{ "_schema": { "version": 1, "dataset": "state-procurement", "title": "State Medicaid Enterprise Systems procurement coverage", "last_verified": "2026-09-20", "generated": "2026-09-20", "scope": "State Medicaid enterprise systems and the routes into them. Not general state IT procurement.", "research_method": "Web search result snippets only (page fetches were blocked in the build environment). Every fact carries the page it came from and the retrieval date. Fields no snippet supported are null and listed in pending; nothing was inferred. Official state, CMS, eCFR and NASPO ValuePoint pages read as high confidence; vendor announcements, trade press and third-party listings as medium.", "freshness_windows_days": { "state_agency": 90, "state_solicitation": 7, "mes_module": 7, "coop_vehicle": 90, "participating_addendum": 7, "funding_condition": 90 }, "coverage_rule": "A query that names a state whose coverage for the requested entity is not_covered returns 409 COVERAGE_GAP with that state's coverage row, never an empty list. partial returns the rows on file with the coverage row beside them.", "entities": [ "state_agency", "state_solicitation", "mes_module", "coop_vehicle", "participating_addendum", "funding_condition" ], "top_ten_basis": "The ten highest total-Medicaid-spending states in KFF's FY2023 table (order as reported by U.S. News): CA, NY, TX, PA, FL, IL, OH, WA, MA, MI. Total Medicaid spending is a proxy for MES market size, not MES spending itself.", "market_context": { "source": "MACPAC issue brief, State Medicaid Enterprise Systems (July 2026)", "url": "https://www.macpac.gov/wp-content/uploads/2026/07/Issue-Brief-State-Medicaid-Enterprise-Systems-FINAL.pdf", "retrieved": "2026-09-20", "fy2025_total_mes_spending_usd": 9000000000, "share_of_medicaid_administrative_spending_pct": 20, "contractor_share_pct": 82, "contractor_spending_usd": 7400000000, "mmis_related_share": "about two-thirds", "ddi_share_pct": 32, "om_share_pct": 65, "federal_match": { "ddi_pct": 90, "om_pct": 75 }, "use": "Sizing context only, never a live feed. Figures are MACPAC's reading of CMS-64 data as quoted in search results.", "confidence": "medium" }, "notes": [ "state_solicitation rows are the RFIs, RFPs and notices found in the research pass, with their status as of the retrieval date. There is no live state portal feed yet; coverage says so for every state.", "The CEF numbers equal the paragraph numbers of 42 CFR 433.112(b); the CMS site's table of short names was not read, so short names are MMT's own.", "No NASPO ValuePoint portfolio for electronic visit verification, MES data and analytics, eligibility or care management was found." ] }, "coverage": { "as_of": "2026-09-20", "statuses": [ "live", "partial", "not_covered" ], "states": [ { "code": "AL", "state": "Alabama", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "AK", "state": "Alaska", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "AZ", "state": "Arizona", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "AR", "state": "Arkansas", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "CA", "state": "California", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "partial", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_solicitation": "dated rows found by search; no live portal feed", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "CO", "state": "Colorado", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "CT", "state": "Connecticut", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "DE", "state": "Delaware", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "DC", "state": "District of Columbia", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "FL", "state": "Florida", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "partial", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_solicitation": "dated rows found by search; no live portal feed", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "GA", "state": "Georgia", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "HI", "state": "Hawaii", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "ID", "state": "Idaho", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "IL", "state": "Illinois", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "partial", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_solicitation": "dated rows found by search; no live portal feed", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "IN", "state": "Indiana", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "IA", "state": "Iowa", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "KS", "state": "Kansas", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "KY", "state": "Kentucky", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "LA", "state": "Louisiana", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "ME", "state": "Maine", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "MD", "state": "Maryland", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "MA", "state": "Massachusetts", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "not_covered", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_solicitation": "no portal ingestion for this state yet", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "MI", "state": "Michigan", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "not_covered", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_solicitation": "no portal ingestion for this state yet", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "MN", "state": "Minnesota", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "MS", "state": "Mississippi", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "MO", "state": "Missouri", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "MT", "state": "Montana", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "NE", "state": "Nebraska", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "NV", "state": "Nevada", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "NH", "state": "New Hampshire", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "NJ", "state": "New Jersey", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "NM", "state": "New Mexico", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "NY", "state": "New York", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "partial", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_solicitation": "dated rows found by search; no live portal feed", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "NC", "state": "North Carolina", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "ND", "state": "North Dakota", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "OH", "state": "Ohio", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "not_covered", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_solicitation": "no portal ingestion for this state yet", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "OK", "state": "Oklahoma", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "OR", "state": "Oregon", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "PA", "state": "Pennsylvania", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "not_covered", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_solicitation": "no portal ingestion for this state yet", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "RI", "state": "Rhode Island", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "SC", "state": "South Carolina", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "SD", "state": "South Dakota", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "partial", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "addenda listed on portfolio or state pages; dates largely unread", "funding_condition": "federal rules apply to every state" } }, { "code": "TN", "state": "Tennessee", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "TX", "state": "Texas", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "partial", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_solicitation": "dated rows found by search; no live portal feed", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "UT", "state": "Utah", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "VT", "state": "Vermont", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "VA", "state": "Virginia", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "WA", "state": "Washington", "status": "partial", "entities": { "state_agency": "live", "state_solicitation": "not_covered", "mes_module": "partial", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-22", "reasons": { "state_solicitation": "the one solicitation on file, RFP 2025HCA15, was read on 2026-09-22 and is a mail order incontinence and urinary supplies RFP, not an MES procurement; no MES solicitation for Washington was found in that pass", "mes_module": "incumbents from official or dated sources; contract ends and certification status largely unread", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "WV", "state": "West Virginia", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "WI", "state": "Wisconsin", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "WY", "state": "Wyoming", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "PR", "state": "Puerto Rico", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "VI", "state": "U.S. Virgin Islands", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "GU", "state": "Guam", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "AS", "state": "American Samoa", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } }, { "code": "MP", "state": "Northern Mariana Islands", "status": "partial", "entities": { "state_agency": "partial", "state_solicitation": "not_covered", "mes_module": "not_covered", "coop_vehicle": "live", "participating_addendum": "not_covered", "funding_condition": "live" }, "last_refresh": "2026-09-20", "reasons": { "state_agency": "agency name, program and official URL only; CIO office and procurement portal not yet mapped", "state_solicitation": "no portal ingestion for this state yet", "mes_module": "module landscape not yet researched", "coop_vehicle": "national NASPO ValuePoint portfolios apply to every state", "participating_addendum": "no participating addendum found for this state in the portfolios read", "funding_condition": "federal rules apply to every state" } } ] }, "state_agencies": [ { "code": "AL", "state": "Alabama", "medicaid_agency": "Alabama Medicaid Agency", "medicaid_agency_url": "https://medicaid.alabama.gov/", "program_name": "Alabama Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Alabama Medicaid Agency (state Medicaid agency directory)", "url": "https://medicaid.alabama.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "AK", "state": "Alaska", "medicaid_agency": "Department of Health, Division of Health Care Services", "medicaid_agency_url": "https://health.alaska.gov/en/division-of-health-care-services/", "program_name": "Alaska Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health, Division of Health Care Services (state Medicaid agency directory)", "url": "https://health.alaska.gov/en/division-of-health-care-services/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "AZ", "state": "Arizona", "medicaid_agency": "Arizona Health Care Cost Containment System (AHCCCS)", "medicaid_agency_url": "https://www.azahcccs.gov/", "program_name": "AHCCCS", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Arizona Health Care Cost Containment System (AHCCCS) (state Medicaid agency directory)", "url": "https://www.azahcccs.