance expansion adults must meet work or community engagement requirements unless exempt, with six-month renewals from the same date (2026 Supplemental Budget Book, 2026-02). The DHS work requirements page gives the same start date (search snippet). As of 2026-02.", "sources": [ { "label": "Minnesota DHS Medical Assistance", "url": "https://mn.gov/dhs/health-care/medical-assistance/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Minnesota Office of State Procurement, Contract Opportunities / Supplier Portal (search snippet; page behind a bot check)", "url": "https://mn.gov/admin/osp/vendors/solicitations-and-contract-opportunities/supplier-portal/index.jsp", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Minnesota Supplier Portal public bidding event page, curl 200", "url": "https://guest.supplier.systems.state.mn.us/psc/fmssupap/SUPPLIER/ERP/c/SCP_PUBLIC_MENU_FL.SCP_PUB_BID_CMP_FL.GBL", "retrieved": "2026-09-22" }, { "label": "MES modernization: Digital Government Hub, Attachment A: Minnesota MES Modernization Strategy Summary (reproduction of a DHS document, 2025)", "url": "https://digitalgovernmenthub.org/examples/attachment-a-minnesota-medicaid-enterprise-systems-mes-modernization-strategy-summary/", "retrieved": "2026-09-22" }, { "label": "MES modernization: HigherGov listing, DHS/Innovative strategy for MES modernization, posted 2025-07-31, due 2025-09-30 (bid aggregator)", "url": "https://www.highergov.com/sl/contract-opportunity/mn-dhs-innovative-strategy-for-mes-moderniz-54088419/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Minnesota DHS 2026 Supplemental Budget Book, February 2026 (official PDF via Minnesota House; text extracted locally)", "url": "https://www.house.mn.gov/comm/docs/DDWrmC34yUO2mThOSBJcxQ.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: Minnesota DHS, Work requirements page (search snippet; page behind a bot check)", "url": "https://mn.gov/dhs/federalchanges/work-requirements/index.jsp", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Minnesota Supplier Portal (SWIFT)" }, { "code": "MS", "state": "Mississippi", "agency": "Mississippi Division of Medicaid, Office of the Governor", "program_name": "Mississippi Medicaid", "url": "https://medicaid.ms.gov/", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.ms.gov/dfa/contract_bid_search/", "mes_modernization": "The Division of Medicaid replaced the Envision MMIS with MESA (Medicaid Enterprise System Assistance), built and operated by Gainwell Technologies as fiscal agent, which went live 2022-10-03; the project page was last updated 2022-08-31. MESA is operating; a Division notice describes a Gainwell claim reconsideration process effective 2026-09-14 (search snippet). No new MES procurement was found in this pass. As of 2026-09-14.", "work_requirements_status": "Has not adopted expansion and is not one of the three non-expansion states (Georgia, Tennessee, Wisconsin) KFF lists as subject through 1115 programs; KFF counts 44 jurisdictions subject to the requirement from 2027-01-01. As of 2026-09-09.", "sources": [ { "label": "Mississippi Division of Medicaid", "url": "https://medicaid.ms.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Mississippi DFA, Buying and Selling to Government of Mississippi, Sell page (opened)", "url": "https://www.ms.gov/dfa/contract_bid_search/home/sell", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Mississippi Contract/Bid Search root, curl 200", "url": "https://www.ms.gov/dfa/contract_bid_search/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Mississippi Division of Medicaid, The Mississippi Medicaid MMIS Replacement Project (opened; last updated 2022-08-31)", "url": "https://medicaid.ms.gov/the-mississippi-medicaid-mmis-replacement-project/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Mississippi Division of Medicaid, Late Breaking News (search snippet: claim reconsideration process effective 2026-09-14)", "url": "https://medicaid.ms.gov/late-breaking-news/", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF: Tracking Implementation of the 2025 Reconciliation Law, Medicaid Work Requirements (overview, page dated 2026-09-09)", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF: Medicaid Work Requirements tracker, 1115 waivers and early implementation (page dated 2026-09-09)", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-1115-waivers/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Mississippi Contract/Bid Search (MAGIC)" }, { "code": "MO", "state": "Missouri", "agency": "Department of Social Services, MO HealthNet Division", "program_name": "MO HealthNet", "url": "https://mydss.mo.gov/mhd", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://missouribuys.mo.gov/", "mes_modernization": "MO HealthNet is replacing its legacy MMIS in modules: Pharmacy Benefit Administration, Prior Authorization, a Managed Care Compliance Tool and an MMIS Core Claims Solution. The legacy MMIS fiscal agent contract with Infocrossing and the CMSP contract with Conduent are extended through SFY 2029 to bridge to the new modules (Senate FY2026 budget notes). Per-module phase was not found on a state page in this pass. As of 2025-07.", "work_requirements_status": "DSS states that community engagement requirements for MO HealthNet Adult Expansion Group members aged 19 to 64 start 2027-01-01, with six-month renewals from the same date. A DSS page (search snippet) says outreach notices to more than 300,000 participants began mailing in 2026-08. As of 2026-08.", "sources": [ { "label": "MO HealthNet Division", "url": "https://mydss.mo.gov/mhd", "retrieved": "2026-09-20" }, { "label": "Procurement portal: MissouriBUYS home page (opened)", "url": "https://missouribuys.mo.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Missouri Senate Appropriations, FY2026 TAFP (after veto) budget notes, HB 11, DSS MO HealthNet (official PDF; text extracted locally)", "url": "https://www.senate.mo.gov/25info/Comm/BudgetNotes/BudgetNotes/HB%2011%20-%20DSS%205%20-%20Medicaid%20Services%20(After%20Veto).pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Missouri Office of Administration, DSS Information Systems MMIS program description (official PDF; text extracted locally; modular replacement of MMIS subsystems)", "url": "https://oa.mo.gov/sites/default/files/dss_information_sys_mmis.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: Missouri DSS, Community Engagement Requirements Frequently Asked Questions (opened)", "url": "https://dss.mo.gov/community-engagement-requirements-frequently-asked-questions", "retrieved": "2026-09-22" }, { "label": "Work requirements: Missouri DSS, H.R.1 Implementation (opened)", "url": "https://dss.mo.gov/hr1-implementation", "retrieved": "2026-09-22" }, { "label": "Work requirements: Missouri DSS, H.R.1 Participant Resources (search snippet: outreach notices from August 2026)", "url": "https://dss.mo.gov/hr1/participant-resources", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "MissouriBUYS" }, { "code": "MT", "state": "Montana", "agency": "Department of Public Health and Human Services (DPHHS)", "program_name": "Montana Medicaid (HELP Plan for expansion adults)", "url": "https://dphhs.mt.gov/healthcare/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://emacs.mt.gov/", "mes_modernization": "DPHHS is replacing its 1984 claims system with the Montana Healthcare Claims System (MTHCS), implemented by Gainwell Technologies under the MES initiative; kickoff was 2024-10-15, system integration testing began 2025-09-19, and go-live is planned for 2027 (page update 2026-08-04). Montana is lead state for the NASPO ValuePoint MES Claims Processing module (term 2021-01-04 to 2030-12-31). As of 2026-08-04.", "work_requirements_status": "DPHHS announced on 2026-06-30 that Medicaid Expansion community engagement requirements took effect 2026-07-01 for non-excluded members aged 19 to 64, documented at the next redetermination; the state converted its 1115 waiver application into a state plan amendment at CMS direction. As of 2026-06-30.", "sources": [ { "label": "Montana DPHHS healthcare programs", "url": "https://dphhs.mt.gov/healthcare/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Montana Department of Administration, State Procurement Services Division (opened)", "url": "https://doa.mt.gov/spsd/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: eMACS root URL, curl 200 (redirects to doa.mt.gov/spsd/)", "url": "https://emacs.mt.