In Response to the COVID-19 Pandemic Med-QUEST to Issue New Request for Proposal for Managed Care Organizations

Posted on May 29, 2020

DEPARTMENT OF HUMAN SERVICES

Information Bulletin
May 29, 2020

In Response to the COVID-19 Pandemic Med-QUEST to Issue New Request for Proposal for Managed Care Organizations

Honolulu, HI — The State of Hawai’i Department of Human Services announced today that in response to the COVID-19 pandemic, Med-QUEST is rescinding the contract awards made to managed care organizations in January, canceling the request for proposal (RFP) released August 2019, and will be issuing a new RFP this fall to address the evolving needs of the community amid this public health crisis.

“The needs of our community have dramatically changed just within the past few months,” said Judy Mohr Peterson, administrator of the Department of Human Service’s Med-QUEST Division. “The impact of the coronavirus caused us to take a new look at how to address the emerging needs of our growing Medicaid population and modify the requirements of the RFP to reflect this new reality we are all facing.  We are grateful to the health plans who submitted proposals in 2019 and look forward to receiving new proposals that respond to this new environment.”

Since March 4, 2020, Med-QUEST enrolled over 24,000 additional beneficiaries, an increase of over 7.5 percent in total enrollment in less than three full months. The number of new applicants is expected to climb even higher as Hawaii responds to one of the highest unemployment rates in the nation. The resulting Medicaid enrollment numbers are likely to remain high until Hawai’i’s economic recovery begins and there is a return to pre-pandemic employment levels.

Based on the RFP issued back in August 2019, Med-QUEST announced in late January that it had awarded contracts to four health plans: Hawaii Medical Services Association and UnitedHealthcare Community Plan to serve Medicaid beneficiaries on all the islands, and to AlohaCare and ‘Ohana Health Plan to serve Medicaid beneficiaries on O‘ahu.

Those contracts were scheduled to go into effect on July 1, 2020. However, Med-QUEST previously announced postponement of the effective contract date to devote internal resources to respond to the COVID-19 pandemic and to avoid placing any added stress and confusion on the part of beneficiaries during a challenging time.

“We determined we needed to go one step further and review the RFP requirements in light of the critical needs of the community,” said Mohr Peterson.

Existing contracts with all health plans shall be extended until the new contract awards are made. The new RFP, which will be issued this fall will be designed to meet the changing and pressing needs of the community and will be issued publicly.

“Innovative approaches will be key to strengthening our resiliency as a state and serving our communities’ health needs, especially in the new landscape that has resulted from this global pandemic,” Mohr Peterson said. “Now, more than ever, we must think creatively and collaboratively to transform our health care delivery system so that we are able to provide quality care and improved outcomes for the benefit of Hawai’i nei.”

About Med-QUEST
Our mission is to empower Hawai'i’s residents to improve and sustain wellbeing by developing, promoting and administering innovative and high-quality healthcare programs with aloha.  The State of Hawai‘i Med-QUEST Division provides eligible low-income adults and children access to health and medical coverage through managed care plans.  The QUEST program is designed to provide Quality care, Universal access, Efficient utilization, Stabilizing costs, and to Transform the way health care is provided to recipients.

If you have any questions please send an email to dhs@dhs.hawaii.gov

The Med-QUEST Division touches the lives of hundreds of thousands of lives in Hawai‘i. We are committed to providing straightforward answers and strive to demonstrate transparency as a public agency. Med-QUEST recently announced we have rescinded the awards to managed care organizations, canceling the Request for Proposals (RFP) and will be reissuing a new RFP. We recognize this is a major development and would like to offer the following responses to questions you may have about this announcement.

1.      Why are you rescinding the awards and canceling the Request for Proposals (RFP) that Med-QUEST issued in August 2019?
In late January, Med-QUEST awarded contracts to four health plans: Hawaii Medical Services Association (HMSA) and UnitedHealthcare Community Plan to serve Medicaid beneficiaries on all the islands, and to AlohaCare and ‘Ohana Health Plan to serve Medicaid beneficiaries on O‘ahu. However, COVID 19 has upended our community and, within a relatively short time, has introduced new challenges in the delivery of health care to our communities. We had to take decisive action to address these new challenges.