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "AR", "state": "Arkansas", "medicaid_agency": "Department of Human Services, Division of Medical Services", "medicaid_agency_url": "https://humanservices.arkansas.gov/divisions-shared-services/medical-services/", "program_name": "Arkansas Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Human Services, Division of Medical Services (state Medicaid agency directory)", "url": "https://humanservices.arkansas.gov/divisions-shared-services/medical-services/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "CA", "state": "California", "medicaid_agency": "California Department of Health Care Services (DHCS), Medi-Cal", "medicaid_agency_url": "https://www.dhcs.ca.gov/", "program_name": "Medi-Cal", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "California Department of Technology (CDT)", "url": "https://cdt.ca.gov/" }, "procurement_portal": { "name": "Cal eProcure", "url": "https://caleprocure.ca.gov/pages/index.aspx" }, "medicaid_procurement_page": "https://www.dhcs.ca.gov/provgovpart/rfa_rfp/Pages/default.aspx", "spend": { "kff_fy2023_rank": 1, "fy2024_total_usd": 157100000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "California Department of Health Care Services (DHCS), Medi-Cal", "url": "https://www.dhcs.ca.gov/", "retrieved": "2026-09-20" }, { "label": "California Department of Technology (CDT)", "url": "https://cdt.ca.gov/", "retrieved": "2026-09-20" }, { "label": "Cal eProcure", "url": "https://caleprocure.ca.gov/pages/index.aspx", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/california/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)" ] }, { "code": "CO", "state": "Colorado", "medicaid_agency": "Department of Health Care Policy and Financing (HCPF)", "medicaid_agency_url": "https://hcpf.colorado.gov/", "program_name": "Health First Colorado", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health Care Policy and Financing (HCPF) (state Medicaid agency directory)", "url": "https://hcpf.colorado.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "CT", "state": "Connecticut", "medicaid_agency": "Department of Social Services", "medicaid_agency_url": "https://portal.ct.gov/husky", "program_name": "HUSKY Health", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Social Services (state Medicaid agency directory)", "url": "https://portal.ct.gov/husky", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "DE", "state": "Delaware", "medicaid_agency": "Department of Health and Social Services, Division of Medicaid and Medical Assistance", "medicaid_agency_url": "https://dhss.delaware.gov/dmma/", "program_name": "Delaware Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health and Social Services, Division of Medicaid and Medical Assistance (state Medicaid agency directory)", "url": "https://dhss.delaware.gov/dmma/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "DC", "state": "District of Columbia", "medicaid_agency": "Department of Health Care Finance (DHCF)", "medicaid_agency_url": "https://dhcf.dc.gov/", "program_name": "DC Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health Care Finance (DHCF) (state Medicaid agency directory)", "url": "https://dhcf.dc.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "FL", "state": "Florida", "medicaid_agency": "Florida Agency for Health Care Administration (AHCA)", "medicaid_agency_url": "https://ahca.myflorida.com/", "program_name": "Florida Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "Florida Digital Service (FL[DS]), Department of Management Services", "url": "https://www.digital.fl.gov/" }, "procurement_portal": { "name": "MyFloridaMarketPlace Vendor Information Portal / Vendor Bid System", "url": "https://vendor.myfloridamarketplace.com/search/bids" }, "medicaid_procurement_page": "https://ahca.myflorida.com/medicaid/florida-health-care-connections-fx", "spend": { "kff_fy2023_rank": 5, "fy2024_total_usd": 35900000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "Florida Agency for Health Care Administration (AHCA)", "url": "https://ahca.myflorida.com/", "retrieved": "2026-09-20" }, { "label": "Florida Digital Service (FL[DS]), Department of Management Services", "url": "https://www.digital.fl.gov/", "retrieved": "2026-09-20" }, { "label": "MyFloridaMarketPlace Vendor Information Portal / Vendor Bid System", "url": "https://vendor.myfloridamarketplace.com/search/bids", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/florida/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)" ] }, { "code": "GA", "state": "Georgia", "medicaid_agency": "Department of Community Health (DCH)", "medicaid_agency_url": "https://medicaid.georgia.gov/", "program_name": "Georgia Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Community Health (DCH) (state Medicaid agency directory)", "url": "https://medicaid.georgia.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "HI", "state": "Hawaii", "medicaid_agency": "Department of Human Services, Med-QUEST Division", "medicaid_agency_url": "https://medquest.hawaii.gov/", "program_name": "Med-QUEST", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Human Services, Med-QUEST Division (state Medicaid agency directory)", "url": "https://medquest.hawaii.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "ID", "state": "Idaho", "medicaid_agency": "Department of Health and Welfare, Division of Medicaid", "medicaid_agency_url": "https://healthandwelfare.idaho.gov/services-programs/medicaid-health", "program_name": "Idaho Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health and Welfare, Division of Medicaid (state Medicaid agency directory)", "url": "https://healthandwelfare.idaho.gov/services-programs/medicaid-health", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "IL", "state": "Illinois", "medicaid_agency": "Illinois Department of Healthcare and Family Services (HFS)", "medicaid_agency_url": "https://hfs.illinois.gov/", "program_name": "Illinois Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "Illinois Department of Innovation and Technology (DoIT)", "url": "https://doit.illinois.gov/" }, "procurement_portal": { "name": "BidBuy", "url": "https://www.bidbuy.illinois.gov/bso/" }, "medicaid_procurement_page": null, "spend": { "kff_fy2023_rank": 6, "fy2024_total_usd": 33700000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "Illinois Department of Healthcare and Family Services (HFS)", "url": "https://hfs.illinois.gov/", "retrieved": "2026-09-20" }, { "label": "Illinois Department of Innovation and Technology (DoIT)", "url": "https://doit.illinois.gov/", "retrieved": "2026-09-20" }, { "label": "BidBuy", "url": "https://www.bidbuy.illinois.gov/bso/", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/illinois/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)", "medicaid_procurement_page" ] }, { "code": "IN", "state": "Indiana", "medicaid_agency": "Family and Social Services Administration, Office of Medicaid Policy and Planning", "medicaid_agency_url": "https://www.in.gov/medicaid/", "program_name": "Indiana Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Family and Social Services Administration, Office of Medicaid Policy and Planning (state Medicaid agency directory)", "url": "https://www.in.gov/medicaid/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "IA", "state": "Iowa", "medicaid_agency": "Iowa Department of Health and Human Services", "medicaid_agency_url": "https://hhs.iowa.gov/medicaid", "program_name": "Iowa Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Iowa Department of Health and Human Services (state Medicaid agency directory)", "url": "https://hhs.iowa.gov/medicaid", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "KS", "state": "Kansas", "medicaid_agency": "Kansas Department of Health and Environment, Division of Health Care Finance (with KDADS)", "medicaid_agency_url": "https://www.kancare.ks.gov/", "program_name": "KanCare", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Kansas Department of Health and Environment, Division of Health Care Finance (with KDADS) (state Medicaid agency directory)", "url": "https://www.kancare.ks.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "KY", "state": "Kentucky", "medicaid_agency": "Cabinet for Health and Family Services, Department for Medicaid Services", "medicaid_agency_url": "https://www.chfs.ky.gov/agencies/dms/Pages/default.aspx", "program_name": "Kentucky Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Cabinet for Health and Family Services, Department for Medicaid Services (state Medicaid agency directory)", "url": "https://www.chfs.ky.gov/agencies/dms/Pages/default.aspx", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "LA", "state": "Louisiana", "medicaid_agency": "Louisiana Department of Health, Bureau of Health Services Financing", "medicaid_agency_url": "https://ldh.la.gov/medicaid", "program_name": "Healthy Louisiana", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Louisiana Department of Health, Bureau of Health Services Financing (state Medicaid agency directory)", "url": "https://ldh.la.gov/medicaid", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "ME", "state": "Maine", "medicaid_agency": "Department of Health and Human Services, Office of MaineCare Services", "medicaid_agency_url": "https://www.maine.gov/dhhs/oms", "program_name": "MaineCare", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health and Human Services, Office of MaineCare Services (state Medicaid agency directory)", "url": "https://www.maine.gov/dhhs/oms", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "MD", "state": "Maryland", "medicaid_agency": "Maryland Department of Health (Medicaid)", "medicaid_agency_url": "https://health.maryland.gov/mmcp/pages/home.aspx", "program_name": "Maryland Medicaid (HealthChoice managed care)", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Maryland Department of Health (Medicaid) (state Medicaid agency directory)", "url": "https://health.maryland.gov/mmcp/pages/home.aspx", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "MA", "state": "Massachusetts", "medicaid_agency": "Executive Office of Health and Human Services (EOHHS), MassHealth", "medicaid_agency_url": "https://www.mass.gov/orgs/executive-office-of-health-and-human-services", "program_name": "MassHealth", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "Executive Office of Technology Services and Security (EOTSS)", "url": "https://www.mass.gov/info-details/about-executive-office-of-technology-services-and-security" }, "procurement_portal": { "name": "COMMBUYS", "url": "https://www.commbuys.com/bso/" }, "medicaid_procurement_page": null, "spend": { "kff_fy2023_rank": 9, "fy2024_total_usd": 26200000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "Executive Office of Health and Human Services (EOHHS), MassHealth", "url": "https://www.mass.gov/orgs/executive-office-of-health-and-human-services", "retrieved": "2026-09-20" }, { "label": "Executive Office of Technology Services and Security (EOTSS)", "url": "https://www.mass.gov/info-details/about-executive-office-of-technology-services-and-security", "retrieved": "2026-09-20" }, { "label": "COMMBUYS", "url": "https://www.commbuys.com/bso/", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/massachusetts/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)", "medicaid_procurement_page" ] }, { "code": "MI", "state": "Michigan", "medicaid_agency": "Michigan Department of Health and Human Services (MDHHS)", "medicaid_agency_url": "https://www.michigan.gov/mdhhs", "program_name": "Michigan Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "Michigan Department of Technology, Management and Budget (DTMB)", "url": "https://www.michigan.gov/dtmb" }, "procurement_portal": { "name": "SIGMA Vendor Self Service", "url": "https://www.michigan.gov/budget/budget-offices/sigma/doing-business-with-the-state" }, "medicaid_procurement_page": null, "spend": { "kff_fy2023_rank": 10, "fy2024_total_usd": 25400000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "Michigan Department of Health and Human Services (MDHHS)", "url": "https://www.michigan.gov/mdhhs", "retrieved": "2026-09-20" }, { "label": "Michigan Department of Technology, Management and Budget (DTMB)", "url": "https://www.michigan.gov/dtmb", "retrieved": "2026-09-20" }, { "label": "SIGMA Vendor Self Service", "url": "https://www.michigan.gov/budget/budget-offices/sigma/doing-business-with-the-state", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/michigan/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)", "medicaid_procurement_page" ] }, { "code": "MN", "state": "Minnesota", "medicaid_agency": "Minnesota Department of Human Services", "medicaid_agency_url": "https://mn.gov/dhs/health-care/medical-assistance/", "program_name": "Medical Assistance (MA)", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Minnesota Department of Human Services (state Medicaid agency directory)", "url": "https://mn.gov/dhs/health-care/medical-assistance/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "MS", "state": "Mississippi", "medicaid_agency": "Mississippi Division of Medicaid, Office of the Governor", "medicaid_agency_url": "https://medicaid.ms.gov/", "program_name": "Mississippi Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Mississippi Division of Medicaid, Office of the Governor (state Medicaid agency directory)", "url": "https://medicaid.ms.