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Montana DPHHS, Claims Modernization (opened; MTHCS update 2026-08-04)", "url": "https://dphhs.mt.gov/MontanaHealthcarePrograms/ClaimsModernization", "retrieved": "2026-09-22" }, { "label": "MES modernization: NASPO ValuePoint, MES Claims Processing and Management Services Module portfolio (opened; lead state Montana)", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-claims-processing-and-management-services-module/", "retrieved": "2026-09-22" }, { "label": "Work requirements: Montana DPHHS news release 2026-06-30, Montana Medicaid Community Engagement Requirements Begin July 1 (opened)", "url": "https://dphhs.mt.gov/News/2026/June/MT-Medicaid-Community-Engagement-July-1", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "eMACS (Montana Acquisition and Contracting System)" }, { "code": "NE", "state": "Nebraska", "agency": "Department of Health and Human Services, Division of Medicaid and Long-Term Care", "program_name": "Heritage Health (managed care)", "url": "https://dhhs.ne.gov/Pages/Heritage-Health-Contacts.aspx", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://das.nebraska.gov/materiel/purchasing/bid-opportunities.html", "mes_modernization": "DHHS is replacing its 1978-certified MMIS module by module. The state page lists the Data Management and Analytics module (launch expected 2019-06) and three modules slated for future RFPs: Central Provider Management, Pharmacy Point of Sale and Medicaid Drug Rebate. Maximus reported a 2022-08-17 award of the Provider module through NASPO ValuePoint for about six years (vendor release). As of 2022-08-17.", "work_requirements_status": "DHHS announced on 2026-04-02 that community engagement requirements for Medicaid expansion adults aged 19 to 64 took effect 2026-05-01 for new applicants, with existing members assessed at renewal. The Governor's 2025-12-17 release called Nebraska first in the nation to pursue the requirement. As of 2026-04-02.", "sources": [ { "label": "Nebraska DHHS Heritage Health", "url": "https://dhhs.ne.gov/Pages/Heritage-Health-Contacts.aspx", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Nebraska DAS Materiel, State Purchasing Bureau Bid Opportunities (opened)", "url": "https://das.nebraska.gov/materiel/purchasing/bid-opportunities.html", "retrieved": "2026-09-22" }, { "label": "MES modernization: Nebraska DHHS, Medicaid Current Initiatives (opened; MMIS replacement section)", "url": "https://dhhs.ne.gov/Pages/Medicaid-Current-Initiatives.aspx", "retrieved": "2026-09-22" }, { "label": "MES modernization: Maximus news release 2022-08-17, Nebraska MMIS Provider module contract (vendor)", "url": "https://maximus.com/news-and-events/nebraska-mmis-provider-contract", "retrieved": "2026-09-22" }, { "label": "Work requirements: Nebraska DHHS news release 2026-04-02, DHHS Preparing Community Partners for Medicaid Work Requirements (opened)", "url": "https://dhhs.ne.gov/Pages/DHHS-Preparing-Community-Partners-for-Medicaid-Work-Requirements.aspx", "retrieved": "2026-09-22" }, { "label": "Work requirements: Office of Governor Jim Pillen, release 2025-12-17, Nebraska first in the nation to pursue Medicaid work requirements (opened)", "url": "https://governor.nebraska.gov/gov-pillen-dr-oz-announce-nebraska-first-nation-pursue-medicaid-work-requirements", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Nebraska State Purchasing Bureau Bid Opportunities" }, { "code": "NV", "state": "Nevada", "agency": "Department of Health and Human Services, Division of Health Care Financing and Policy (DHCFP)", "program_name": "Nevada Medicaid", "url": "https://dhcfp.nv.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "GovRAMP (formal state program page)", "procurement_portal_url": "https://nevadaepro.com/bso/", "mes_modernization": "DHCFP's modernized MMIS went live 2019-02-01 and is operating; Gainwell Technologies is the fiscal agent responsible for the MMIS (DHCFP training document, 2025-12, search snippet). No MMIS re-procurement or MES modernization notice was found on a state page in this pass; a 2024-02-16 DHCFP legislative update lists no MMIS replacement. As of 2025-12.", "work_requirements_status": "The Nevada Health Authority posted a 2026-09-03 release urging Nevadans to watch for a letter on Medicaid eligibility changes. Press reporting (search snippet) says notices to about 250,000 expansion enrollees began mailing that week and the 80-hour rule starts in 2027. As of 2026-09-03.", "sources": [ { "label": "Nevada DHCFP", "url": "https://dhcfp.nv.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Nevada State Purchasing Division, Vendors page (opened)", "url": "https://www.purchasing.nv.gov/vendors/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: NevadaEPro root URL, curl 200", "url": "https://nevadaepro.com/bso/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Nevada Medicaid, Modernization Project page (opened; modernized MMIS go-live 2019-02-01)", "url": "https://medicaid.nv.gov/providers/Modernization", "retrieved": "2026-09-22" }, { "label": "MES modernization: Nevada DHCFP, Centralized Credentialing Training, December 2025 (search snippet: Gainwell Technologies responsible for the MMIS)", "url": "https://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Providers/Centralized%20Credentialing%20Training_FINAL%20Dec%202025_.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Nevada Legislature, Updates from the Nevada Medicaid Program, 2024-02-16 (official PDF; text extracted locally)", "url": "https://www.leg.state.nv.us/App/InterimCommittee/REL/Document/29652", "retrieved": "2026-09-22" }, { "label": "Work requirements: Nevada Health Authority, Be Informed (opened; release dated 2026-09-03 listed)", "url": "https://www.nvha.nv.gov/working-together/be-informed/", "retrieved": "2026-09-22" }, { "label": "Work requirements: Nevada Current, Nevada Medicaid begins outreach effort over work requirements, 2026-09-04 (press; search snippet)", "url": "https://nevadacurrent.com/2026/09/04/nevada-medicaid-begins-outreach-effort-over-work-requirements/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "NevadaEPro" }, { "code": "NH", "state": "New Hampshire", "agency": "Department of Health and Human Services, Division of Medicaid Services", "program_name": "NH Medicaid", "url": "https://www.dhhs.nh.gov/programs-services/medicaid", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "GovRAMP (formal state program page)", "procurement_portal_url": null, "mes_modernization": "DHHS plans a modular MES to replace an MMIS built about 15 years ago, covering MMIS modules, eligibility and enrollment and pharmacy benefits management; a bid-tracking listing (RFI 2022 OCOM 01 MEDIC) estimates RFP release 2026-05 and award 2026-08 with a $460,640,000 ceiling. Conduent has run the MMIS since 2005 under an extension to 2031 (vendor release, 2021-09-09). A DHHS RFP-2026-DMS-01 document returned 403. As of 2026-05.", "work_requirements_status": "NHPR reported on 2026-07-20 that Granite Advantage members aged 19 to 64 must meet an 80-hour monthly requirement from 2027-01-01, applied at their first 2027 redetermination, with 47,571 members subject as of 2026-07-01; DHHS said it awaited final federal guidance. The DHHS page returned 403.", "sources": [ { "label": "New Hampshire DHHS Medicaid", "url": "https://www.dhhs.nh.gov/programs-services/medicaid", "retrieved": "2026-09-20" }, { "label": "MES modernization: GDIC solicitation profile, NH DHHS MMIS Modular Implementation, MES Program (bid tracker)", "url": "https://www.gdicwins.com/active-rfps/solicitation-profile/dhhs-mmis-modular-implementation-mes-program/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Conduent news release 2021-09-09, New Hampshire extends MMIS partnership (vendor)", "url": "https://www.news.conduent.com/news/new-hampshire-extends-partnership-with-conduent-to-maintain-operate-and-enhance-medicaid-management-information-system", "retrieved": "2026-09-22" }, { "label": "MES modernization: NH DHHS RFP-2026-DMS-01 (official PDF; returned 403, search result only)", "url": "https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/inline-documents/sonh/rfp-2026-dms-01-ebint_1.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: NHPR, Work requirements coming for people on Medicaid Granite Advantage, 2026-07-20 (press)", "url": "https://www.nhpr.org/health/2026-07-20/medicaid-work-requirements-nh-granite-advantage", "retrieved": "2026-09-22" }, { "label": "Work requirements: NH DHHS, Medicaid Work Requirements: What You Need to Know (official page; returned 403, search result only)", "url": "https://www.dhhs.nh.gov/programs-services/stay-covered-new-hampshire/medicaid-work-requirements-what-you-need-know", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [ "procurement_portal_url" ] }, { "code": "NJ", "state": "New Jersey", "agency": "Department of Human Services, Division of Medical Assistance and Health Services (DMAHS)", "program_name": "NJ FamilyCare", "url": "https://www.nj.gov/humanservices/dmahs/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.njstart.gov/bso/", "mes_modernization": "DMAHS is replacing aging legacy components of the Medicaid enterprise in modules. A Treasury special notice with comments due 2024-04-29 states the intent to join the NASPO ValuePoint Provider Services Module master agreement (lead state Montana) for a provider module; the MMIS Provider Services contract was set to expire 2025-05-28 with an option to extend up to three years. As of 2024-04-29.", "work_requirements_status": "DMAHS states the community engagement requirement starts 2027-01-01 for certain adults 19 to 64 on NJ FamilyCare Plan ABP, with general notices mailed in fall 2026 and renewals every six months. No waiver or early implementation is mentioned. As of 2026-09-22.", "sources": [ { "label": "New Jersey DMAHS", "url": "https://www.nj.gov/humanservices/dmahs/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: NJ Division of Purchase and Property, Vendors page (opened)", "url": "https://nj.gov/treasury/purchase/vendor.shtml", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Business.NJ.gov, Government Contracting (search snippet)", "url": "https://business.nj.gov/pages/government-contracting", "retrieved": "2026-09-22" }, { "label": "MES modernization: NJ Treasury special notice M4024, Notice of Intent to Join Cooperative Agreement, MMIS Provider Services (opened, PDF text extracted)", "url": "https://nj.gov/treasury/purchase/specialnotices/M4024_Special%20Notice.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: DMAHS 2025 Core Medicaid-MLTSS Annual Technical Report (search snippet)", "url": "https://www.nj.gov/humanservices/dmahs/documents/news/2025_Core_Medicaid-MLTSS_Annual_Technical_Report.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: NJ DMAHS, Community Engagement / Work Requirements (opened)", "url": "https://www.nj.gov/humanservices/dmahs/obbba/work-requirements/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "NJSTART" }, { "code": "NM", "state": "New Mexico", "agency": "Health Care Authority, Medical Assistance Division", "program_name": "Turquoise Care (managed care since 2024-07-01)", "url": "https://www.hca.nm.