No one could have predicted the extraordinary impact of the pandemic. The original RFP simply did not take into account the realities of COVID 19. In response to the pandemic, Med-QUEST decided to rescind the awards made to the managed care organizations, cancel the request for proposal (RFP) released August 2019, and issue a new RFP in the fall to address the evolving needs of the community.

It is important to point out the decision to rescind awards and cancel the RFP was not made lightly. The Med-QUEST Division team and the health plans who submitted proposals worked very hard to address plans for the future we anticipated.

2.      What kinds of changes have you been seeing in the community?
Since March 4, 2020, Med-QUEST enrolled over 24,000 additional beneficiaries, an increase of over 7.5 percent in total enrollment in less than three full months. The number of new applicants is expected to climb even higher as Hawaii responds to one of the highest unemployment rates in the nation. We currently serve nearly 350,000 beneficiaries. The resulting Medicaid enrollment numbers are likely to remain high until Hawai’i’s economic recovery begins and there is a return to pre-pandemic employment levels.

3.      Is this a new development or something that Med-QUEST has been considering for some time?
We have been paying close attention to the community and listening to their feedback since the start of the pandemic. Providers have shared they are struggling with maintaining their practices where people are reluctant to access care, and telehealth is still so new and not yet part of routine practices.

As a result, in late March, Med-QUEST announced that we were postponing the July 1, 2020 start date of the new contracts to ensure beneficiaries could continue to access care through their current health plan and Med-QUEST could devote internal resources to respond to the pandemic.

In light of the critical needs of the community, we determined the need to go one step further and review the RFP requirements. Our decision to rescind the awards and cancel the RFP altogether was based on our ongoing assessment, and was made with the best interests of Medicaid beneficiaries, providers, and health plans in mind.

4.      Does this mean Med-QUEST will be starting the Request for Proposals (RFP) process all over again?
No, much of the foundational work that was part of the RFP that was released in August 2019 will still be important in a new RFP, but the priorities may change. We will still place a strong focus on healthcare transformation and achieving better health outcomes for beneficiaries. We’ll continue to place a greater emphasis on primary care; improving outcomes for high-need, high-cost Medicaid beneficiaries; integrating behavioral health care; addressing the social factors that influence health; and aligning payment reform and financial incentives.

The new environment requires more collaboration to address the challenges in the new landscape. This process will ensure the resulting RFP will address the extraordinary changes brought about by COVID 19. Healthcare transformation is more important than ever. Incorporating innovative ideas will strengthen our resiliency as a state and improve the health of our communities in the face of these significant, new challenges for providers and members.

5.      When will Med-QUEST have the RFP ready?
The new RFP is targeted for release in the fall of 2020.
 

6.      Will Med-QUEST limit the number of health plans for the neighbor islands as in the last contract?
It is too early to answer this question. Before issuing the RFP, we will first develop and issue a Request for Information (RFI), as we have done previously. This is a critical first step to engage with all those who are interested in bidding for the managed care contracts. This provides an equitable approach and enhances transparency in the procurement process.
 

7.      What do these changes mean for Medicaid beneficiaries and health plans?
Existing contracts with all of the health plans will be extended until the new contract awards are made. For you and your family, this means that you will be able to continue with your current health plan through the end of this calendar year. You do not take any action now.

Earlier, some beneficiaries contacted Med-QUEST to express concern about having to change their health plan before July 1, 2020. We would like to reassure you that you do not have to make any changes in your health plan now. You can continue to receive the care you need without any interruption in services.

However, our Annual Plan Change period will still be held in October 2020, as scheduled. During that month, you will have the option of changing to another health plan or remaining with your current one. Your health plan choice will begin on January 1, 2021. Watch for more information on the Annual Plan Change in the near future.

Modified on May 29, 2020
Scroll to top