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "MO", "state": "Missouri", "medicaid_agency": "Department of Social Services, MO HealthNet Division", "medicaid_agency_url": "https://mydss.mo.gov/mhd", "program_name": "MO HealthNet", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Social Services, MO HealthNet Division (state Medicaid agency directory)", "url": "https://mydss.mo.gov/mhd", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "MT", "state": "Montana", "medicaid_agency": "Department of Public Health and Human Services (DPHHS)", "medicaid_agency_url": "https://dphhs.mt.gov/healthcare/", "program_name": "Montana Medicaid (HELP Plan for expansion adults)", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Public Health and Human Services (DPHHS) (state Medicaid agency directory)", "url": "https://dphhs.mt.gov/healthcare/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "NE", "state": "Nebraska", "medicaid_agency": "Department of Health and Human Services, Division of Medicaid and Long-Term Care", "medicaid_agency_url": "https://dhhs.ne.gov/Pages/Heritage-Health-Contacts.aspx", "program_name": "Heritage Health (managed care)", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health and Human Services, Division of Medicaid and Long-Term Care (state Medicaid agency directory)", "url": "https://dhhs.ne.gov/Pages/Heritage-Health-Contacts.aspx", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "NV", "state": "Nevada", "medicaid_agency": "Department of Health and Human Services, Division of Health Care Financing and Policy (DHCFP)", "medicaid_agency_url": "https://dhcfp.nv.gov/", "program_name": "Nevada Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health and Human Services, Division of Health Care Financing and Policy (DHCFP) (state Medicaid agency directory)", "url": "https://dhcfp.nv.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "NH", "state": "New Hampshire", "medicaid_agency": "Department of Health and Human Services, Division of Medicaid Services", "medicaid_agency_url": "https://www.dhhs.nh.gov/programs-services/medicaid", "program_name": "NH Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health and Human Services, Division of Medicaid Services (state Medicaid agency directory)", "url": "https://www.dhhs.nh.gov/programs-services/medicaid", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "NJ", "state": "New Jersey", "medicaid_agency": "Department of Human Services, Division of Medical Assistance and Health Services (DMAHS)", "medicaid_agency_url": "https://www.nj.gov/humanservices/dmahs/", "program_name": "NJ FamilyCare", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) (state Medicaid agency directory)", "url": "https://www.nj.gov/humanservices/dmahs/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "NM", "state": "New Mexico", "medicaid_agency": "Health Care Authority, Medical Assistance Division", "medicaid_agency_url": "https://www.hca.nm.gov/", "program_name": "Turquoise Care (managed care since 2024-07-01)", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Health Care Authority, Medical Assistance Division (state Medicaid agency directory)", "url": "https://www.hca.nm.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "NY", "state": "New York", "medicaid_agency": "New York State Department of Health, Medicaid program", "medicaid_agency_url": "https://www.health.ny.gov/health_care/medicaid/", "program_name": "New York State Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "New York State Office of Information Technology Services (ITS)", "url": "https://its.ny.gov/" }, "procurement_portal": { "name": "NYS Contract Reporter", "url": "https://www.nyscr.ny.gov/" }, "medicaid_procurement_page": "https://www.health.ny.gov/funding/", "spend": { "kff_fy2023_rank": 2, "fy2024_total_usd": 98200000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "New York State Department of Health, Medicaid program", "url": "https://www.health.ny.gov/health_care/medicaid/", "retrieved": "2026-09-20" }, { "label": "New York State Office of Information Technology Services (ITS)", "url": "https://its.ny.gov/", "retrieved": "2026-09-20" }, { "label": "NYS Contract Reporter", "url": "https://www.nyscr.ny.gov/", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/new-york/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)" ] }, { "code": "NC", "state": "North Carolina", "medicaid_agency": "Department of Health and Human Services, Division of Health Benefits", "medicaid_agency_url": "https://medicaid.ncdhhs.gov/", "program_name": "NC Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health and Human Services, Division of Health Benefits (state Medicaid agency directory)", "url": "https://medicaid.ncdhhs.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "ND", "state": "North Dakota", "medicaid_agency": "Health and Human Services, Medical Services Division", "medicaid_agency_url": "https://www.hhs.nd.gov/healthcare/medicaid", "program_name": "North Dakota Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Health and Human Services, Medical Services Division (state Medicaid agency directory)", "url": "https://www.hhs.nd.gov/healthcare/medicaid", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "OH", "state": "Ohio", "medicaid_agency": "Ohio Department of Medicaid (ODM)", "medicaid_agency_url": "https://medicaid.ohio.gov/", "program_name": "Ohio Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "Ohio Department of Administrative Services, Office of Information Technology", "url": "https://das.ohio.gov/technology-and-strategy/overview" }, "procurement_portal": { "name": "OhioBuys", "url": "https://procure.ohio.gov/state-and-local-agencies/resources/ohiobuys-overview" }, "medicaid_procurement_page": "https://medicaid.ohio.gov/stakeholders-and-partners/legal-and-contracts/requests-for-proposals", "spend": { "kff_fy2023_rank": 7, "fy2024_total_usd": 35200000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "Ohio Department of Medicaid (ODM)", "url": "https://medicaid.ohio.gov/", "retrieved": "2026-09-20" }, { "label": "Ohio Department of Administrative Services, Office of Information Technology", "url": "https://das.ohio.gov/technology-and-strategy/overview", "retrieved": "2026-09-20" }, { "label": "OhioBuys", "url": "https://procure.ohio.gov/state-and-local-agencies/resources/ohiobuys-overview", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/ohio/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)" ] }, { "code": "OK", "state": "Oklahoma", "medicaid_agency": "Oklahoma Health Care Authority (OHCA)", "medicaid_agency_url": "https://oklahoma.gov/ohca.html", "program_name": "SoonerCare", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Oklahoma Health Care Authority (OHCA) (state Medicaid agency directory)", "url": "https://oklahoma.gov/ohca.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "OR", "state": "Oregon", "medicaid_agency": "Oregon Health Authority", "medicaid_agency_url": "https://www.oregon.gov/oha/hsd/ohp/pages/index.aspx", "program_name": "Oregon Health Plan (OHP)", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Oregon Health Authority (state Medicaid agency directory)", "url": "https://www.oregon.gov/oha/hsd/ohp/pages/index.aspx", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "PA", "state": "Pennsylvania", "medicaid_agency": "Pennsylvania Department of Human Services, Office of Medical Assistance Programs", "medicaid_agency_url": "https://www.pa.gov/agencies/dhs", "program_name": "Medical Assistance", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "Pennsylvania Office of Administration, Office for Information Technology (OA/OIT)", "url": "https://www.pa.gov/agencies/oa/programs/information-technology2" }, "procurement_portal": { "name": "PA eMarketplace", "url": "https://www.emarketplace.state.pa.us/" }, "medicaid_procurement_page": null, "spend": { "kff_fy2023_rank": 4, "fy2024_total_usd": 44400000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "Pennsylvania Department of Human Services, Office of Medical Assistance Programs", "url": "https://www.pa.gov/agencies/dhs", "retrieved": "2026-09-20" }, { "label": "Pennsylvania Office of Administration, Office for Information Technology (OA/OIT)", "url": "https://www.pa.gov/agencies/oa/programs/information-technology2", "retrieved": "2026-09-20" }, { "label": "PA eMarketplace", "url": "https://www.emarketplace.state.pa.us/", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/pennsylvania/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)", "medicaid_procurement_page" ] }, { "code": "RI", "state": "Rhode Island", "medicaid_agency": "Executive Office of Health and Human Services (EOHHS)", "medicaid_agency_url": "https://eohhs.ri.gov/", "program_name": "Rhode Island Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Executive Office of Health and Human Services (EOHHS) (state Medicaid agency directory)", "url": "https://eohhs.ri.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "SC", "state": "South Carolina", "medicaid_agency": "Department of Health and Human Services (SCDHHS)", "medicaid_agency_url": "https://www.scdhhs.gov/", "program_name": "Healthy Connections", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health and Human Services (SCDHHS) (state Medicaid agency directory)", "url": "https://www.scdhhs.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "SD", "state": "South Dakota", "medicaid_agency": "Department of Social Services, Division of Medical Services", "medicaid_agency_url": "https://dss.sd.gov/medicaid/", "program_name": "South Dakota Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Social Services, Division of Medical Services (state Medicaid agency directory)", "url": "https://dss.sd.gov/medicaid/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "TN", "state": "Tennessee", "medicaid_agency": "Division of TennCare", "medicaid_agency_url": "https://www.tn.gov/tenncare.html", "program_name": "TennCare", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Division of TennCare (state Medicaid agency directory)", "url": "https://www.tn.gov/tenncare.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "TX", "state": "Texas", "medicaid_agency": "Texas Health and Human Services Commission (HHSC)", "medicaid_agency_url": "https://www.hhs.texas.gov/", "program_name": "Texas Medicaid and CHIP", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "Texas Department of Information Resources (DIR)", "url": "https://dir.texas.gov/" }, "procurement_portal": { "name": "Electronic State Business Daily (ESBD)", "url": "https://www.txsmartbuy.gov/esbd" }, "medicaid_procurement_page": "https://www.hhs.texas.gov/business/contracting-hhs/procurement-opportunities", "spend": { "kff_fy2023_rank": 3, "fy2024_total_usd": 49400000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "Texas Health and Human Services Commission (HHSC)", "url": "https://www.hhs.texas.gov/", "retrieved": "2026-09-20" }, { "label": "Texas Department of Information Resources (DIR)", "url": "https://dir.texas.gov/", "retrieved": "2026-09-20" }, { "label": "Electronic State Business Daily (ESBD)", "url": "https://www.txsmartbuy.gov/esbd", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/texas/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)" ] }, { "code": "UT", "state": "Utah", "medicaid_agency": "Department of Health and Human Services, Division of Integrated Healthcare", "medicaid_agency_url": "https://medicaid.utah.gov/", "program_name": "Utah Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health and Human Services, Division of Integrated Healthcare (state Medicaid agency directory)", "url": "https://medicaid.utah.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "VT", "state": "Vermont", "medicaid_agency": "Department of Vermont Health Access (DVHA), Agency of Human Services", "medicaid_agency_url": "https://dvha.vermont.gov/", "program_name": "Green Mountain Care (Vermont Medicaid)", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Vermont Health Access (DVHA), Agency of Human Services (state Medicaid agency directory)", "url": "https://dvha.vermont.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "VA", "state": "Virginia", "medicaid_agency": "Department of Medical Assistance Services (DMAS)", "medicaid_agency_url": "https://www.dmas.virginia.gov/", "program_name": "Cardinal Care", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Medical Assistance Services (DMAS) (state Medicaid agency directory)", "url": "https://www.dmas.virginia.