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://generalservices.state.nm.us/state-purchasing/online-procurement/", "mes_modernization": "New Mexico is replacing its MMIS in modules. HCA's Turquoise Claims, replacing the NM Medicaid Provider Web Portal and OmniCaid, went live at YES.NM.GOV on 2026-03-23 as one piece of a larger project to update the Medicaid enterprise system. Conduent was awarded the new MMIS contract (enterprise claims, self-directed HCBS, PBM, drug rebate, data exchange) on 2023-02-14 per its press release. As of 2026-03-23.", "work_requirements_status": "HCA's 2026-08-31 briefing states that starting Jan. 1 (2027 under the federal rule) some adults 19 to 64 must complete 80 hours a month of work or other qualifying activities unless exempt; HCA projects about 89,000 New Mexicans could lose coverage. No waiver or extension is mentioned. As of 2026-08-31.", "sources": [ { "label": "New Mexico Health Care Authority", "url": "https://www.hca.nm.gov/", "retrieved": "2026-09-20" }, { "label": "Turquoise Care overview", "url": "https://www.hca.nm.gov/turquoise-care/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: NM GSD State Purchasing Division, Online Procurement (opened)", "url": "https://generalservices.state.nm.us/state-purchasing/online-procurement/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: New Mexico Business Portal, Procurement Opportunities (opened)", "url": "https://biz.nm.gov/procurement-opportunities/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: NM GSD State Purchasing Division FAQs (opened)", "url": "https://generalservices.state.nm.us/state-purchasing/faqs/", "retrieved": "2026-09-22" }, { "label": "MES modernization: NM Health Care Authority, Turquoise Claims (opened)", "url": "https://www.hca.nm.gov/turquoise-claims/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Conduent press release, New Mexico awards MMIS contract, 2023-02-14 (opened; vendor release, medium)", "url": "https://www.news.conduent.com/news/new-mexico-awards-contract-for-new-medicaid-management-information-system-to-conduent", "retrieved": "2026-09-22" }, { "label": "MES modernization: UHCprovider.com, New Mexico Medicaid claims process change (search snippet, medium)", "url": "https://www.uhcprovider.com/content/provider/en/resource-library/news/2026/nm-medicaid-claims-single-point.html", "retrieved": "2026-09-22" }, { "label": "Work requirements: NM Health Care Authority, New Mexico briefs public on new federal Medicaid requirements, 2026-08-31 (opened)", "url": "https://www.hca.nm.gov/2026/08/31/new-mexico-briefs-public-on-new-federal-medicaid-requirements/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "State Purchasing Division Online Procurement System" }, { "code": "NY", "state": "New York", "agency": "Department of Health, Office of Health Insurance Programs", "program_name": "New York State Medicaid", "url": "https://www.health.ny.gov/health_care/medicaid/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.nyscr.ny.gov/", "mes_modernization": "eMedNY (fiscal agent CSRA, contract C014305) stays extended while DOH aligns procurement to its MES roadmap (2026-09-20 record). DOH's eligibility modernization page (revised 2026-03) says the modern eligibility system launched 2025-09-30 with limited users, added users in 2025-12 for dual-eligible and most over-65 consumers via the updated member portal, and moves the remaining non-MAGI population from 2026. As of 2026-03.", "work_requirements_status": "NY State of Health (published 2026-09-16) states work requirements start 2027-01-01 for some adults 19 to 64, checked at application and renewal, with notices by mail or email by 2026-09-30 and six-month renewals. No waiver or early implementation is mentioned. As of 2026-09-16.", "sources": [ { "label": "New York State Medicaid", "url": "https://www.health.ny.gov/health_care/medicaid/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: NYS Contract Reporter (state-procurement.json, verified 2026-09-20)", "url": "https://www.nyscr.ny.gov/", "retrieved": "2026-09-20" }, { "label": "MES modernization: NYS DOH, Continuing the Medicaid Eligibility Modernization, revised March 2026 (opened via curl)", "url": "https://www.health.ny.gov/health_care/medicaid/program/medicaid_modernization/", "retrieved": "2026-09-22" }, { "label": "Work requirements: NY State of Health, Stay Covered: H.R.1 changes (opened via curl)", "url": "https://info.nystateofhealth.ny.gov/stay-covered", "retrieved": "2026-09-22" }, { "label": "Work requirements: NYC Health Department, New Medicaid Eligibility Requirements for Provider Awareness, 2026-07-27 (opened, PDF text extracted; city page, medium)", "url": "https://www.nyc.gov/assets/doh/downloads/pdf/letters/2026/new-medicaid-eligibility-requirements.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "NYS Contract Reporter" }, { "code": "NC", "state": "North Carolina", "agency": "Department of Health and Human Services, Division of Health Benefits", "program_name": "NC Medicaid", "url": "https://medicaid.ncdhhs.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "GovRAMP (formal state program page)", "procurement_portal_url": "https://evp.nc.gov/", "mes_modernization": "NC runs a modular MES whose portal lists NCTracks, the Encounter Processing System and a Pharmacy Benefit Administrator. NCDHHS awarded Optum the PDM/CVO module to replace the provider enrollment components of NCTracks; launch moved to 2026 (post of 2024-06-11), and the NC Medicaid PDM/CVO page now says implementation is paused until further notice, with providers continuing to use NCTracks. As of 2026-09-22.", "work_requirements_status": "NC Medicaid (page modified 2026-08-31) states that starting 2027-01-01 most adults 19 through 64 must work, attend school, volunteer or meet an income amount each month to keep Medicaid, with recertification every six months. No waiver or extension is mentioned. As of 2026-08-31.", "sources": [ { "label": "NC Medicaid", "url": "https://medicaid.ncdhhs.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: NC eProcurement, New electronic Vendor Portal (eVP) is Live (opened)", "url": "https://eprocurement.nc.gov/new-electronic-vendor-portal-evp-live", "retrieved": "2026-09-22" }, { "label": "Procurement portal: NC eVP home page (opened)", "url": "https://evp.nc.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: NC Medicaid, Provider Data Management / Credentialing Verification Organization (opened)", "url": "https://medicaid.ncdhhs.gov/providers/provider-data-management-credentialing-verification-organization", "retrieved": "2026-09-22" }, { "label": "MES modernization: NC Medicaid, PDM/CVO Solution New Launch Date of 2026, 2024-06-11 (opened)", "url": "https://medicaid.ncdhhs.gov/blog/2024/06/11/provider-data-management-credentialing-verification-organization-solution-new-launch-date-2026", "retrieved": "2026-09-22" }, { "label": "MES modernization: NC MES portal (opened)", "url": "https://mes.medicaid.ncdhhs.gov/", "retrieved": "2026-09-22" }, { "label": "Work requirements: NC Medicaid, The Work and Community Engagement Requirement (opened)", "url": "https://medicaid.ncdhhs.gov/beneficiaries/impact-hr-1-and-federal-changes-medicaid/nc-medicaid-work-and-community-engagement-requirements", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "NC electronic Vendor Portal (eVP)" }, { "code": "ND", "state": "North Dakota", "agency": "Health and Human Services, Medical Services Division", "program_name": "North Dakota Medicaid", "url": "https://www.hhs.nd.gov/healthcare/medicaid", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "GovRAMP (formal state program page)", "procurement_portal_url": "https://www.omb.nd.gov/doing-business-state/procurement/ndbuys", "mes_modernization": "ND HHS is modernizing its MES in modules over about 12 years (estimated completion 2033-03). A 2024-09-30 project report says the System Integrator vendor was procured 2022-04-18 to 2024-05-17, SI platform implementation (Project 2) is in progress, and the first module RFP is in development. The 2026-04-09 MMIS Modernization oversight committee agenda includes provider module procurement review and recommendation. As of 2026-04-09.", "work_requirements_status": "ND HHS (release 2026-07-21) states that starting 2027-01-01 adults 19 to 64 in Medicaid Expansion must complete 80 hours a month of work or other approved activities unless excluded; an estimated 5,000 to 7,000 members are affected. No waiver or early implementation is mentioned. As of 2026-07-21.", "sources": [ { "label": "North Dakota HHS Medicaid", "url": "https://www.hhs.nd.gov/healthcare/medicaid", "retrieved": "2026-09-20" }, { "label": "Procurement portal: ND OMB, NDBuys (opened)", "url": "https://www.omb.nd.gov/doing-business-state/procurement/ndbuys", "retrieved": "2026-09-22" }, { "label": "MES modernization: ND Legislative Branch, Iterative Project Report, MMIS Modernization, submitted 2024-09-30 (opened, PDF text extracted)", "url": "https://ndlegis.gov/sites/default/files/pdf/committees/69-2025/27.5019.020002-medicaidmanagementinformationsystem-phase2-startup.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: ND HHS, Meeting Notice, MMIS Modernization Project Oversight Committee, 2026-04-09 (opened)", "url": "https://www.hhs.nd.gov/events/meeting-notice-medicaid-management-information-system-mmis-modernization-project-oversight", "retrieved": "2026-09-22" }, { "label": "Work requirements: ND HHS, HHS preparing to implement federal work requirements, 2026-07-21 (opened)", "url": "https://www.hhs.nd.gov/news/hhs-preparing-implement-federal-work-requirements-and-other-changes-medicaid-program", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "NDBuys" }, { "code": "OH", "state": "Ohio", "agency": "Ohio Department of Medicaid (ODM)", "program_name": "Ohio Medicaid", "url": "https://medicaid.ohio.