D-SNP Core System Request for Proposals

Background 

CenCal Health (CCH) is a Non-Profit Community-Based Health Care Organization contracted with the State of California to administer Medi-Cal benefits through local care providers in Santa Barbara and San Luis Obispo counties. We provide health coverage for 1 in 3 people in Santa Barbara County, and 1 in 4 in San Luis Obispo County. We have been in operation since 1983 and are recognized nationally as the oldest Medicaid managed care program of its kind in the country. Our mission is to improve the health and well-being of the communities we serve by providing access to high-quality health services, along with education and outreach, for our members.

Per the planned Medi-Cal coverage expansions, movement of members dually eligible for Medi-Cal and Medicare into managed care, and rapidly shifting local managed care environments highlight an opportunity and responsibility to expand our service role and reach in serving our local communities and ensuring sustainability for the long-term.

As we prepare to deliver a sustainable and integrated Medi-Cal and Medicare program serving dually-eligible members beginning in 2026, we are seeking to partner with a Core Managed Care System Vendor (Core System Vendor) that will support this effort.

Opportunity Description 

CenCal Health is seeking to partner with a Core System Vendor (Vendor) expected to support CenCal Health’s intent to operate a fully integrated, exclusively aligned enrollment dual eligible special needs plan (EAE D-SNP).

CenCal Health seeks a Vendor to provide a high-quality, responsive Core System platform that CenCal Health can utilize to achieve its goal of effectively administering the EAE D-SNP.  CenCal Health currently has approximately 23,000 dual-eligible members within its Medi-Cal line of business.   Our initial enrollment target for 2026 is to capture around 8% of our dual-eligible population (1,664 members) into our D-SNP line of business, with an estimated D-SNP net enrollment growth of approximately 1,800 members per year through 2031 where we are targeting a 50% capture rate of our dual-eligible members into our D-SNP by 2031.  CenCal Health’s current Medi-Cal membership is 241,000. CenCal Health intends to migrate all Medi-Cal membership to the Core System after the D-SNP implementation.

The ideal Vendor will provide or arrange for a suite of innovative Core System capabilities enabling health plan operational functions supported by comprehensive data analytics, informatics and reporting, and interoperable information technology solutions. CenCal Health seeks a Vendor with experience providing a Core System to a Medicare Advantage D-SNP (EAE or FIDE SNP preferred), and Medi-Cal Managed Care Plans (MCPs).

The RFP seeks to understand how the Vendor’s system will support the health plan functions managed by CenCal Health, including integrating seamlessly with other health plan systems. Currently, CenCal Health oversees its Medi-Cal membership using a proprietary Oracle platform, which will eventually transition to a Core System post-2026. During this transition period, it’s crucial for the Core system to maintain compatibility and interface capabilities with the existing Oracle system. Additionally, CenCal Health relies on the MHK CareProminence® platform for Care Management, Utilization Management, and Grievances and Appeals, necessitating seamless data exchange between the Core system and the MHK system.

Click here for the CenCal Health Core Request for Proposal Introduction.

Click here for the CenCal Health Core Request for Proposal.