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "WA", "state": "Washington", "medicaid_agency": "Washington State Health Care Authority (HCA), Apple Health", "medicaid_agency_url": "https://www.hca.wa.gov/", "program_name": "Apple Health", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": { "name": "WaTech (Washington Technology Solutions)", "url": "https://watech.wa.gov/" }, "procurement_portal": { "name": "Washington's Electronic Business Solution (WEBS)", "url": "https://des.wa.gov/sell/how-work-state/register-bid-opportunities" }, "medicaid_procurement_page": null, "spend": { "kff_fy2023_rank": 8, "fy2024_total_usd": 21300000000, "basis": "total Medicaid spending, state and federal; a proxy for MES market size, not MES spend" }, "sources": [ { "label": "Washington State Health Care Authority (HCA), Apple Health", "url": "https://www.hca.wa.gov/", "retrieved": "2026-09-20" }, { "label": "WaTech (Washington Technology Solutions)", "url": "https://watech.wa.gov/", "retrieved": "2026-09-20" }, { "label": "Washington's Electronic Business Solution (WEBS)", "url": "https://des.wa.gov/sell/how-work-state/register-bid-opportunities", "retrieved": "2026-09-20" }, { "label": "U.S. News: Top States for Medicaid Spending (KFF FY2023 order)", "url": "https://www.usnews.com/news/best-states/slideshows/top-states-for-medicaid-spending", "retrieved": "2026-09-20" }, { "label": "KFF State Health Facts: Total Medicaid Spending", "url": "https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/", "retrieved": "2026-09-20" }, { "label": "USAFacts: How much does Medicaid cost (FY2024 combined state and federal)", "url": "https://usafacts.org/answers/how-much-does-medicaid-cost-in-the-us/state/washington/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "sister_agencies (sister agencies that buy MES modules not yet mapped)", "medicaid_procurement_page" ] }, { "code": "WV", "state": "West Virginia", "medicaid_agency": "Department of Human Services, Bureau for Medical Services", "medicaid_agency_url": "https://bms.wv.gov/", "program_name": "West Virginia Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Human Services, Bureau for Medical Services (state Medicaid agency directory)", "url": "https://bms.wv.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "WI", "state": "Wisconsin", "medicaid_agency": "Department of Health Services (ForwardHealth)", "medicaid_agency_url": "https://www.dhs.wisconsin.gov/medicaid/index.htm", "program_name": "BadgerCare Plus and Wisconsin Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health Services (ForwardHealth) (state Medicaid agency directory)", "url": "https://www.dhs.wisconsin.gov/medicaid/index.htm", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "WY", "state": "Wyoming", "medicaid_agency": "Department of Health, Division of Healthcare Financing", "medicaid_agency_url": "https://health.wyo.gov/healthcarefin/", "program_name": "Wyoming Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Health, Division of Healthcare Financing (state Medicaid agency directory)", "url": "https://health.wyo.gov/healthcarefin/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "PR", "state": "Puerto Rico", "medicaid_agency": "Puerto Rico Medicaid Program (Departamento de Salud), with ASES administering Plan Vital", "medicaid_agency_url": "https://www.medicaid.pr.gov/", "program_name": "Plan Vital", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Puerto Rico Medicaid Program (Departamento de Salud), with ASES administering Plan Vital (state Medicaid agency directory)", "url": "https://www.medicaid.pr.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "VI", "state": "U.S. Virgin Islands", "medicaid_agency": "Department of Human Services, Office of Medicaid", "medicaid_agency_url": "https://dhs.vi.gov/office-of-medicaid/", "program_name": "USVI Medicaid (Medical Assistance Program)", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Human Services, Office of Medicaid (state Medicaid agency directory)", "url": "https://dhs.vi.gov/office-of-medicaid/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "GU", "state": "Guam", "medicaid_agency": "Department of Public Health and Social Services, Bureau of Health Care Financing Administration", "medicaid_agency_url": "https://dphss.guam.gov/", "program_name": "Guam Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Department of Public Health and Social Services, Bureau of Health Care Financing Administration (state Medicaid agency directory)", "url": "https://dphss.guam.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "AS", "state": "American Samoa", "medicaid_agency": "American Samoa Medicaid State Agency, Office of the Governor", "medicaid_agency_url": "https://www.medicaid.as.gov/", "program_name": "American Samoa Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "American Samoa Medicaid State Agency, Office of the Governor (state Medicaid agency directory)", "url": "https://www.medicaid.as.gov/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] }, { "code": "MP", "state": "Northern Mariana Islands", "medicaid_agency": "Commonwealth Medicaid Agency (CNMI)", "medicaid_agency_url": "https://www.cnmimedicaid.org/", "program_name": "CNMI Medicaid", "agency_type": "medicaid_agency", "sister_agencies": [], "cio_office": null, "procurement_portal": null, "medicaid_procurement_page": null, "spend": null, "sources": [ { "label": "Commonwealth Medicaid Agency (CNMI) (state Medicaid agency directory)", "url": "https://www.cnmimedicaid.org/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "cio_office", "procurement_portal", "medicaid_procurement_page", "sister_agencies" ] } ], "mes_modules": [ { "id": "ca-claims-mmis-fiscal-intermediary-", "state": "CA", "module": "claims (MMIS fiscal intermediary)", "incumbent": "Gainwell Technologies", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "CA-MMIS fiscal intermediary, formerly DXC; operating as Gainwell since October 1 2020. DHCS is developing a Fiscal Intermediary Maintenance and Operations (FI-M&O) RFP.", "sources": [ { "label": "Medi-Cal newsroom: fiscal intermediary name change to Gainwell", "url": "https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30715.aspx", "retrieved": "2026-09-20" }, { "label": "DHCS: FI-M&O RFI", "url": "https://www.dhcs.ca.gov/provgovpart/rfa_rfp/Pages/FI-M&O-RFI.aspx", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "ca-pharmacy", "state": "CA", "module": "pharmacy", "incumbent": "Magellan Medicaid Administration", "contract_id": "19-96125", "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Medi-Cal Rx; awarded December 13 2019; full assumption of operations January 1 2022.", "sources": [ { "label": "DHCS Medi-Cal Rx FAQ", "url": "https://www.dhcs.ca.gov/provgovpart/pharmacy/Pages/Medi-Cal-Rx-FAQ.aspx", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "ca-evv", "state": "CA", "module": "EVV", "incumbent": null, "contract_id": null, "contract_end": null, "certification_status": null, "status": "procurement", "note": "An EVV Phase II RFP document is published; vendor and dates not read.", "sources": [ { "label": "DHCS EVV Phase II RFP", "url": "https://www.dhcs.ca.gov/Documents/EVV-PHASE-II-PART-1-RFP.pdf", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "incumbent", "contract_end", "certification_status" ] }, { "id": "ca-provider-services-pave-", "state": "CA", "module": "provider services (PAVE)", "incumbent": null, "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "PAVE is DHCS's provider enrollment system, described as the foundation for provider enrollment programs within the MES.", "sources": [ { "label": "DHCS PAVE", "url": "https://www.dhcs.ca.gov/provgovpart/Pages/PAVE.aspx", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "incumbent", "contract_end", "certification_status" ] }, { "id": "ny-claims-mmis-fiscal-agent-emedny-", "state": "NY", "module": "claims (MMIS fiscal agent, eMedNY)", "incumbent": "CSRA State and Local Solutions LLC", "contract_id": "C014305", "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Extension requested to maintain MMIS functionality while DOH aligns its procurement strategy to the MES roadmap; OSC approved a notice exemption on November 12 2024.", "sources": [ { "label": "NYS DOH single source notice C014305", "url": "https://www.health.ny.gov/funding/single_source/c014305_x22.htm", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "ny-data-and-analytics-medicaid-data-warehouse-", "state": "NY", "module": "data and analytics (Medicaid Data Warehouse)", "incumbent": "Currier, McCabe and Associates (CMA)", "contract_id": "C024937", "contract_end": null, "certification_status": null, "status": "in_operation", "note": "O&M and DDI of the Medicaid Data Warehouse; OSC approved a notice exemption on September 26 2024.", "sources": [ { "label": "NYS DOH single source notice C024937", "url": "https://www.health.ny.gov/funding/single_source/c024937_x8.htm", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "ny-eligibility-and-enrollment-mecm-non-magi-", "state": "NY", "module": "eligibility and enrollment (MECM, non-MAGI)", "incumbent": "Deloitte", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Reported by a consumer advocacy site: MECM for the non-MAGI population went live on NY State of Health on December 1 2025. Not yet confirmed against a DOH source.", "sources": [ { "label": "NY Health Access (secondary)", "url": "https://nyhealthaccess.org/entry/257/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "contract_id", "contract_end", "certification_status", "official_source (DOH confirmation not yet read)" ] }, { "id": "tx-claims-administration-tmhp-", "state": "TX", "module": "claims administration (TMHP)", "incumbent": "Accenture", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Accenture continues as the TMHP claims vendor after the Conduent claims contract that was to start December 2024 was terminated. HHSC plans two claims solicitations: claims administration and a new claims system.", "sources": [ { "label": "TMHP news 2024-04-05: contracts update", "url": "https://www.tmhp.com/news/2024-04-05-new-texas-medicaid-healthcare-partnership-contracts-update", "retrieved": "2026-09-20" }, { "label": "HHSC procurement opportunities", "url": "https://www.hhs.texas.gov/business/contracting-hhs/procurement-opportunities", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "tx-business-operations-and-integration-tmhp-busops-", "state": "TX", "module": "business operations and integration (TMHP BusOps)", "incumbent": "Accenture State Healthcare Services LLC", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Effective September 1 2023.", "sources": [ { "label": "TMHP news 2023-09-26: new TMHP contracts", "url": "https://www.tmhp.com/news/2023-09-26-new-texas-medicaid-healthcare-partnership-tmhp-contracts", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "tx-application-maintenance-and-development-tmhp-amd-", "state": "TX", "module": "application maintenance and development (TMHP AMD)", "incumbent": "Deloitte Consulting LLP", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": null, "sources": [ { "label": "TMHP news 2023-09-26: new TMHP contracts", "url": "https://www.tmhp.com/news/2023-09-26-new-texas-medicaid-healthcare-partnership-tmhp-contracts", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "tx-pharmacy-vendor-drug-program-benefits-administrator-", "state": "TX", "module": "pharmacy (Vendor Drug Program benefits administrator)", "incumbent": "Gainwell Technologies", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Effective March 30 2024; award announced 2022.", "sources": [ { "label": "TMHP news 2024-01-17: VDP vendor change", "url": "https://www.tmhp.com/news/2024-01-17-texas-vdp-vendor-change-begins-march-2024", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "tx-evv", "state": "TX", "module": "EVV", "incumbent": "Accenture and HHAeXchange", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Award posted May 5 2023.", "sources": [ { "label": "TMHP news 2023-05-05: EVV contract awarded", "url": "https://www.tmhp.com/news/2023-05-05-electronic-visit-verification-contract-awarded-accenture-and-hhaexchange", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "fl-claims-fmmis-", "state": "FL", "module": "claims (FMMIS)", "incumbent": "Gainwell Technologies", "contract_id": "MED037", "contract_end": "2027-12-31", "certification_status": null, "status": "in_operation", "note": "Contract end date reported by Health Management Associates (April 2 2025 roundup); the contract number is from AHCA's amendment record. Not yet read on an AHCA page.", "sources": [ { "label": "AHCA contract MED037 amendment 57", "url": "https://ahca.myflorida.com/content/download/8476/file/AHCA_ContractNo.MED037_AmendmentNo._57.pdf", "retrieved": "2026-09-20" }, { "label": "HMA weekly roundup 2025-04-02 (secondary)", "url": "https://www.healthmanagement.com/insights/weekly-roundup/april-2-2025/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "certification_status" ] }, { "id": "fl-core-systems-module-fx-", "state": "FL", "module": "core systems module (FX)", "incumbent": "Gainwell Technologies (terminated)", "contract_id": null, "contract_end": null, "certification_status": null, "status": "terminated", "note": "The FX Executive Steering Committee decided on February 25 2025 to terminate the Core Systems Module contract.", "sources": [ { "label": "AHCA FX history", "url": "https://ahca.myflorida.com/medicaid/florida-health-care-connections-fx/fx-history", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "successor procurement", "certification_status" ] }, { "id": "fl-provider-services-module-fx-psm-", "state": "FL", "module": "provider services module (FX PSM)", "incumbent": null, "contract_id": "EXD115", "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Contract executed October 2023; vendor name not read.", "sources": [ { "label": "AHCA FX contracts", "url": "https://ahca.myflorida.com/medicaid/florida-health-care-connections-fx/fx-contracts.