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://procure.ohio.gov/state-and-local-agencies/resources/ohiobuys-overview", "mes_modernization": "Ohio operates the modular OMES (fiscal intermediary and single PBM Gainwell, PNM module Maximus, EVV Sandata, per the 2026-09-20 record). A search snippet from ODM's Next Generation MyCare page says EDI claims submitted on or after 2026-01-01 go through the OMES one front door regardless of date of service. As of 2026-01-01.", "work_requirements_status": "Ohio filed a Section 1115 work requirement application 2025-02-28 targeting 2026-01-01 (CMS bulletin; federal comment 2025-03-07 to 2025-04-07). A 2025-11-13 provider association report says ODM will instead implement the H.R. 1 requirement by 2026-12-31 with mailed notices. As of 2025-11-13.", "sources": [ { "label": "Ohio Department of Medicaid", "url": "https://medicaid.ohio.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: OhioBuys (state-procurement.json, verified 2026-09-20)", "url": "https://procure.ohio.gov/state-and-local-agencies/resources/ohiobuys-overview", "retrieved": "2026-09-20" }, { "label": "MES modernization: Ohio Department of Medicaid, Next Generation MyCare Program (search snippet)", "url": "https://medicaid.ohio.gov/resources-for-providers/special-programs-and-initiatives/mycareohio/mycare-ohio", "retrieved": "2026-09-22" }, { "label": "Work requirements: CMS Medicaid.gov bulletin, Ohio Group VIII Work Requirement and Community Engagement Section 1115 Demonstration (opened)", "url": "https://content.govdelivery.com/accounts/USCMSMEDICAID/bulletins/3d5d8c4", "retrieved": "2026-09-22" }, { "label": "Work requirements: LeadingAge Ohio, Ohio Department of Medicaid Outlines New Work and Community Engagement Requirements, 2025-11-13 (opened, medium)", "url": "https://www.leadingageohio.org/aws/LAO/pt/sd/news_article/606943/_PARENT/layout_details/false", "retrieved": "2026-09-22" }, { "label": "Work requirements: Medicaid.gov, Ohio Group VIII Work Requirement and Community Engagement Section 1115 Demonstration, status withdrawn (opened)", "url": "https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82896", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "OhioBuys" }, { "code": "OK", "state": "Oklahoma", "agency": "Oklahoma Health Care Authority (OHCA)", "program_name": "SoonerCare", "url": "https://oklahoma.gov/ohca.html", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.ok.gov/dcs/solicit/app/index.php", "mes_modernization": "OHCA's Project NEXUS is a modernization of its Medicaid Enterprise System to comply with CMS requirements and replace current systems. OHCA held a Medicaid Enterprise System vendor conference on 2025-09-16 and published a NEXUS Journey Map; the page names no vendors, RFPs or dates beyond the conference. As of 2025-09-16.", "work_requirements_status": "OHCA (release 2026-09-02) states federal work requirements take effect 2027-01-01 for SoonerCare expansion adults 19 to 64 who are not exempt, and it has begun mailing yellow notice letters to members likely affected. No waiver or early implementation is mentioned. As of 2026-09-02.", "sources": [ { "label": "Oklahoma Health Care Authority", "url": "https://oklahoma.gov/ohca.html", "retrieved": "2026-09-20" }, { "label": "Procurement portal: OMES Central Purchasing, Solicitations public search utility (opened)", "url": "https://www.ok.gov/dcs/solicit/app/index.php", "retrieved": "2026-09-22" }, { "label": "Procurement portal: OMES Central Purchasing division page (opened)", "url": "https://oklahoma.gov/omes/divisions/central-purchasing.html", "retrieved": "2026-09-22" }, { "label": "MES modernization: Oklahoma Health Care Authority, Nexus (opened)", "url": "https://oklahoma.gov/ohca/nexus.html", "retrieved": "2026-09-22" }, { "label": "Work requirements: OHCA, OHCA Notifies SoonerCare Members About New Federal Work Requirements, 2026-09-02 (opened)", "url": "https://oklahoma.gov/ohca/about/newsroom/2026/september/ohca-notifies-soonercare-members-about-new-federal-work-requirements.html", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "OMES Central Purchasing Solicitations Public Search Utility" }, { "code": "OR", "state": "Oregon", "agency": "Oregon Health Authority", "program_name": "Oregon Health Plan (OHP)", "url": "https://www.oregon.gov/oha/hsd/ohp/pages/index.aspx", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "GovRAMP (formal state program page)", "procurement_portal_url": "https://oregonbuys.gov/bso/", "mes_modernization": null, "work_requirements_status": "OHA's OHP page (updated 2026-09-18) states that starting in 2027 some adults 19 to 64 must meet work or activity rules when they apply for or renew OHP; in 2027 exemptions can be self-attested, and proof is required for more exemptions in 2028. No waiver is mentioned. As of 2026-09-18.", "sources": [ { "label": "Oregon Health Plan", "url": "https://www.oregon.gov/oha/hsd/ohp/pages/index.aspx", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Oregon DAS, Get Started As A Supplier (opened)", "url": "https://www.oregon.gov/das/procurement/pages/supplier.aspx", "retrieved": "2026-09-22" }, { "label": "Work requirements: Oregon Health Authority, OHP Work or Activity Rules and Federal Changes to Oregon Health Plan (opened)", "url": "https://www.oregon.gov/oha/hsd/ohp/pages/federal-changes.aspx", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [ "mes_modernization" ], "procurement_portal_name": "OregonBuys" }, { "code": "PA", "state": "Pennsylvania", "agency": "Department of Human Services, Office of Medical Assistance Programs (OMAP)", "program_name": "Medical Assistance", "url": "https://www.pa.gov/agencies/dhs/departments-offices/omap-info", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.emarketplace.state.pa.us/", "mes_modernization": "PA's MMIS 2020 Platform Project replaces PROMISe (operated by Gainwell) with modules under a system integrator. TurningPoint Global Solutions was awarded the System Integrator/Data Hub contract on 2020-01-15 (seven-year base plus four option years, vendor release). Per the 2026-09-20 record, a replacement RFP was announced for 2022-09-01, EDI as a Service went live 2025-09-22, and IV&V is by SLI. As of 2025-09-22.", "work_requirements_status": "PA DHS states work and community engagement requirements start 2027-01-01 for adults 19 to 64 without dependent children under 14 who are not exempt, with outreach to current recipients by mail, calls and texts from 2026-08 and communication by 2026-09. No waiver or extension is mentioned. As of 2026-09-22.", "sources": [ { "label": "Pennsylvania OMAP", "url": "https://www.pa.gov/agencies/dhs/departments-offices/omap-info", "retrieved": "2026-09-20" }, { "label": "Procurement portal: PA eMarketplace (state-procurement.json, verified 2026-09-20)", "url": "https://www.emarketplace.state.pa.us/", "retrieved": "2026-09-20" }, { "label": "MES modernization: TurningPoint Global Solutions press release, SI/Data Hub contract for Pennsylvania MES, 2020-01-15 (opened; vendor release, medium)", "url": "https://www.tpgsi.com/news/tp_press_release/turningpoint_commonwealth_of_pennsylvania_mes.html", "retrieved": "2026-09-22" }, { "label": "MES modernization: PA DHS, The Platform: MMIS 2020 Platform Project newsletter, Q2 2019 (opened, PDF text extracted)", "url": "https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/docs/documents/omap/c_289028.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: PA DHS, Changes Coming to Medicaid in Pennsylvania (opened)", "url": "https://www.pa.gov/agencies/dhs/resources/medicaid/medicaid-changes", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "PA eMarketplace" }, { "code": "RI", "state": "Rhode Island", "agency": "Executive Office of Health and Human Services (EOHHS)", "program_name": "Rhode Island Medicaid", "url": "https://eohhs.ri.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://ridop.ri.gov/vendors/bidding-opportunities", "mes_modernization": "EOHHS's OASIS program is replacing the legacy MMIS with a modular MES; no module is implemented yet (page updated 2026-07-17). The System Integrator and Operational Data Store RFP (RFP25004569) posted to OSP 2024-08-26; the EVV RFP (RFP26006663) posted 2026-05-22; the TPL award was rescinded with a new RFP planned 2027-07; Provider Services and Core RFPs are planned for 2026-11 and 2026-12 and SURS for 2028-01. As of 2026-07-17.", "work_requirements_status": "RI Medicaid's Stay Covered page (updated 2026-09-01) states community engagement rules apply from 2027 to expansion adults 19 to 64, reported at the member's first renewal that year; notices and texts went out through 2026-08. No waiver or extension is mentioned. As of 2026-09-01.", "sources": [ { "label": "Rhode Island EOHHS", "url": "https://eohhs.ri.