New Mexico closes Medicaid actuarial-support solicitation and enters evaluation
New Mexico Health Care Authority RFP 27-630-8000-0009 seeks one or more independent contractors for Medicaid actuarial, rate-setting and financial consulting services, including managed-care capitation rates, risk adjustment, financial reconciliation and Section 1115 modeling. Proposals were due October 12, 2026 (past). The solicitation marks finalist selection on October 19, oral presentations on October 22, contract award on November 10 and protest deadline on November 25 as estimated dates. Amendment 1 says the procurement may produce one, multiple or no awards and adds conflict-of-interest restrictions involving New Mexico Medicaid managed-care organizations.
Precapture analysis
This is an oversight and rate-setting support procurement, not a health-plan award. The selected adviser or advisers will influence the analytic framework used for Turquoise Care rates, risk adjustment, financial oversight and future managed-care procurement support, making the official award and any protest the next material watch points.
Parent, plan, and program come from the plan graph. Enrollment and share use the latest CMS reported count. Operations counts are CMS MCPAR. A dollar amount is not on this page.
Innovage Greater New Mexico PACE dba Total Community Care
not reported
787 (2016)
100.0% calculated
not reported
not reported
Innovage New Mexico PACE dba Total Community Care
not reported
800 (2018)
100.0% calculated
not reported
not reported
Molina Healthcare of New Mexico Inc
not reported
232,702 (2016)
34.0% calculated
not reported
not reported
Presbyterian Health Plan
not reported
225,115 (2016)
32.9% calculated
not reported
not reported
UnitedHealthcare Community Plan
not reported
88,270 (2016)
12.9% calculated
not reported
CMS reported enrollment
CMS reporting years in this file run from 2016 through 2024. Retrieved 2026-11-01. The latest reporting year is 2024, which is behind the retrieval date. Enrollment figures are the CMS cell for that reporting year. Share is calculated from CMS reported total enrollment for that state, program, and year. Precapture does not combine rows. A year missing from a trend was not reported. A plan and region with more than one CMS row in a year has no trend and no year-over-year change. The dataset says a reported 0 may not truly represent 0 when a state suppressed a small count. CMS reported.
Counts, rates, dates, and status are the CMS MCPAR cells for that plan, program, and reporting year. The appeal rate is calculated from CMS reported appeals resolved in favor of the enrollee divided by CMS reported appeals resolved. It is not a CMS-published rate. A plan links when the name matches one enrollment plan in that same state and program. Unmatched is shown and is not guessed. A sanction amount is not on this page. Retrieved 2026-11-02. CMS MCPAR.
Appeals, grievances, and enrollment share (2024) 7
Plan
Parent
Program
Appeals resolved
In favor of enrollee
Appeal rate
Grievances resolved
Medicaid enrollment share
Managed care enrollment share
Blue Cross Blue Shield
Health Care Service Corporation
Centennial Care 2.0
2,059
1,115
54.2% calculated
2,447
29.9%
36.4%
Presbyterian Health Plan
Presbyterian Health Plan
Centennial Care 2.0
3,145
849
27.0% calculated
1,584
42.7%
51.9%
Western Sky Community Care
Centene
Centennial Care 2.0
270
122
45.2% calculated
302
9.7%
11.8%
Blue Cross Blue Shield
Health Care Service Corporation
Turquoise Care
not reported
not reported
not reported
not reported
30.5%
37.5%
Molina Healthcare
Molina
Turquoise Care
not reported
not reported
not reported
not reported
4.6%
5.8%
show all 7
Plan
Parent
Program
Appeals resolved
In favor of enrollee
Appeal rate
Grievances resolved
Medicaid enrollment share
Managed care enrollment share
Presbyterian Health Plan
Presbyterian Health Plan
Turquoise Care
not reported
not reported
not reported
not reported
41.6%
51.1%
UnitedHealthcare
UnitedHealth
Turquoise Care
not reported
not reported
not reported
not reported
4.5%
5.6%
Sanctions (2024)
Sanctions (2024) 7
Plan
Parent
Topic
Date
Corrective action plan
Remediation status
Blue Cross Blue Shield
Health Care Service Corporation
Performance improvement (N/A)
2025-01-20
No
No, no remediation
Presbyterian Health Plan
Presbyterian Health Plan
Performance improvement
2024-11-04
No
No, no remediation
Western Sky Community Care
Centene
Reporting
2024-11-06
No
Yes, remediated
Western Sky Community Care
Centene
Performance improvement
2024-10-07
No
No, no remediation
Blue Cross Blue Shield
Health Care Service Corporation
Performance improvement
2025-01-20
Yes
No, no remediation
show all 7
Plan
Parent
Topic
Date
Corrective action plan
Remediation status
Presbyterian Health Plan
Presbyterian Health Plan
Performance improvement
2024-12-16
Yes
No, no remediation
Presbyterian Health Plan
Presbyterian Health Plan
Performance improvement
2024-11-04
No
No, no remediation
Award history
Turquoise Care 23-630-8000-0001: awarded. The August 11, 2023 HSD announcement says the department intends to award Turquoise Care contracts to BlueCross BlueShield, Presbyterian Health Plan, United Health Plan, and Molina Health Plan, with a start date of July 1, 2024, and that it does not intend to negotiate with Western Sky Community Care. The announcement also says HSD rescinded a January 30, 2023 cancellation of the Turquoise Care RFP. The transition agreement says HSD issued the RFP on September 30, 2022. The RFP number is printed across a line break as 23-630- and 8000-0001. The agreement says HSD has entered into contracts with Blue Cross and Blue Shield of New Mexico, Presbyterian Health Plan, Inc., UnitedHealthcare Insurance Company, and Molina Healthcare of New Mexico, operational July 1, 2024. Scores and a contract end date are not in those documents.
No official early-procurement document has been retrieved for this state. This is not a finding that no signal exists. Early signals
Contract amendments
No official Medicaid managed-care contract amendment has been retrieved for this state. This is not a finding that no amendment exists. Contract amendments
Medicaid policy
Indiana rows are official policy instruments. Other states show only Federal Register notices of hearings on SPA disapprovals, which are a narrow slice and not waiver or SPA coverage.
Federal Register notices of hearings on SPA disapprovals are read from the Federal Register JSON API. That covers no approved SPAs, waivers, or section 1115 demonstrations.
Coverage not_collected.
No official Medicaid managed-care policy instrument has been retrieved for this state. This is not a finding that no waiver, state plan amendment, or rule exists. Medicaid policy
Federal Register SPA disapproval hearing notices (2015 or later): 0
Plan financials
No official Medicaid plan financial filing has been retrieved for this state. This is not a finding that no filing exists, and it is not a zero. Plan financials. Coverage: not_collected.