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "incumbent", "contract_end", "certification_status" ] }, { "id": "fl-enterprise-data-warehouse-fx-edw-", "state": "FL", "module": "enterprise data warehouse (FX EDW)", "incumbent": null, "contract_id": "EXD091", "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Contract executed December 2020; vendor name not read.", "sources": [ { "label": "AHCA FX contracts", "url": "https://ahca.myflorida.com/medicaid/florida-health-care-connections-fx/fx-contracts.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "incumbent", "contract_end", "certification_status" ] }, { "id": "fl-unified-operations-center-fx-uoc-", "state": "FL", "module": "unified operations center (FX UOC)", "incumbent": null, "contract_id": "EXD106", "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Contract executed October 2022; vendor name not read.", "sources": [ { "label": "AHCA FX contracts", "url": "https://ahca.myflorida.com/medicaid/florida-health-care-connections-fx/fx-contracts.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "incumbent", "contract_end", "certification_status" ] }, { "id": "pa-claims-mmis-promise-", "state": "PA", "module": "claims (MMIS, PROMISe)", "incumbent": "Gainwell Technologies", "contract_id": "4000022569", "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Operation, maintenance and turnover of PROMISe. A replacement RFP was announced for September 1 2022 with implementation targeted November 1 2024; the outcome is not yet read.", "sources": [ { "label": "PA Treasury contract 4000022569 amendment", "url": "https://contracts.patreasury.gov/Admin/Upload/784556_4000022569s%20OMAP%20AMND%2010.pdf", "retrieved": "2026-09-20" }, { "label": "Penn State PORH: PROMISe replacement RFP", "url": "https://www.porh.psu.edu/pa-promise-no-quite-meeting-promises", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status", "replacement award (2022 RFP outcome not yet read)" ] }, { "id": "pa-edi-edi-as-a-service-", "state": "PA", "module": "EDI (EDI as a Service)", "incumbent": "Gainwell Technologies", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "EDIaaS production go-live September 22 2025, replacing BES.", "sources": [ { "label": "PA DHS PROMISe EDIaaS FAQ", "url": "https://www.pa.gov/agencies/dhs/resources/for-providers/promise/faq-ediaas", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "pa-iv-v-mmis-", "state": "PA", "module": "IV&V (MMIS)", "incumbent": "SLI Government Solutions", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": null, "sources": [ { "label": "Public Knowledge: SLI Pennsylvania MMIS IV&V award", "url": "https://pubknow.com/media-center/sli-announces-award-of-pennsylvania-mmis-ivv-contract/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "contract_id", "contract_end", "award_date" ] }, { "id": "pa-evv", "state": "PA", "module": "EVV", "incumbent": "Gainwell Technologies with Sandata", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "EVV system integrated with PROMISe.", "sources": [ { "label": "PA DHS EVV FAQ", "url": "https://www.pa.gov/agencies/dhs/resources/for-providers/evv/faq-evv", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "oh-claims-fiscal-intermediary-omes-", "state": "OH", "module": "claims (fiscal intermediary, OMES)", "incumbent": "Gainwell Technologies", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Awarded December 8 2020; EDI claims processing began February 1 2023.", "sources": [ { "label": "ODM press release 2020-12-08", "url": "https://medicaid.ohio.gov/news/press-release/12-08-2020-odm-awards-fiscal-intermediary-contract-to-gainwell-technologies", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "oh-provider-network-management-pnm-", "state": "OH", "module": "provider network management (PNM)", "incumbent": "Maximus", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "New OMES features implemented in the PNM module June 30 2024.", "sources": [ { "label": "ODM: about the PNM module", "url": "https://managedcare.medicaid.ohio.gov/managed-care/centralized-credentialing/about-pnm", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "oh-pharmacy-single-pharmacy-benefit-manager-", "state": "OH", "module": "pharmacy (single pharmacy benefit manager)", "incumbent": "Gainwell Technologies", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "SPBM for fee-for-service from July 1 2023.", "sources": [ { "label": "ODM: single pharmacy benefit manager", "url": "https://managedcare.medicaid.ohio.gov/managed-care/single-pharmacy-benefit-manager/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "oh-edi", "state": "OH", "module": "EDI", "incumbent": "Deloitte", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Named on a managed care plan's provider page, not yet on an ODM page.", "sources": [ { "label": "Buckeye Health Plan EDI page (secondary)", "url": "https://www.buckeyehealthplan.com/providers/next-gen-contract-information/edi--electronic-data-interchange.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "contract_id", "contract_end", "official_source" ] }, { "id": "oh-evv", "state": "OH", "module": "EVV", "incumbent": "Sandata Technologies", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Contract renewal in 2023 from a DAS-administered competitive procurement (vendor announcement).", "sources": [ { "label": "Business Wire 2023-08-16: Ohio Sandata renewal", "url": "https://www.businesswire.com/news/home/20230816207292/en/Ohio-Continues-Leading-Charge-on-Medicaid-Modernization-with-Sandata-Technologies-Contract-Renewal", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "contract_end", "certification_status" ] }, { "id": "il-claims-mmis-impact-", "state": "IL", "module": "claims (MMIS, IMPACT)", "incumbent": "Acentra Health (formerly CNSI)", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "Selected June 2021 for core claims, encounter processing and managed care coordination under a four-year CMS-approved contract (vendor announcement). IMPACT is shared with Michigan.", "sources": [ { "label": "PR Newswire 2021: Illinois selects CNSI", "url": "https://www.prnewswire.com/news-releases/illinois-selects-cnsi-to-support-ongoing-medicaid-modernization-efforts-301307542.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "contract_end", "certification_status" ] }, { "id": "il-provider-enrollment-impact-pe-module-m-o-", "state": "IL", "module": "provider enrollment (IMPACT PE module M&O)", "incumbent": "Acentra Health, LLC", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "M&O contract for March 30 to May 31 2025 valued at $1,236,359.47 per the Comptroller's contract record.", "sources": [ { "label": "Illinois Comptroller contract record", "url": "https://illinoiscomptroller.gov/CTDDocs/478-2025-4100213116-E-06252025-824379367-G-NA-NA-ACENTRA%20HOLDINGS%20LLC-CTD.PDF", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "current contract_end", "certification_status" ] }, { "id": "wa-claims-mmis-providerone-", "state": "WA", "module": "claims (MMIS, ProviderOne)", "incumbent": "Acentra Health (formerly CNSI)", "contract_id": null, "contract_end": "2026-06-30", "certification_status": null, "status": "in_operation", "note": "A 2021 vendor announcement said the contract was extended through June 2026; HCA is staffing a ProviderOne Modular Replacement project. Status after June 2026 not yet read.", "sources": [ { "label": "CNSI: Washington extension announcement", "url": "https://www.cns-inc.com/insights/press-releases/washington-state-cms-approve-five-year-extension-of-cnsi-contract/", "retrieved": "2026-09-20" }, { "label": "Washington job posting: ProviderOne Modular Replacement Project Manager", "url": "https://www.governmentjobs.com/careers/washington/jobs/newprint/2498455", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "status after 2026-06-30", "certification_status" ] }, { "id": "wa-pharmacy-point-of-sale", "state": "WA", "module": "pharmacy point of sale", "incumbent": "Optum", "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "POS vendor and subcontractor under the HCA-CNSI MMIS; RFP 2020HCA28; go-live June 8 2024.", "sources": [ { "label": "HCA pharmacy POS replacement FAQ", "url": "https://www.hca.wa.gov/assets/billers-and-providers/pharmacy-point-of-sale-replacement-project-FAQ.pdf", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "contract_end", "certification_status" ] }, { "id": "ma-claims-mmis-", "state": "MA", "module": "claims (MMIS)", "incumbent": null, "contract_id": null, "contract_end": null, "certification_status": null, "status": "in_operation", "note": "A NewMMIS RFR listing exists; the incumbent's name did not appear on a MassHealth page in this pass.", "sources": [ { "label": "Bid listing: NewMMIS RFR announcement", "url": "https://bidbanana.thebidlab.com/bid/SIcU8CbdtYOB8OqPnQB0", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "incumbent", "contract_end", "certification_status" ] }, { "id": "mi-claims-mmis-champs-", "state": "MI", "module": "claims (MMIS, CHAMPS)", "incumbent": "Acentra Health (formerly CNSI)", "contract_id": "071B6200168C", "contract_end": "2026-09-30", "certification_status": null, "status": "in_operation", "note": "DTMB change notice shows a revised expiration of September 30 2026; an earlier change notice extended the contract by eight years and added $480,000,000. A re-procurement notice is not yet read.", "sources": [ { "label": "Michigan DTMB contract 071B6200168C change notice 26", "url": "https://www.michigan.gov/-/media/Project/Websites/dtmb/Procurement/Contracts/Folder3/6200168CN26.pdf?rev=a66c4ea362be4c749bcaea1c5ce9f2b4", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "status after 2026-09-30", "certification_status" ] } ], "state_solicitations": [ { "id": "ca-rfi-23-072-fi-mo", "state": "CA", "agency": "DHCS", "title": "Fiscal Intermediary Maintenance and Operations (FI-M&O) RFI 23-072", "module": "claims (MMIS fiscal intermediary)", "type": "RFI", "posted": null, "due": null, "status": "closed", "award": null, "portal_url": null, "note": "Precedes the FI-M&O RFP DHCS says it is developing; dates not read.", "sources": [ { "label": "DHCS RFI 23-072", "url": "https://www.dhcs.ca.gov/providers-partners/procurement-and-contracting-division/request-for-information-23-072/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "posted", "due" ] }, { "id": "ca-rfp-fi-mo-planned", "state": "CA", "agency": "DHCS", "title": "Fiscal Intermediary Maintenance and Operations (FI-M&O) RFP", "module": "claims (MMIS fiscal intermediary)", "type": "RFP", "posted": null, "due": null, "status": "planned", "award": null, "portal_url": null, "note": "DHCS states it is developing the RFP.", "sources": [ { "label": "DHCS FI-M&O RFI page", "url": "https://www.dhcs.ca.gov/provgovpart/rfa_rfp/Pages/FI-M&O-RFI.aspx", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "posted", "due" ] }, { "id": "ny-rfi-mes-solutions", "state": "NY", "agency": "NYS DOH", "title": "Request for Information for Innovative Medicaid Enterprise Systems (MES) Solutions", "module": "MMIS, eligibility