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: RI Division of Purchases, Ocean State Procures (OSP) (opened)", "url": "https://ridop.ri.gov/ocean-state-procures-osp", "retrieved": "2026-09-22" }, { "label": "MES modernization: RI EOHHS, Medicaid Enterprise System Transformation Project (OASIS) (opened)", "url": "https://eohhs.ri.gov/OASIS", "retrieved": "2026-09-22" }, { "label": "Work requirements: Stay Covered Rhode Island, Community Engagement Requirements (opened)", "url": "https://staycovered.ri.gov/updates-news/medicaid-updates/community-engagement-requirements", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "Ocean State Procures (OSP)" }, { "code": "SC", "state": "South Carolina", "agency": "Department of Health and Human Services (SCDHHS)", "program_name": "Healthy Connections", "url": "https://www.scdhhs.gov/", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://scbo.sc.gov/", "mes_modernization": "SCDHHS is replacing its 40-year-old legacy Core MMIS under an MES modernization program. A Gartner roadmap dated 2024-08-28 sets 17 workstreams over five years, including a Provider Management Module procurement, a Systems Integrator procurement and incremental decommissioning of the Core MMIS. SCDHHS reviewed the roadmap with vendors at a conference on 2026-04-29. As of 2026-04-29.", "work_requirements_status": "South Carolina has not expanded Medicaid; Georgetown CCF (2025-07-23) states the H.R. 1 requirement does not apply in non-expansion states including South Carolina. SCDHHS separately proposed an 1115 demonstration with 80 hours a month of community engagement (public notice 2025-04-30). As of 2025-07-23.", "sources": [ { "label": "SCDHHS", "url": "https://www.scdhhs.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: SCBO home page, South Carolina Business Opportunities", "url": "https://scbo.sc.gov/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: SC Division of Procurement Services home page (links SCBO and Bidding Opportunities)", "url": "https://procurement.sc.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: SCDHHS vendor information page, MES modernization vendor conference 2026-04-29", "url": "https://www.scdhhs.gov/partners/vendor-information", "retrieved": "2026-09-22" }, { "label": "MES modernization: SCDHHS MES Modernization Roadmap, Gartner final draft v1.0, 2024-08-28 (PDF)", "url": "https://www.scdhhs.gov/sites/dhhs/files/SCDHHS%20MES%20Modernization%20Roadmap_REDACTED.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: SCDHHS MES Modernization Current State Assessment (search snippet)", "url": "https://www.scdhhs.gov/sites/dhhs/files/SCDHHS%20MES%20Modernization%20_Current%20State%20Assessment_REDACTED.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: Georgetown CCF, how the OBB changed the landscape for Medicaid work requirements, 2025-07-23", "url": "https://ccf.georgetown.edu/2025/07/23/states-pursuing-medicaid-work-requirement-waivers-must-make-changes-how-the-obb-changed-the-landscape-for-medicaid-work-requirements/", "retrieved": "2026-09-22" }, { "label": "Work requirements: SCDHHS public notice, Palmetto Pathways to Independence demonstration waiver, 2025-04-30", "url": "https://www.scdhhs.gov/communications/public-notice-south-carolina-department-health-and-human-services-palmetto-pathways", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF, tracking implementation of Medicaid work requirements, overview updated 2026-09-09", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "South Carolina Business Opportunities (SCBO)" }, { "code": "SD", "state": "South Dakota", "agency": "Department of Social Services, Division of Medical Services", "program_name": "South Dakota Medicaid", "url": "https://dss.sd.gov/medicaid/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": null, "mes_modernization": null, "work_requirements_status": "DSS states that effective 2027-01-01 adults 19 to 64 enrolled in Medicaid Expansion must complete at least 80 hours a month of work, job training, community service or half-time school unless exempt; DSS lists nine exemption groups and a member town hall on 2026-11-04. As of 2026-09-22.", "sources": [ { "label": "South Dakota DSS Medicaid", "url": "https://dss.sd.gov/medicaid/", "retrieved": "2026-09-20" }, { "label": "Work requirements: South Dakota DSS, Medicaid eligibility changes coming soon (H.R. 1 page)", "url": "https://dss.sd.gov/medicaid/HR1.aspx", "retrieved": "2026-09-22" }, { "label": "Work requirements: South Dakota Searchlight, 1,213 South Dakotans could lose Medicaid, 2026-04-26 (search snippet)", "url": "https://southdakotasearchlight.com/2026/04/26/1213-south-dakotans-could-lose-medicaid-as-federal-work-requirements-take-effect-department-says/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [ "procurement_portal_url", "mes_modernization" ] }, { "code": "TN", "state": "Tennessee", "agency": "Division of TennCare", "program_name": "TennCare", "url": "https://www.tn.gov/tenncare.html", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.tn.gov/generalservices/procurement/central-procurement-office--cpo-/supplier-information.html", "mes_modernization": "TennCare lists procurement 31865-00662, projected release Q1 2027, for a contractor to assume, operate, migrate to the cloud and enhance the MMIS (member enrollment automation, centralized financial management, MCO encounter processing). The Tennessee Eligibility Platform reprocurement (31865-00648) is projected for Q3 2026, and an enterprise testing services solicitation for MMIS module UAT was released 2026-07-15. As of 2026-09-22.", "work_requirements_status": "Tennessee has not expanded Medicaid. TennCare's notice says CMS determined a small group of parents is subject to the H.R. 1 community engagement requirement and that they automatically meet it from income data TennCare holds, so no action is needed. KFF (2026-09-09) lists Tennessee on the CMS list. As of 2026-09-09.", "sources": [ { "label": "TennCare", "url": "https://www.tn.gov/tenncare.html", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Tennessee CPO supplier information page", "url": "https://www.tn.gov/generalservices/procurement/central-procurement-office--cpo-/supplier-information.html", "retrieved": "2026-09-22" }, { "label": "MES modernization: TennCare upcoming procurements page", "url": "https://www.tn.gov/tenncare/information-statistics/upcoming-procurements.html", "retrieved": "2026-09-22" }, { "label": "Work requirements: TennCare notices page, information about community engagement", "url": "https://www.tn.gov/tenncare/information-statistics/notices.html", "retrieved": "2026-09-22" }, { "label": "Work requirements: Tennessee Rural Health Association updates, 2026-07-21 (links the TennCare notice)", "url": "https://www.tnruralhealth.org/updates", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF, tracking implementation of Medicaid work requirements, overview updated 2026-09-09", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "Edison Supplier Portal (Central Procurement Office)" }, { "code": "TX", "state": "Texas", "agency": "Health and Human Services Commission (HHSC)", "program_name": "Texas Medicaid and CHIP", "url": "https://www.hhs.texas.gov/", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "TX-RAMP (Texas Government Code 2054.0593; GovRAMP reciprocity at Level 2)", "procurement_portal_url": "https://www.txsmartbuy.gov/esbd", "mes_modernization": "HHSC's procurement opportunities page lists two anticipated solicitations: Medicaid claims administration (continued operation of the Texas MMIS with claims administration and financial services), posting Q2 2027, award notice Q2 2028, operations 2030; and a new claims processing, adjudication and financial services system, posting 2029, award notice 2031, operations 2033. As of 2026-09-22.", "work_requirements_status": "Texas has not expanded Medicaid. Georgetown CCF (2025-07-23) states the H.R. 1 community engagement requirement does not apply in non-expansion states including Texas, and KFF's tracker (2026-09-09) does not list Texas among 1115 programs on the CMS list. No HHSC notice was found in this pass. As of 2026-09-09.", "sources": [ { "label": "Texas HHSC", "url": "https://www.hhs.texas.gov/", "retrieved": "2026-09-20" }, { "label": "Texas DIR TX-RAMP", "url": "https://dir.texas.gov/information-security/texas-risk-and-authorization-management-program-tx-ramp", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Electronic State Business Daily (ESBD) (state-procurement.json, verified 2026-09-20)", "url": "https://www.txsmartbuy.gov/esbd", "retrieved": "2026-09-20" }, { "label": "MES modernization: Texas HHS procurement opportunities page", "url": "https://www.hhs.texas.gov/business/contracting-hhs/procurement-opportunities", "retrieved": "2026-09-22" }, { "label": "Work requirements: Georgetown CCF, how the OBB changed the landscape for Medicaid work requirements, 2025-07-23", "url": "https://ccf.georgetown.edu/2025/07/23/states-pursuing-medicaid-work-requirement-waivers-must-make-changes-how-the-obb-changed-the-landscape-for-medicaid-work-requirements/", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF, tracking implementation of Medicaid work requirements, overview updated 2026-09-09", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Electronic State Business Daily (ESBD)" }, { "code": "UT", "state": "Utah", "agency": "Department of Health and Human Services, Division of Integrated Healthcare", "program_name": "Utah Medicaid", "url": "https://medicaid.utah.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": true }, "statewide_cloud_program": "GovRAMP (formal state program page)", "procurement_portal_url": "https://purchasing.utah.gov/", "mes_modernization": "Utah Medicaid replaced its legacy MMIS with PRISM (Provider Reimbursement Information System for Medicaid), soft launch 2023-01 and full operation from 2023-04, covering managed care, prior authorization, eligibility, claims adjudication and payment, a member portal and audit. The state page names no vendor and no further phases; Acentra Health's 2023-06-22 release (medium confidence) says PRISM runs on evoBrix. As of 2026-09-22.", "work_requirements_status": "Utah Medicaid states that from 2027-01-01 adults 19 to 64 in Adult Expansion and Targeted Adult Medicaid must show 80 hours a month of work, training, school or volunteering (or $580 monthly income) unless excluded; members need do nothing until renewal letters arrive. Letters are dated 2026-07. As of 2026-07.", "sources": [ { "label": "Utah Medicaid", "url": "https://medicaid.utah.