and enrollment, supporting services", "type": "RFI", "posted": null, "due": null, "status": "closed", "award": null, "portal_url": null, "note": "Vendor meetings were scheduled for December 2021 or January 2022.", "sources": [ { "label": "NYS DOH MES Solutions RFI", "url": "https://www.health.ny.gov/funding/rfi/mes_solutions/index.htm", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "posted", "due" ] }, { "id": "tx-claims-solicitations-planned", "state": "TX", "agency": "HHSC", "title": "Medicaid claims administration and new Medicaid claims system solicitations", "module": "claims", "type": "RFP", "posted": null, "due": null, "status": "planned", "award": null, "portal_url": null, "note": "HHSC says it will reprocure the TMHP contracts and issue two claims solicitations.", "sources": [ { "label": "HHSC procurement opportunities", "url": "https://www.hhs.texas.gov/business/contracting-hhs/procurement-opportunities", "retrieved": "2026-09-20" }, { "label": "HHSC procurement forecast", "url": "https://apps.hhs.texas.gov/procurement-calendar/procurement-forecast.pdf", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "posted", "due" ] }, { "id": "fl-rfi-014-24-25", "state": "FL", "agency": "AHCA", "title": "RFI 014-24/25 Florida Medicaid Management Information System modernization", "module": "claims (MMIS)", "type": "RFI", "posted": "2025-04-01", "due": null, "status": "closed", "award": null, "portal_url": null, "note": "Submission deadlines fell in April and May 2025.", "sources": [ { "label": "AHCA RFI 014-24/25 (Government Navigator copy)", "url": "https://media.governmentnavigator.com/media/bid/1743548635_2025-04-01_014-24-25.pdf", "retrieved": "2026-09-20" }, { "label": "GovTech Insider: AHCA issues RFI", "url": "https://insider.govtech.com/florida/news/ahca-issues-rfi-for-medicaid-management-information-system-modernization", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "due" ] }, { "id": "il-24-478hfs-direc-b-38467", "state": "IL", "agency": "HFS", "title": "Integrated Eligibility System maintenance, operations and hosting (24-478HFS-DIREC-B-38467)", "module": "eligibility and enrollment", "type": "RFP", "posted": null, "due": "2025-05-15", "status": "closed", "award": null, "portal_url": "https://www.bidbuy.illinois.gov/bso/external/bidDetail.sda?docId=24-478HFS-DIREC-B-38467&external=true&parentUrl=close", "note": null, "sources": [ { "label": "BidBuy 24-478HFS-DIREC-B-38467", "url": "https://www.bidbuy.illinois.gov/bso/external/bidDetail.sda?docId=24-478HFS-DIREC-B-38467&external=true&parentUrl=close", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "posted", "award" ] }, { "id": "il-26-478hfs-direc-b-49319", "state": "IL", "agency": "HFS", "title": "Sole Economically Feasible Source: Integrated Eligibility System vendor (26-478HFS-DIREC-B-49319)", "module": "eligibility and enrollment", "type": "sole source", "posted": null, "due": "2025-10-01", "status": "closed", "award": null, "portal_url": null, "note": null, "sources": [ { "label": "HigherGov listing (secondary)", "url": "https://www.highergov.com/sl/contract-opportunity/il-sole-economically-feasible-source-integ-55903272/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "posted", "award", "official_source" ] } ], "coop_vehicles": [ { "id": "naspo-vp-mes-provider-services", "name": "NASPO ValuePoint Medicaid Enterprise Systems: Provider Services Module", "lead_state": "MT", "portfolio_url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-provider-services-module/", "solicitation": "DPHHS-RFP-2018-0127JT", "award_date": "2018-06-01", "term_start": "2018-06-01", "term_end": "2028-05-31", "module_scope": [ "provider enrollment", "screening and monitoring", "revalidation", "provider maintenance" ], "awarded_suppliers": [ { "name": "Acentra Health, LLC (formerly CNSI)", "master_agreement": null }, { "name": "Gainwell Technologies LLC (formerly DXC Technology)", "master_agreement": null }, { "name": "HHS Technology Group, LLC", "master_agreement": "18091790030" }, { "name": "MAXIMUS", "master_agreement": "18091790020" }, { "name": "OptumInsight, Inc.", "master_agreement": "18091790010" } ], "participating_states": [ "AZ", "GA", "IA", "MO", "MT", "SD" ], "note": "Six suppliers were awarded in 2018 (including Digital Harbor, absent from the current listing). As of May 5 2025 Montana was working on renewals of the master agreements.", "sources": [ { "label": "NASPO ValuePoint portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-provider-services-module/", "retrieved": "2026-09-20" }, { "label": "NASPO ValuePoint press release: MMIS Provider Services Module contract", "url": "https://www.naspovaluepoint.org/press_release/mmis-provider-services-module-contract/", "retrieved": "2026-09-20" }, { "label": "Montana participating addendum with OptumInsight (EPIC copy)", "url": "https://epic.org/wp-content/uploads/2023/09/1548274042_Montana-OptumPA.pdf", "retrieved": "2026-09-20" }, { "label": "Maximus: NASPO provider services contract vehicle", "url": "https://maximus.com/contract-vehicles/naspo-provider-services", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "awarded_suppliers[].master_agreement (Acentra, Gainwell)", "option structure", "renewal outcome (Montana renewals in progress as of 2025-05-05)" ] }, { "id": "naspo-vp-mes-claims-processing", "name": "NASPO ValuePoint Medicaid Enterprise Systems: Claims Processing and Management Services Module", "lead_state": "MT", "portfolio_url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-claims-processing-and-management-services-module/", "solicitation": "DPHHS-RFP-2020-025454T", "award_date": "2021-01-04", "term_start": "2021-01-04", "term_end": "2028-01-03", "module_scope": [ "claims receipt", "adjudication and editing", "pricing and payment", "SaaS delivery" ], "awarded_suppliers": [ { "name": "Acentra Health, LLC", "master_agreement": null }, { "name": "Conduent State Healthcare, LLC", "master_agreement": null }, { "name": "Gainwell Technologies LLC", "master_agreement": null }, { "name": "Infocrossing, LLC", "master_agreement": null } ], "participating_states": [ "AK", "MT" ], "note": "Optum describes itself as an approved vendor for this module; Georgia published a notice of intent to utilize. Master agreement executed by Montana January 4 2021 with renewals through January 3 2028.", "sources": [ { "label": "NASPO ValuePoint portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-claims-processing-and-management-services-module/", "retrieved": "2026-09-20" }, { "label": "NASPO ValuePoint press release: claims module added", "url": "https://www.naspovaluepoint.org/press_release/naspo-valuepoint-adds-mmis-claims-processing-and-management-services-module-to-portfolio-of-cooperative-contracts/", "retrieved": "2026-09-20" }, { "label": "Gainwell announcement 2021-05-27", "url": "https://www.globenewswire.com/news-release/2021/05/27/2237340/0/en/Gainwell-to-provide-services-through-NASPO-ValuePoint-MMIS-Claims-Processing-and-Management-Services-contract.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "awarded_suppliers[].master_agreement", "option structure", "Optum listing on the portfolio page" ] }, { "id": "naspo-vp-mes-third-party-liability", "name": "NASPO ValuePoint Medicaid Enterprise Systems: Third Party Liability", "lead_state": "GA", "portfolio_url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-third-party-liability/", "solicitation": "41900-DCH0000120", "award_date": "2022-02-01", "term_start": "2022-02-01", "term_end": "2031-12-31", "module_scope": [ "TPL recovery", "TPL commercial billing recoupment", "TPL hospital and physician", "TPL care management organization come-behind", "TPL system module" ], "awarded_suppliers": [ { "name": "Accenture State Healthcare Services, LLC", "master_agreement": null }, { "name": "Conduent State Healthcare, LLC", "master_agreement": null }, { "name": "Health Management Systems, Inc. (Gainwell)", "master_agreement": null }, { "name": "HHS Technology Group, LLC", "master_agreement": null }, { "name": "Stellarware Corporation", "master_agreement": "99999-NVP-DCH0000120-0002" } ], "participating_states": [ "LA", "MN", "MS", "MO", "RI" ], "note": "Sourcing partners at solicitation: Louisiana, Missouri, Montana, Rhode Island; Alaska submitted an intent to participate. The term shown is Stellarware's master agreement term.", "sources": [ { "label": "NASPO ValuePoint portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-third-party-liability/", "retrieved": "2026-09-20" }, { "label": "Georgia DCH TPL procurement page", "url": "https://medicaid.georgia.gov/programs/third-party-liability/procurement", "retrieved": "2026-09-20" }, { "label": "Stellarware NASPO page", "url": "https://stellarware.com/naspo", "retrieved": "2026-09-20" }, { "label": "Conduent announcement 2022-05-11", "url": "https://www.globenewswire.com/news-release/2022/05/11/2440858/0/en/Conduent-Selected-as-Preferred-Provider-to-Deliver-Third-Party-Liability-Services-to-State-Medicaid-Agencies-Under-NASPO-Procurement.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "full supplier count", "awarded_suppliers[].master_agreement (all but Stellarware)" ] }, { "id": "naspo-vp-mes-pharmacy-benefit-services", "name": "NASPO ValuePoint Medicaid Enterprise Systems: Pharmacy Benefit Services", "lead_state": "GA", "portfolio_url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-pharmacy-benefits-services/", "solicitation": "41900-DCH0000136", "award_date": "2025-10-29", "term_start": "2025-10-29", "term_end": "2026-10-28", "module_scope": [ "pharmacy fraud, waste and abuse audit (PFWA)", "pharmacy benefit administrator (PBA)", "pharmacy clinical management (PCM)", "pharmacy drug rebate (PDRS)" ], "awarded_suppliers": [ { "name": "Northstar Healthcare Consulting Technologies, LLC", "master_agreement": "99999-DCH0000136-001" }, { "name": "Gainwell Technologies, LLC", "master_agreement": "99999-DCH0000136-002" }, { "name": "Optum Rx, Inc.", "master_agreement": "99999-DCH0000136-0003" }, { "name": "MedImpact Healthcare Systems, Inc.", "master_agreement": "99999-DCH0000136-004" }, { "name": "Conduent State Healthcare, LLC", "master_agreement": "99999-DCH0000136-005" }, { "name": "Prime Therapeutics State Government Solutions, LLC", "master_agreement": null }, { "name": "Myers and Stauffer, LC", "master_agreement": null } ], "participating_states": [], "note": "Notice of intent to award October 20 2025; master agreements effective October 29 2025; the portfolio page shows an expiry of October 28 2026 while the portfolio slug reads 2025-2035, so the renewal path is not yet confirmed. No participating addenda were available as of the research date; Georgia will down-select through a state participating addendum.", "sources": [ { "label": "NASPO ValuePoint portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-pharmacy-benefits-services/", "retrieved": "2026-09-20" }, { "label": "NASPO ValuePoint award announcement", "url": "https://www.naspovaluepoint.org/news/naspo-valuepoint-announces-supplier-contract-awards-for-medicaid-enterprise-systems-pharmacy-benefit-services/", "retrieved": "2026-09-20" }, { "label": "Georgia DCH notice of intent to award 2025-10-20", "url": "https://dch.georgia.gov/announcement/2025-10-20/notice-intent-award-pharmacy-benefit-services-procurement", "retrieved": "2026-09-20" }, { "label": "Gainwell announcement 2025-11-17", "url": "https://www.globenewswire.com/news-release/2025/11/17/3189312/0/en/Gainwell-Technologies-Expands-NASPO-ValuePoint-Footprint-with-Medicaid-Pharmacy-Benefits-Services-Award.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "term_end renewal structure (2026-10-28 shown; slug says 2035)", "awarded_suppliers[].master_agreement (Prime Therapeutics, Myers and Stauffer)" ] }, { "id": "naspo-vp-cloud-software-2026", "name": "NASPO ValuePoint Cloud and Software Solutions 2026 to 2036", "lead_state": "UT", "portfolio_url": "https://www.naspovaluepoint.org/portfolios/cloud-and-software-solutions/", "solicitation": null, "award_date": "2025-10-29", "term_start": "2026-09-16", "term_end": "2036-09-15", "module_scope": [ "SaaS", "IaaS", "PaaS", "on-premise software", "value-added services" ], "awarded_suppliers": [ { "name": "58 suppliers awarded; named in announcements: AT&T, Accenture, CDW Government LLC, CGI, Carahsoft, Vertosoft (LS5028), Four Inc.", "master_agreement": null } ], "participating_states": [], "note": "Successor to Cloud Solutions 2016 to 2026, which expires September 15 2026. No evidence in this pass that an MES module has been bought through it; an MES vendor holding a cloud master agreement is not the same fact.", "sources": [ { "label": "NASPO ValuePoint portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/cloud-and-software-solutions/", "retrieved": "2026-09-20" }, { "label": "NASPO ValuePoint award announcement", "url": "https://naspovaluepoint.org/press_release/naspo-valuepoint-announces-supplier-contract-awards-for-cloud-and-software-solutions/", "retrieved": "2026-09-20" }, { "label": "Carahsoft announcement 2026-03-10", "url": "https://www.globenewswire.com/news-release/2026/03/10/3252891/0/en/Carahsoft-Awarded-NASPO-ValuePoint-Contract-for-Cloud-and-Software-Solutions.html", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "solicitation", "full supplier list", "participating_states", "MES purchases through this vehicle" ] } ], "participating_addenda": [ { "id": "mt-psm-optum", "state": "MT", "coop_vehicle_id": "naspo-vp-mes-provider-services", "supplier": "OptumInsight, Inc.", "status": "executed", "effective": null, "expires": null, "reference": "18091790100", "note": "Base term of four years and nine months: nine months DDI and four base operations years.", "sources": [ { "label": "Montana participating addendum with OptumInsight (EPIC copy)", "url": "https://epic.org/wp-content/uploads/2023/09/1548274042_Montana-OptumPA.pdf", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [ "effective", "expires" ] }, { "id": "ga-psm-acentra", "state": "GA", "coop_vehicle_id": "naspo-vp-mes-provider-services", "supplier": "Acentra Health, LLC (formerly CNSI)", "status": "executed", "effective": "2022-02-28", "expires": null, "reference": null, "note": "Ten-year, $116 million provider services module for Georgia's MES transformation (vendor announcement).", "sources": [ { "label": "Georgia participating addendum with CNSI (NASPO copy)", "url": "https://imlive.s3.amazonaws.com/NASPO%20ValuePoint/ID42284608657117021996001322079743267871/1641317107_MMIS%20Client%20Network%20Services%20Georgia.pdf", "retrieved": "2026-09-20" }, { "label": "Acentra announcement", "url": "https://acentra.com/news/cnsis-provider-services-module-to-support-georgia-department-of-community-healths-medicaid-enterprise-system-transformation-program", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "expires" ] }, { "id": "sd-psm-htg", "state": "SD", "coop_vehicle_id": "naspo-vp-mes-provider-services", "supplier": "HHS Technology Group, LLC", "status": "executed", "effective": null, "expires": null, "reference": null, "note": null, "sources": [ { "label": "NASPO ValuePoint supplier page: HHS Technology Group", "url": "https://www.naspovaluepoint.org/suppliers/hhs-technology-group/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "effective", "expires" ] }, { "id": "az-psm", "state": "AZ", "coop_vehicle_id": "naspo-vp-mes-provider-services", "supplier": null, "status": "executed", "effective": null, "expires": null, "reference": null, "note": "Listed as a participating state on the portfolio page; supplier not read.", "sources": [ { "label": "NASPO ValuePoint portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-provider-services-module/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "supplier", "effective", "expires" ] }, { "id": "ia-psm", "state": "IA", "coop_vehicle_id": "naspo-vp-mes-provider-services", "supplier": null, "status": "executed", "effective": null, "expires": null, "reference": null, "note": "Listed as a participating state on the portfolio page; supplier not read.", "sources": [ { "label": "NASPO ValuePoint portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-provider-services-module/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "supplier", "effective", "expires" ] }, { "id": "mo-psm", "state": "MO", "coop_vehicle_id": "naspo-vp-mes-provider-services", "supplier": null, "status": "executed", "effective": null, "expires": null, "reference": null, "note": "Listed as a participating state on the portfolio page; supplier not read.", "sources": [ { "label": "NASPO ValuePoint portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-provider-services-module/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "supplier", "effective", "expires" ] }, { "id": "ak-claims", "state": "AK", "coop_vehicle_id": "naspo-vp-mes-claims-processing", "supplier": null, "status": "executed", "effective": null, "expires": null, "reference": null, "note": "Alaska is listed as a participating state; supplier not read.", "sources": [ { "label": "NASPO ValuePoint claims portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-claims-processing-and-management-services-module/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "supplier", "effective", "expires" ] }, { "id": "mt-claims", "state": "MT", "coop_vehicle_id": "naspo-vp-mes-claims-processing", "supplier": null, "status": "executed", "effective": null, "expires": null, "reference": null, "note": "Montana is listed as a participating state; supplier not read.", "sources": [ { "label": "NASPO ValuePoint claims portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-claims-processing-and-management-services-module/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "supplier", "effective", "expires" ] }, { "id": "ga-claims-intent", "state": "GA", "coop_vehicle_id": "naspo-vp-mes-claims-processing", "supplier": null, "status": "in_process", "effective": null, "expires": null, "reference": null, "note": "Georgia published a notice of intent to utilize the claims module.", "sources": [ { "label": "Georgia notice of intent (ScoutGrants copy, secondary)", "url": "https://scoutgrants.ai/grant/3092e338-c5bc-469a-8f6b-8998d8916248/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "supplier", "effective", "expires", "official_source" ] }, { "id": "la-tpl-accenture", "state": "LA", "coop_vehicle_id": "naspo-vp-mes-third-party-liability", "supplier": "Accenture State Healthcare Services, LLC", "status": "executed", "effective": null, "expires": null, "reference": null, "note": null, "sources": [ { "label": "NASPO ValuePoint TPL portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-third-party-liability/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "effective", "expires" ] }, { "id": "mn-tpl-hms", "state": "MN", "coop_vehicle_id": "naspo-vp-mes-third-party-liability", "supplier": "Health Management Systems, Inc.", "status": "executed", "effective": null, "expires": null, "reference": null, "note": null, "sources": [ { "label": "NASPO ValuePoint TPL portfolio: HMS", "url": "https://www.naspovaluepoint.org/portfolio/medicaid-enterprise-systems-third-party-liability/health-management-systems-inc/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "effective", "expires" ] }, { "id": "ms-tpl-hms", "state": "MS", "coop_vehicle_id": "naspo-vp-mes-third-party-liability", "supplier": "Health Management Systems, Inc.", "status": "executed", "effective": null, "expires": null, "reference": null, "note": null, "sources": [ { "label": "NASPO ValuePoint TPL portfolio: HMS", "url": "https://www.naspovaluepoint.org/portfolio/medicaid-enterprise-systems-third-party-liability/health-management-systems-inc/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "effective", "expires" ] }, { "id": "mo-tpl-hms", "state": "MO", "coop_vehicle_id": "naspo-vp-mes-third-party-liability", "supplier": "Health Management Systems, Inc.", "status": "executed", "effective": null, "expires": null, "reference": null, "note": null, "sources": [ { "label": "NASPO ValuePoint TPL portfolio: HMS", "url": "https://www.naspovaluepoint.org/portfolio/medicaid-enterprise-systems-third-party-liability/health-management-systems-inc/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "effective", "expires" ] }, { "id": "ri-tpl-stellarware", "state": "RI", "coop_vehicle_id": "naspo-vp-mes-third-party-liability", "supplier": "Stellarware Corporation", "status": "executed", "effective": null, "expires": null, "reference": null, "note": null, "sources": [ { "label": "NASPO ValuePoint TPL portfolio page", "url": "https://www.naspovaluepoint.org/portfolios/medicaid-enterprise-systems-third-party-liability/", "retrieved": "2026-09-20" }, { "label": "Stellarware NASPO page", "url": "https://stellarware.com/naspo", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "effective", "expires" ] } ], "funding_conditions": [ { "id": "cef_01", "cef": "CEF1", "name": "Efficient, economical and effective administration", "citation": "42 CFR 433.112(b)(1)", "requirement": "CMS determines the system is likely to provide more efficient, economical and effective administration of the State plan.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_02", "cef": "CEF2", "name": "State Medicaid Manual Part 11", "citation": "42 CFR 433.112(b)(2)", "requirement": "The system meets the system requirements, standards and conditions, and performance standards in Part 11 of the State Medicaid Manual, as periodically amended.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_03", "cef": "CEF3", "name": "Medicare compatibility", "citation": "42 CFR 433.112(b)(3)", "requirement": "The system is compatible with the claims processing and information retrieval systems used in the administration of Medicare for prompt eligibility verification and for processing claims for persons eligible for both programs.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_04", "cef": "CEF4", "name": "Quality improvement organization data", "citation": "42 CFR 433.112(b)(4)", "requirement": "The system supports the data requirements of quality improvement organizations established under Part B of title XI of the Act.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_05", "cef": "CEF5", "name": "State ownership of software", "citation": "42 CFR 433.112(b)(5)", "requirement": "The State owns any software that is designed, developed, installed or improved with 90 percent FFP.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "The state must hold ownership of software built with enhanced funding; a vendor cannot retain ownership of custom-built code (see also 45 CFR 95.617).", "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "medium", "pending": [ "citation paragraph number (the ownership sentence sits between (4) and (6); the numeral was not visible in the read)" ] }, { "id": "cef_06", "cef": "CEF6", "name": "Federal license", "citation": "42 CFR 433.112(b)(6)", "requirement": "The Department has a royalty-free, non-exclusive and irrevocable license to reproduce, publish or otherwise use, and authorize others to use for Federal Government purposes, software, modifications and documentation designed, developed, installed or enhanced with 90 percent FFP.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "Custom-built software and documentation carry a federal government-purpose license; a vendor's commercial terms cannot block it.", "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_07", "cef": "CEF7", "name": "Cost principles", "citation": "42 CFR 433.112(b)(7)", "requirement": "The costs of the system are determined in accordance with 2 CFR parts 200 and 300, subpart E.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_08", "cef": "CEF8", "name": "Period of use", "citation": "42 CFR 433.112(b)(8)", "requirement": "The Medicaid agency agrees in writing to use the system for the period specified in the CMS-approved advance planning document, or a shorter period CMS determines justifies the federal funds invested.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_09", "cef": "CEF9", "name": "Safeguarding information", "citation": "42 CFR 433.112(b)(9)", "requirement": "The agency agrees in writing that the information in the system will be safeguarded in accordance with subpart F of part 431.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "Security and privacy evidence (penetration test results, security and privacy assessment report, POA&M) is reviewed for CEF 9, 12 and 18.", "evidence_reviewed": "Third-party penetration test results, security and privacy assessment report, plan of action and milestones (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_10", "cef": "CEF10", "name": "Modularity", "citation": "42 CFR 433.112(b)(10)", "requirement": "Use a modular, flexible approach to systems development, including open interfaces and exposed application programming interfaces; the separation of business rules from core programming, available in both human and machine readable formats.