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Utah Division of Purchasing and General Services home page", "url": "https://purchasing.utah.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Utah Medicaid PRISM page", "url": "https://medicaid.utah.gov/prism", "retrieved": "2026-09-22" }, { "label": "MES modernization: Acentra Health press release, PRISM implementation for Utah, 2023-06-22 (vendor, medium confidence)", "url": "https://acentra.com/news/acentra-health-implements-modular-cloud-based-medicaid-claims-system-for-utah/", "retrieved": "2026-09-22" }, { "label": "Work requirements: Utah Medicaid community engagement requirement page", "url": "https://medicaid.utah.gov/community-engagement-requirement/", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF, tracking implementation of Medicaid work requirements, overview updated 2026-09-09", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "Utah Public Procurement Place (U3P)" }, { "code": "VT", "state": "Vermont", "agency": "Department of Vermont Health Access (DVHA), Agency of Human Services", "program_name": "Green Mountain Care (Vermont Medicaid)", "url": "https://dvha.vermont.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://vtbuysprocurement.vermont.gov/", "mes_modernization": "DVHA is procuring a replacement for its 40-plus-year-old mainframe MMIS through an MMIS Core Claims and Fiscal Agent Services RFP. A 2026-02 strategy deck says RFP requirements are in development with BerryDunn, next steps are to submit the RFP to CMS and post it, with a 30 to 40 month DDI phase and a 10-year contract, while incumbent Gainwell is extended to run the legacy system through DDI. As of 2026-02.", "work_requirements_status": "DVHA's Medicaid changes page (last update 2026-08-06) states that from 2027-01-01 some adults 19 to 64 must show work, volunteering or education hours (80 hours a month or at least $580 monthly income) to keep Medicaid; those under 19, 65 and over, pregnant or postpartum, or on Medicare are exempt. As of 2026-08-06.", "sources": [ { "label": "Department of Vermont Health Access", "url": "https://dvha.vermont.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Vermont BGS Office of Purchasing and Contracting", "url": "https://bgs.vermont.gov/purchasing", "retrieved": "2026-09-22" }, { "label": "Procurement portal: State of Vermont VTBuys Procurement home page", "url": "https://vtbuysprocurement.vermont.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: DVHA MMIS Core Claims and Fiscal Agent Services Modernization Strategy deck, February 2026 (PPSX)", "url": "https://dvha.vermont.gov/sites/dvha/files/documents/MMIS-Core-Strategy-20260222.ppsx", "retrieved": "2026-09-22" }, { "label": "MES modernization: DVHA MMIS Core Claims / Fiscal Agent initiative page", "url": "https://dvha.vermont.gov/initiatives/mmis-core-claims-fiscal-agent", "retrieved": "2026-09-22" }, { "label": "MES modernization: DVHA MMIS Modernization initiatives hub", "url": "https://dvha.vermont.gov/initiatives", "retrieved": "2026-09-22" }, { "label": "Work requirements: DVHA, federal Medicaid changes: Vermont impact (last update 2026-08-06)", "url": "https://dvha.vermont.gov/medicaid-changes", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "VTBuys" }, { "code": "VA", "state": "Virginia", "agency": "Department of Medical Assistance Services (DMAS)", "program_name": "Cardinal Care", "url": "https://www.dmas.virginia.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://eva.virginia.gov/", "mes_modernization": "Virginia's modular Medicaid Enterprise System, built from 2016 to replace the all-in-one VAMMIS, went live for providers on 2022-04-04 with Conduent continuing to run the MMIS and Gainwell taking provider enrollment (PRSS); modules include Provider, Care, Pharmacy, Encounter Processing, Enterprise Data Warehouse, Integrated Services and Appeals. The DMAS procurement page listed no MES solicitation on 2026-09-22. As of 2026-09-22.", "work_requirements_status": "Virginia Medicaid states that from 2027-01-01 adults 19 to 64 in Medicaid Expansion must work or do other qualifying activities 80 hours a month unless exempt, meet it in 1 of the 6 months before each renewal, and renew every 6 months; the page says implementation details are still being finalized. As of 2026-09-22.", "sources": [ { "label": "Virginia DMAS", "url": "https://www.dmas.virginia.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: eVA, Virginia's eProcurement Marketplace", "url": "https://eva.virginia.gov/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: DMAS procurements page (directs vendors to eVA)", "url": "https://dmas.virginia.gov/about-us/procurement/", "retrieved": "2026-09-22" }, { "label": "MES modernization: DMAS MES about page (document dated 2022-12-28)", "url": "https://vamedicaid.dmas.virginia.gov/about", "retrieved": "2026-09-22" }, { "label": "MES modernization: DMAS bulletin, transition from VAMMIS to MES, 2022-03-11", "url": "https://vamedicaid.dmas.virginia.gov/bulletin/dmas-transition-vammis-medicaid-enterprise-system-mes-key-functions-fee-service-providers", "retrieved": "2026-09-22" }, { "label": "Work requirements: DMAS federal work and community engagement requirements page", "url": "https://www.dmas.virginia.gov/news-updates/new-federal-requirements/work-community-engagement-requirements/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "eVA" }, { "code": "WA", "state": "Washington", "agency": "Washington State Health Care Authority", "program_name": "Apple Health", "url": "https://www.hca.wa.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://des.wa.gov/sell/how-work-state/register-bid-opportunities", "mes_modernization": "ProviderOne remains Washington's MMIS; the record on file has Acentra Health operating it under an extension through 2026-06-30, and no HCA page stating its status after that date was found on 2026-09-22. RFP 2025HCA15 (proposals due 2026-03-26) is a mail order incontinence supplies solicitation, not an MES procurement; the pharmacy point of sale module RFP 2020HCA28 (due 2021-04-12) required ProviderOne integration. As of 2026-09-22.", "work_requirements_status": "HCA's fact sheet (2026-06) states that beginning 2027-01-01 adults 19 to 64 applying for or renewing Apple Health for Adults must meet work requirements (80 hours a month or $580 monthly income) or an exemption, with 6-month certification periods; citizenship and immigration changes begin 2026-10. As of 2026-06.", "sources": [ { "label": "Washington State Health Care Authority", "url": "https://www.hca.wa.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Washington's Electronic Business Solution (WEBS) (state-procurement.json, verified 2026-09-20)", "url": "https://des.wa.gov/sell/how-work-state/register-bid-opportunities", "retrieved": "2026-09-20" }, { "label": "MES modernization: HCA RFP 2025HCA15, Mail Order Incontinence and Urinary Supplies and Services (PDF)", "url": "https://www.hca.wa.gov/assets/program/rfp-2025hca15.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Washington OMWBE bid listing, HCA Pharmacy Point of Sale Module Replacement Project (RFP 2020HCA28)", "url": "https://omwbe.wa.gov/bid-opportunities/pharmacy-point-sale-module-replacement-project", "retrieved": "2026-09-22" }, { "label": "Work requirements: HCA work requirements and 6-month renewals fact sheet, June 2026 (PDF)", "url": "https://www.hca.wa.gov/assets/free-or-low-cost/hr1-work-requirements-and-renewals-fact-sheet.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [], "procurement_portal_name": "Washington's Electronic Business Solution (WEBS)" }, { "code": "WV", "state": "West Virginia", "agency": "Department of Human Services, Bureau for Medical Services", "program_name": "West Virginia Medicaid", "url": "https://bms.wv.gov/", "expansion_status": "adopted", "govramp": { "participating_entity_in_state": true, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://wvoasis.gov/VSS/Default", "mes_modernization": "West Virginia DoHS has implemented Gainwell Technologies' Claims, Encounters and Financials (CEF) solution on AWS as its modernized, modular MMIS. A DoHS article dated 2025-08-04 says the system is operating (36 million claims and over $5 billion in payments a year) and won a 2025 AWS Champions award; it gives no go-live date and no next procurement. As of 2025-08-04.", "work_requirements_status": "DoHS states that from 2027-01-01 Medicaid members 19 to 64 in the expansion group must complete at least 80 hours a month of work or approved activities unless exempt, applied at renewals from 2027-03; a 2026-06-24 release says DoHS is on schedule for federal deadlines and opened WVMedicaidHelp.org. As of 2026-06-24.", "sources": [ { "label": "West Virginia Bureau for Medical Services", "url": "https://bms.wv.