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "The module must expose open interfaces and APIs and keep business rules separable; CMS expects the state to show the system keeps performing in a plug-and-play manner through vendor turnover.", "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_11", "cef": "CEF11", "name": "MITA maturity", "citation": "42 CFR 433.112(b)(11)", "requirement": "Align to, and advance increasingly in, MITA maturity for business, architecture and data.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "Vendors supply the MITA alignment evidence the state attests to.", "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_12", "cef": "CEF12", "name": "Industry standards", "citation": "42 CFR 433.112(b)(12)", "requirement": "Ensure alignment with, and incorporation of, ONC standards (45 CFR part 170 subpart B), HIPAA privacy, security, breach notification and enforcement regulations (45 CFR parts 160 and 164), HIPAA and ACA section 1104 transaction standards and operating rules, section 508 accessibility standards or standards that provide greater accessibility, federal civil rights laws, and standards adopted under ACA section 1561.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "Section 508 evidence was revised after the April 24 2024 final rule requiring WCAG 2.1 Level AA for state and local government web content and mobile apps.", "evidence_reviewed": "Third-party penetration test results, security and privacy assessment report, plan of action and milestones (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_13", "cef": "CEF13", "name": "Sharing and reuse", "citation": "42 CFR 433.112(b)(13)", "requirement": "Promote sharing and reuse of Medicaid technologies and systems within and among States, building on what other states have already built (the regulation's own wording for this condition is sharing, leveraging and reuse).", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "Reuse terms reach the vendor through the state's procurement; proprietary lock-in works against this condition.", "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_14", "cef": "CEF14", "name": "Business results", "citation": "42 CFR 433.112(b)(14)", "requirement": "Support accurate and timely processing and adjudications or eligibility determinations, and effective communications with providers, beneficiaries and the public.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_15", "cef": "CEF15", "name": "Reporting", "citation": "42 CFR 433.112(b)(15)", "requirement": "Produce transaction data, reports and performance information that would contribute to program evaluation, continuous improvement in business operations, and transparency and accountability.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "States must report system performance to CMS as a condition of enhanced funding; the module must produce the metrics.", "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_16", "cef": "CEF16", "name": "Interoperability", "citation": "42 CFR 433.112(b)(16)", "requirement": "Ensure seamless coordination and integration with the Marketplace and the Federal Data Services Hub, and allow interoperability with health information exchanges, public health agencies, human services programs and community organizations providing outreach and enrollment assistance, as applicable.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_17", "cef": "CEF17", "name": "MAGI functionality (E&E systems)", "citation": "42 CFR 433.112(b)(17)", "requirement": "For E&E systems, the State must have delivered acceptable MAGI-based system functionality, demonstrated by performance testing and results based on critical success factors, with limited mitigations and workarounds.", "applies_to": { "modules": [ "eligibility and enrollment" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "Applies to eligibility and enrollment modules only; CMS states it does not apply to a provider management module.", "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_18", "cef": "CEF18", "name": "Mitigation plan", "citation": "42 CFR 433.112(b)(18)", "requirement": "Submit plans that contain strategies for reducing the operational consequences of failure to meet applicable requirements for all major milestones and functionality.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "Business continuity and disaster recovery must be tested within six months after go-live, with an actual exercise before the certification review.", "evidence_reviewed": "Third-party penetration test results, security and privacy assessment report, plan of action and milestones (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_19", "cef": "CEF19", "name": "Key personnel", "citation": "42 CFR 433.112(b)(19)", "requirement": "In writing through the APD, identify key state personnel by name, type and time commitment assigned to each project.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_20", "cef": "CEF20", "name": "Documentation", "citation": "42 CFR 433.112(b)(20)", "requirement": "Systems and modules developed, installed or improved with 90 percent match must include documentation of components and procedures such that the systems could be operated by a variety of contractors or other users.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "Documentation must let another contractor operate the system; delivery of complete design and operations documentation is a vendor obligation through the state.", "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_21", "cef": "CEF21", "name": "Alternate hardware and operating systems", "citation": "42 CFR 433.112(b)(21)", "requirement": "For software systems developed, installed or improved with 90 percent match, the State must consider strategies to minimize the costs and difficulty of operating the software on alternate hardware or operating systems.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": "Portability is weighed; a platform-locked design needs a state mitigation.", "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "cef_22", "cef": "CEF22", "name": "Other conditions", "citation": "42 CFR 433.112(b)(22)", "requirement": "Other conditions for compliance with existing statutory and regulatory requirements, issued through formal guidance procedures, determined by the Secretary to be necessary to update and ensure proper implementation of those existing requirements.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations (433.116(c) requires (b)(1) through (22) at approval)" ] }, "vendor_obligation": null, "evidence_reviewed": "APD (alternatives analysis and cost benefit analysis), security self-assessment, vendor contracts, system design documents, section 508 test results, T-MSIS concurrence, concept of operations, disaster recovery plans and test report (CMS CEF tips).", "numbering_note": "The CEF number equals the paragraph number of 42 CFR 433.112(b); CMS's site shows CEF10, CEF11, CEF12 and CEF17 matching (b)(10), (b)(11), (b)(12) and (b)(17). The site's full table of short names was not read, so the short names here are MMT's.", "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": "CMS certification site: Conditions for Enhanced Funding (CEFs)", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEFs/", "retrieved": "2026-09-20" }, { "label": "CMS certification site: CEF tips", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Conditions%20for%20Enhanced%20Funding/CEF%20Tips/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "ffp_operations_433_116", "cef": null, "name": "75 percent FFP for operations", "citation": "42 CFR 433.116", "requirement": "FFP at 75 percent of expenditures for operation of a CMS-approved mechanized claims processing and information retrieval system from the first day of the calendar quarter after the system met the conditions of initial approval. Conditions include meeting 433.112(b)(1) through (22) at the time of approval, continuous operation during the period claimed, beneficiary notices within 45 days of payment of claims, fraud-control-unit access to probable fraud information, and the standards in 433.112(b)(10) through (b)(16).", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "75 percent operations" ] }, "vendor_obligation": "Operations contracts inherit the conditions; a module that stops meeting them puts the state's 75 percent match at risk.", "evidence_reviewed": null, "numbering_note": null, "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", "pending": [ "433.116(g) text (not read)" ] }, { "id": "ffp_reduction_433_119", "cef": null, "name": "Reduction to 50 percent on disapproval", "citation": "42 CFR 433.119", "requirement": "If CMS disapproves a system on reapproval review, FFP for system operations is reduced from 75 percent to 50 percent of expenditures beginning with the first day of the first calendar quarter after CMS issues the written notice.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "75 percent operations" ] }, "vendor_obligation": "The financial consequence a state faces when a module falls out of compliance; it shapes how states write performance and remediation terms.", "evidence_reviewed": null, "numbering_note": null, "sources": [ { "label": "eCFR 42 CFR 433.119", "url": "https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-C/section-433.119", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "software_ownership_95_617", "cef": null, "name": "Ownership clause in every procurement instrument", "citation": "45 CFR 95.617", "requirement": "The state must include a clause in all procurement instruments giving the state or local government all ownership rights in software, modifications and associated documentation designed, developed or installed with FFP; HHS reserves a royalty-free, nonexclusive, irrevocable license for federal government purposes. Commercial off-the-shelf software sold at catalog or market prices to the general public is exempt from the ownership provisions, and FFP is not available for proprietary application software developed specifically for public assistance programs.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "all FFP" ] }, "vendor_obligation": "Expect the ownership and license clause in every state MES contract; only true COTS at market price keeps its commercial ownership.", "evidence_reviewed": null, "numbering_note": null, "sources": [ { "label": "eCFR 45 CFR 95.617", "url": "https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-95/subpart-F/subject-group-ECFR8ea7e78ba47a262/section-95.617", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] }, { "id": "smc_process", "cef": null, "name": "Streamlined Modular Certification (SMC)", "citation": "SMD #22-001 (April 14 2022); SHO #25-003 (August 6 2025)", "requirement": "SMC replaced MECT and MEET for MES projects initiated after SMD 22-001. After APD approval the state completes the SMC Intake Form with outcomes and CEFs; CMS evaluates the CEF tab at the Operational Readiness Review before go-live and at the Certification Review six to twelve months after go-live, and may periodically review and reapprove systems for the 75 percent match. SHO 25-003 folded EVV into SMC (ending EVV outcomes-based certification) and standardized the APD, MDBT, ORW, alternatives analysis and project-status templates; the templates received PRA approval December 23 2025 and are required from July 1 2026.", "applies_to": { "modules": [ "all MES modules" ], "procurement_types": [ "all" ], "funding": [ "90 percent DDI", "75 percent operations" ] }, "vendor_obligation": "A vendor's delivery plan has to land the ORR before go-live and produce the metric data the CR needs; CEFs marked not applicable need an attested justification.", "evidence_reviewed": null, "numbering_note": null, "sources": [ { "label": "SMD 22-001", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/smd22001.pdf", "retrieved": "2026-09-20" }, { "label": "SHO 25-003", "url": "https://www.medicaid.gov/federal-policy-guidance/downloads/sho25003.pdf", "retrieved": "2026-09-20" }, { "label": "Medicaid.gov: MES templates", "url": "https://www.medicaid.gov/medicaid/data-systems/streamlining-medicaid-enterprise-systems-templates", "retrieved": "2026-09-20" }, { "label": "CMS certification site: SMC intake form", "url": "https://cmsgov.github.io/CMCS-DSG-DSS-Certification/Intake%20Form/", "retrieved": "2026-09-20" } ], "verified": "2026-09-20", "confidence": "high", "pending": [] } ] }