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: West Virginia Purchasing Division, wvOASIS procurement page", "url": "https://www.state.wv.us/admin/purchase/oasis.html", "retrieved": "2026-09-22" }, { "label": "Procurement portal: wvOASIS Vendor Self Service portal", "url": "https://wvoasis.gov/VSS/Default", "retrieved": "2026-09-22" }, { "label": "MES modernization: WV Bureau for Medical Services article, DoHS nationally recognized for modernizing Medicaid system, 2025-08-04", "url": "https://bms.wv.gov/article/west-virginia-department-human-services-nationally-recognized-modernizing-medicaid-system", "retrieved": "2026-09-22" }, { "label": "Work requirements: WV BMS, new Medicaid rules are coming", "url": "https://bms.wv.gov/new-medicaid-rules-are-coming", "retrieved": "2026-09-22" }, { "label": "Work requirements: WV BMS release, DoHS encourages Medicaid members to stay informed, 2026-06-24", "url": "https://bms.wv.gov/article/west-virginia-department-human-services-encourages-medicaid-members-stay-informed-about", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "wvOASIS Vendor Self Service (VSS), West Virginia Purchasing Bulletin" }, { "code": "WI", "state": "Wisconsin", "agency": "Department of Health Services (ForwardHealth)", "program_name": "BadgerCare Plus and Wisconsin Medicaid", "url": "https://www.dhs.wisconsin.gov/medicaid/index.htm", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://esupplier.wi.gov/", "mes_modernization": "Wisconsin DHS reported to the legislature on 2021-06-28 that DXC held the MMIS Takeover and Enhancement contract (target completion 2022-06) and that DHS was carving Enterprise Data Warehouse, Data Analytics and Reporting and Program Integrity modules out of the MMIS under a modular MES plan (DHS timeline P-01621C, 2019-06). No DHS page dated after 2021 on MES status was found on 2026-09-22. As of 2021-06-28.", "work_requirements_status": "DHS states (page revised 2026-07-17) that BadgerCare Plus adults 19 to 64 with no dependent children under 19 must meet the federal work requirement (80 hours a month or $580 monthly income) or an exemption: new applicants from 2027-01-01, current members at renewals from 2027-03. As of 2026-07-17.", "sources": [ { "label": "Wisconsin DHS Medicaid", "url": "https://www.dhs.wisconsin.gov/medicaid/index.htm", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Wisconsin DOA eSupplier Portal page", "url": "https://doa.wi.gov/Pages/DoingBusiness/eSupplier.aspx", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Wisconsin DOA procurement page (links VendorNet and eSupplier)", "url": "https://doa.wi.gov/Pages/StateEmployees/Procurement.aspx", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Wisconsin DOA VendorNet brochure (search snippet)", "url": "https://doa.wi.gov/Documents/DEO/VendorNet%20Brochure.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Wisconsin DHS report to the legislature on data processing projects 2020, received 2021-06-29 (PDF)", "url": "https://docs.legis.wisconsin.gov/misc/mandatedreports/2021/department_of_health_services/2020_data_processing_projects_report_s_46_03_26_received_6_29_2021.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Wisconsin DHS MES procurement timeline P-01621C, 2019-06 (PDF)", "url": "https://www.dhs.wisconsin.gov/publications/p01621c.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Wisconsin DHS Medicaid Enterprise Systems Procurement collection P-01621", "url": "https://www.dhs.wisconsin.gov/library/collection/p-01621", "retrieved": "2026-09-22" }, { "label": "Work requirements: Wisconsin DHS, Medicaid: new federal work requirement (revised 2026-07-17)", "url": "https://www.dhs.wisconsin.gov/medicaid/work.htm", "retrieved": "2026-09-22" }, { "label": "Work requirements: Wisconsin DHS webinar, new federal Medicaid work requirement for BadgerCare Plus, 2026-06-18 (PDF)", "url": "https://www.dhs.wisconsin.gov/forwardhealth/partners/work-requirement-webinar-6-18-26.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: KFF, tracking implementation of Medicaid work requirements, overview updated 2026-09-09", "url": "https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "eSupplier Portal (with VendorNet)" }, { "code": "WY", "state": "Wyoming", "agency": "Department of Health, Division of Healthcare Financing", "program_name": "Wyoming Medicaid", "url": "https://health.wyo.gov/healthcarefin/", "expansion_status": "not_adopted", "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://ai.wyo.gov/divisions/general-services/purchasing/bid-opportunities", "mes_modernization": "The WINGS project replaces the legacy MMIS through separate module procurements. The Benefit Management System (claims, provider enrollment, call center, third party liability) runs under a CNSI contract executed 2020-03-20 and has been live since 2021-10. Pharmacy module live 2017-07-23 and CMS certified 2019-02-01; EVV live 2022-02-15; fraud, waste and abuse module live 2025-06-17. Phase: operating. As of 2025-07-22.", "work_requirements_status": "Not applicable. The Wyoming Department of Health states on its Medicaid application page, under the heading Wyoming not impacted by work requirements, that Wyoming will not be impacted by work requirements, also called community engagement requirements. The CMS bulletin of 2025-12-08 states that section 1902(xx) applies in states that elect to cover the adult group. As of 2026-09-22.", "sources": [ { "label": "Wyoming Department of Health, Healthcare Financing", "url": "https://health.wyo.gov/healthcarefin/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Wyoming Administration and Information, Purchasing, Bid Opportunities (opened)", "url": "https://ai.wyo.gov/divisions/general-services/purchasing/bid-opportunities", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Wyoming Administration and Information, Purchasing, Non-Construction Bids (opened)", "url": "https://ai.wyo.gov/divisions/general-services/purchasing/non-construction-bids", "retrieved": "2026-09-22" }, { "label": "MES modernization: Wyoming Department of Health, WINGS Project page, last updated 2025-07-22 (opened)", "url": "https://health.wyo.gov/healthcarefin/wyoming-integrated-next-generation-system-wings-project/", "retrieved": "2026-09-22" }, { "label": "Work requirements: Wyoming Department of Health, Apply for Medicaid or Kid Care CHIP, Announcements (opened)", "url": "https://health.wyo.gov/healthcarefin/apply/", "retrieved": "2026-09-22" }, { "label": "Work requirements: CMS, CMCS Informational Bulletin, Section 71119 of P.L. 119-21, Requirements for States to Establish Medicaid Community Engagement Requirements, 2025-12-08 (opened, PDF)", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [], "procurement_portal_name": "State of Wyoming A&I Procurement bid opportunities (Public Purchase)" }, { "code": "PR", "state": "Puerto Rico", "agency": "Puerto Rico Medicaid Program (Departamento de Salud), with ASES administering Plan Vital", "program_name": "Plan Vital", "url": "https://www.medicaid.pr.gov/", "expansion_status": null, "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://www.asg.pr.gov/subastas", "mes_modernization": "PRMMIS, the Puerto Rico Medicaid Management Information System, is operating; MACPAC's 2021-02 fact sheet reports a fully operational MMIS certified to report to T-MSIS. The Puerto Rico Medicaid Program issued RFP 2021-PRMP-MES-MMIS-P3-001 (2021-07-06, amended 2021-08-13) for a Phase III financial management module for capitation payments to carriers. No page in this pass states the Phase III award or vendor. As of 2024-11-05.", "work_requirements_status": "Not applicable. The CMS informational bulletin of 2025-12-08 states that the community engagement provision is not applicable to the U.S. territories, regardless of whether they elect to cover the adult group, because section 1902(xx)(9)(C) defines State as one of the 50 states or the District of Columbia. Its footnote names Puerto Rico among the territories to which section 1902(xx) does not apply. As of 2025-12-08.", "sources": [ { "label": "Puerto Rico Medicaid Program", "url": "https://www.medicaid.pr.gov/", "retrieved": "2026-09-20" }, { "label": "ASES", "url": "https://www.ases.pr.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Administracion de Servicios Generales, Licitaciones (opened)", "url": "https://www.asg.pr.gov/subastas", "retrieved": "2026-09-22" }, { "label": "MES modernization: Puerto Rico Medicaid Program, PRMMIS page, dated 2024-11-05 (opened via curl)", "url": "https://www.medicaid.pr.gov/CMS/19", "retrieved": "2026-09-22" }, { "label": "MES modernization: Puerto Rico Medicaid Program, MES MMIS Phase III RFP 2021-PRMP-MES-MMIS-P3-001, Amendment 1 tracked changes, 2021-08-13 (opened, PDF)", "url": "https://medicaid.pr.gov/pdf/PRMMIS/RPF-P3/2021-PRMP-MES-MMIS-P3-001-Amendment-1-Tracked-Changes.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: MACPAC, Medicaid and CHIP in the Territories, fact sheet 2021-02 (opened, PDF)", "url": "https://www.macpac.gov/wp-content/uploads/2019/07/Medicaid-and-CHIP-in-the-Territories.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: CMS, CMCS Informational Bulletin, Section 71119 of P.L. 119-21, Requirements for States to Establish Medicaid Community Engagement Requirements, 2025-12-08 (opened, PDF)", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [ "expansion_status (territory financing differs; not assessed)" ], "procurement_portal_name": "ASG Licitaciones (Registro Unico de Subastas)" }, { "code": "VI", "state": "U.S. Virgin Islands", "agency": "Department of Human Services, Office of Medicaid", "program_name": "USVI Medicaid (Medical Assistance Program)", "url": "https://dhs.vi.gov/office-of-medicaid/", "expansion_status": null, "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://dpp.vi.gov/advertisements/", "mes_modernization": "VIMMIS, the territory's Medicaid Management Information System, operates under a 2013 arrangement to use West Virginia's MMIS, paying operating costs to the fiscal agent; MACPAC's 2021-02 fact sheet reports it fully operational and T-MSIS certified. An online Provider Enrollment Application on vimmis.com took effect 2026-03-02 with a Gainwell Technologies enrollment team. No replacement procurement found. As of 2026-03-02.", "work_requirements_status": "Not applicable. The CMS informational bulletin of 2025-12-08 states that the community engagement provision is not applicable to the U.S. territories, regardless of whether they elect to cover the adult group, because section 1902(xx)(9)(C) defines State as one of the 50 states or the District of Columbia. Its footnote names the Virgin Islands among the territories to which section 1902(xx) does not apply. As of 2025-12-08.", "sources": [ { "label": "USVI DHS Office of Medicaid", "url": "https://dhs.vi.gov/office-of-medicaid/", "retrieved": "2026-09-20" }, { "label": "Medicaid.gov: U.S. Virgin Islands", "url": "https://www.medicaid.gov/state-overviews/usvi.html", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Virgin Islands Department of Property and Procurement, Advertisements listing (opened)", "url": "https://dpp.vi.gov/advertisements/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Virgin Islands Department of Property and Procurement, Division of Procurement (opened)", "url": "https://dpp.vi.gov/divisions/procurement/", "retrieved": "2026-09-22" }, { "label": "MES modernization: MACPAC, Medicaid and CHIP in the Territories, fact sheet 2021-02 (opened, PDF)", "url": "https://www.macpac.gov/wp-content/uploads/2019/07/Medicaid-and-CHIP-in-the-Territories.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: CMS, CMCS Informational Bulletin, Section 71119 of P.L. 119-21, Requirements for States to Establish Medicaid Community Engagement Requirements, 2025-12-08 (opened, PDF)", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [ "expansion_status (territory financing differs; not assessed)" ], "procurement_portal_name": "DPP Advertisements (Government of the Virgin Islands)" }, { "code": "GU", "state": "Guam", "agency": "Department of Public Health and Social Services, Bureau of Health Care Financing Administration", "program_name": "Guam Medicaid", "url": "https://dphss.guam.gov/", "expansion_status": null, "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://gsa.doa.guam.gov/invitation-for-bid/", "mes_modernization": "Guam had no MMIS as of MACPAC's 2021-02 fact sheet. DPHSS is modernizing its Medicaid Enterprise System by reusing West Virginia and Virgin Islands systems under a reuse law of 2024-07; a pharmacy benefit manager went live 2025-09-01 on the Virgin Islands contract. CMS approved $39 million for FY2025-26 to modernize eligibility and enrollment and update the MMIS (2025-08-01). MMIS phase: planning; no vendor named. As of 2025-11-24.", "work_requirements_status": "Not applicable. The CMS informational bulletin of 2025-12-08 states that the community engagement provision is not applicable to the U.S. territories, regardless of whether they elect to cover the adult group, because section 1902(xx)(9)(C) defines State as one of the 50 states or the District of Columbia. Its footnote names Guam among the territories to which section 1902(xx) does not apply. As of 2025-12-08.", "sources": [ { "label": "Guam DPHSS", "url": "https://dphss.guam.gov/", "retrieved": "2026-09-20" }, { "label": "Procurement portal: Guam General Services Agency, Invitation for Bid (opened)", "url": "https://gsa.doa.guam.gov/invitation-for-bid/", "retrieved": "2026-09-22" }, { "label": "Procurement portal: Guam General Services Agency home page (opened)", "url": "https://gsa.doa.guam.gov/", "retrieved": "2026-09-22" }, { "label": "MES modernization: Office of the Governor of Guam, press release, Guam Medicaid Transformation Underway with $39M Federal Investment, 2025-08-01 (opened)", "url": "https://governor.guam.gov/press_release/guam-medicaid-transformation-underway-with-39m-federal-investment/", "retrieved": "2026-09-22" }, { "label": "MES modernization: National Association of Medicaid Directors news, Guam Wins National Award for Innovative Collaboration to Modernize Medicaid IT Systems and Operations, 2025-11-24 (opened; association news, medium confidence)", "url": "https://medicaiddirectors.org/news/guam-wins-national-award-for-innovative-collaboration-to-modernize-medicaid-it-systems-operations/", "retrieved": "2026-09-22" }, { "label": "MES modernization: MACPAC, Medicaid and CHIP in the Territories, fact sheet 2021-02 (opened, PDF)", "url": "https://www.macpac.gov/wp-content/uploads/2019/07/Medicaid-and-CHIP-in-the-Territories.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: CMS, CMCS Informational Bulletin, Section 71119 of P.L. 119-21, Requirements for States to Establish Medicaid Community Engagement Requirements, 2025-12-08 (opened, PDF)", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [ "expansion_status (territory financing differs; not assessed)" ], "procurement_portal_name": "Guam General Services Agency Invitation for Bid listing" }, { "code": "AS", "state": "American Samoa", "agency": "American Samoa Medicaid State Agency, Office of the Governor", "program_name": "American Samoa Medicaid", "url": "https://www.medicaid.as.gov/", "expansion_status": null, "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": "https://procurement.as.gov/?page_id=212", "mes_modernization": "American Samoa had no MMIS and did not report to T-MSIS as of MACPAC's 2021-02 fact sheet. The Office of Procurement lists RFP-057-2025 for an Eligibility and Enrollment System for the Medicaid State Agency (file created 2025-09-16); phase: RFP. A 2023-12 trade press report describes $4.2 million for eligibility and enrollment and MMIS upgrades. No MMIS procurement or award found in this pass. As of 2025-09-16.", "work_requirements_status": "Not applicable. The CMS informational bulletin of 2025-12-08 states that the community engagement provision is not applicable to the U.S. territories, regardless of whether they elect to cover the adult group, because section 1902(xx)(9)(C) defines State as one of the 50 states or the District of Columbia. Its footnote names American Samoa among the territories to which section 1902(xx) does not apply. As of 2025-12-08.", "sources": [ { "label": "American Samoa Medicaid State Agency", "url": "https://www.medicaid.as.gov/", "retrieved": "2026-09-20" }, { "label": "Medicaid.gov: American Samoa", "url": "https://www.medicaid.gov/state-overviews/american-samoa.html", "retrieved": "2026-09-20" }, { "label": "Procurement portal: American Samoa Government Office of Procurement, Bid Notices (opened)", "url": "https://procurement.as.gov/?page_id=212", "retrieved": "2026-09-22" }, { "label": "MES modernization: American Samoa Government Office of Procurement, RFP-057-2025 attachment, PDF metadata only (opened)", "url": "https://procurement.as.gov/?attachment_id=567", "retrieved": "2026-09-22" }, { "label": "MES modernization: MACPAC, Medicaid and CHIP in the Territories, fact sheet 2021-02 (opened, PDF)", "url": "https://www.macpac.gov/wp-content/uploads/2019/07/Medicaid-and-CHIP-in-the-Territories.pdf", "retrieved": "2026-09-22" }, { "label": "MES modernization: Samoa News Hub, American Samoa's medicaid transformation through a US$4.2 million boost, 2023-12-09 (search snippet; trade press, medium confidence)", "url": "https://samoanewshub.com/2023/12/09/american-samoas-medicaid-transformation-through-a-us4-2-million-boost/", "retrieved": "2026-09-22" }, { "label": "Work requirements: CMS, CMCS Informational Bulletin, Section 71119 of P.L. 119-21, Requirements for States to Establish Medicaid Community Engagement Requirements, 2025-12-08 (opened, PDF)", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "medium", "pending": [ "expansion_status (territory financing differs; not assessed)" ], "procurement_portal_name": "American Samoa Government Office of Procurement Bid Notices" }, { "code": "MP", "state": "Northern Mariana Islands", "agency": "Commonwealth Medicaid Agency (CNMI)", "program_name": "CNMI Medicaid", "url": "https://www.cnmimedicaid.org/", "expansion_status": null, "govramp": { "participating_entity_in_state": false, "formal_program": false }, "statewide_cloud_program": null, "procurement_portal_url": null, "mes_modernization": "CNMI has no MMIS; MACPAC's 2021-02 fact sheet lists it among territories without one; Public Law 21-28 (2020) requires the agency to implement MES modules including an MMIS, a claims and clinical data warehouse, and a community health record. The agency's MES page says it is exploring options to implement an MMIS (phase: planning), runs a data warehouse, and launched a provider health IT survey on 2024-12-31. As of 2024-12-31.", "work_requirements_status": "Not applicable. The CMS informational bulletin of 2025-12-08 states that the community engagement provision is not applicable to the U.S. territories, regardless of whether they elect to cover the adult group, because section 1902(xx)(9)(C) defines State as one of the 50 states or the District of Columbia. Its footnote names the Northern Mariana Islands among the territories to which section 1902(xx) does not apply. As of 2025-12-08.", "sources": [ { "label": "Commonwealth Medicaid Agency", "url": "https://www.cnmimedicaid.org/", "retrieved": "2026-09-20" }, { "label": "Medicaid.gov: Northern Mariana Islands", "url": "https://www.medicaid.gov/state-overviews/cnmi.html", "retrieved": "2026-09-20" }, { "label": "MES modernization: Commonwealth Medicaid Agency, Medicaid Enterprise Systems department page (opened)", "url": "https://www.cnmimedicaid.org/departments/medicaid-enterprise-systems", "retrieved": "2026-09-22" }, { "label": "MES modernization: Commonwealth Medicaid Agency, About (opened)", "url": "https://www.cnmimedicaid.org/about", "retrieved": "2026-09-22" }, { "label": "MES modernization: MACPAC, Medicaid and CHIP in the Territories, fact sheet 2021-02 (opened, PDF)", "url": "https://www.macpac.gov/wp-content/uploads/2019/07/Medicaid-and-CHIP-in-the-Territories.pdf", "retrieved": "2026-09-22" }, { "label": "Work requirements: CMS, CMCS Informational Bulletin, Section 71119 of P.L. 119-21, Requirements for States to Establish Medicaid Community Engagement Requirements, 2025-12-08 (opened, PDF)", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf", "retrieved": "2026-09-22" } ], "verified": "2026-09-22", "confidence": "high", "pending": [ "expansion_status (territory financing differs; not assessed)", "procurement_portal_url" ] } ] }