RFP: Medicaid Enrollment and Renewal Work Requirements Navigation Services

THE CITY OF ST. LOUIS
DEPARTMENT OF HEALTH
REQUEST FOR PROPOSALS
AND
APPLICATION REQUIREMENTS
MEDICAID ENROLLMENT AND RENEWAL
&
WORK REQUIREMENTS NAVIGATION SERVICES
ISSUANCE DATE: June 3, 2026
DUE DATE: June 24, 2026
City St. Louis Department of Health
1200 Market Street, Room 4051
St. Louis, MO 63103
Note: If this RFP was downloaded from the City of St. Louis Website each applicant must provide contact information to the RFP contact person in order to
be notified of any changes in this RFP document.
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TABLE OF CONTENTS
I. Purpose and Intent 3
II. Contact Person & Questions 5
III. Submission 5
IV. Required Qualifications & Certifications 6
V. Method of Compensation 6
VI. Scope of Services 7
VII. Required Application Contents 8
VIII. Program Narrative 9
IX. Application Evaluation & Selection Criteria (Scoring) 10
X. Living Wage 11
XI. Miscellaneous Terms and Conditions Applicable to RFP 12
A. Indemnification 12
B. Amendments 12
C. Right to Withdraw Application 12
D. Contents of Applications 12
E. Respondents Responsibility 12
XII. Insurance Requirements 13
XIII. Service Contract Prevailing Wage 13
XIV. Earnings Tax Requirements 13
XV. Additional Terms to be Required in Subawards 14
A. Recordkeeping & Audits 14
B. Non-Discrimination Policy 14
C. Public Records Law 15
D. Unauthorized Aliens Affidavit 15
E. Indemnification 15
F. Subject to Appropriation of Funds 15
G. Prohibition on Limitation of Liability Clauses 16
H. Termination 16
XVI. Governing Law and Venue 16
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ESTIMATED SCHEDULE (SUBJECT TO CHANGE):
Date Activity/Time
June 3, 2026 Issuance of Request for Proposals
June 16, 2026 Final Submission of Questions to Contact Person
June 24, 2026 Applications Due - No Later than 4:00 pm CDT
August 3, 2026 Selection by Selection Committee
September 1, 2026 Tentative Contract Start Date
August 31, 2027 Tentative 1 year completion of the Project Period, plus four 1-
year renewal options (subject to funding availability)
I. Purpose and Intent
This Request for Proposals ("RFP") is for navigation services to assist Medicaid qualifying residents of
the City of St. Louis with enrollments, annual and semi-annual (every 6 months) renewals, and
verifications by Medicaid Expansion adult persons (ages 19-64, earning 138% or below of Federal Poverty
Level) of 80 hours per month of qualifying activities (e.g. work, education, community service, workforce
training, certain caregivers, and inmates) or exemption because of certain verified disabilities and medical
conditions that prevent compliance -- all as required by the Reconciliation Act of 2025 (a/k/a H.B. #1,
One Big Beautiful Bill) (Public Law 119-21).
The City of St. Louis Department of Health ("DOH") is accepting applications to provide navigation
services to assist Medicaid qualifying residents of the City of St. Louis with enrollments, semi-annual
(every 6 months) renewals, and verifications by Medicaid Expansion adult persons, funded with up to
One Million Two Hundred Thousand ($1,200,000.00) from the Health Care Trust Fund (Fund 1110;
Center 700020).
The City of St. Louis Department of Health is seeking to contract with experienced, reputable, capable
community-based nonprofit organization(s) to support residents with all requirements of the
Reconciliation Act of 2025 (a/k/a H.B. #1, One Big Beautiful Bill) (Public Law 119-21) to provide and
document enrollments, renewals of Medicaid qualifying residents of the City of St. Louis annually and
semi-annually (every 6 months), and verifications by Medicaid Expansion persons (ages 19-64, earning
138% or below of Federal Poverty Level) of 80 hours per month of qualifying activities (e.g. work,
education, community service, workforce training, certain caregivers, and inmates) or exemption because
of certain verified disabilities and medical conditions that prevent compliance.
At the beginning of the 20th Century the City of St. Louis owned a female hospital, insane asylum,
quarantine hospital, and traditional "City Hospital" (which became Max C. Starkloff - City Hospital #1).
From 1919 to 1937 City Hospital #2 was created for treatment of African American patients. On February
22, 1937 a new African American Hospital (Homer G. Phillips - Hospital #2) was opened in The Ville
Neighborhood of North St. Louis. Homer G. Phillips closed on August 17, 1979 among much controversy;
Max C. Starkloff - City Hospital #1 closed in 1985. Collaborating with St. Louis County, the St. Louis
Regional Health Care Corporation was created (Regional Hospital), which also closed in 1997. There was
a transition to a new model of indigent healthcare in 1998, known as ConnectCare, as an urgent care center
and issuer of vouchers for care in private hospitals for primary and specialty care, with funding coming
from the State of Missouri and Disproportionate Share Hospital (DSH) funds. ConnectCare ceased
operations in November 15, 2013. In 2000 the St. Louis Regional Health Commission (RHC) was formed
to help coordinate indigent health care in the City and County. In 2010 in partnership with the State of
Missouri the RHC obtained approval of an 1115 demonstration program called Gateway to Better Health,
approved by CMS on July 28, 2010 to help to pay for outpatient care services for uninsured adults in the
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St. Louis area with Community Health Centers/Federally Qualified Health Centers providing primary care
homes.
City of St. Louis Ordinance 65609 created a health care trust fund in 2002 from use tax funding for "public
health care services within the City of St. Louis". Those funds were used by the City of St. Louis
Department of Health & Hospitals during the existence of the Gateway to Better Health demonstration
program to help fund access to public health services through access to healthcare for the uninsured, prior
to the expansion of Medicaid. Now that expansion coverage is once again potentially threatened by the
bureaucratic hurdles of renewal and verification of work qualifying activities (e.g. work, education,
community service, workforce training, certain caregivers, and inmates) or exemption because of certain
verified disabilities and medical conditions that prevent compliance -- all as required by the Reconciliation
Act of 2025 (a/k/a H.B. #1, One Big Beautiful Bill) (Public Law 119-21).
According to the Missouri Budget Project, an estimated 177,000 eligible Medicaid recipients are
anticipated to lose coverage in Missouri as a result of bureaucratic processes from the One Big Beautiful
Bill renewal and work requirements. According to Dr. Timothy McBride and the Washington
University in St. Louis Center for Advancing Health Services, Policy & Economics Research, current
annual enrollment renewals of Medicaid coverage are resulting in one quarter losing coverage, with 90%
of those losing coverage because of procedural reasons (such as missing or lost paperwork), not because
they are ineligible. Since January 2025 there has been a reduction in children enrolled in Medicaid in
Missouri of over 27,000 (down 4.6%) even though there has been no change in eligibility criteria. It is
believed that this is as a result of disenrollment for procedural reasons. It is anticipated that doubling the
number of times for renewal to twice per year and adding verification of qualifying activities e.g. work,
education, community service, workforce training, certain caregivers, and inmates) or exemption
because of certain verified disabilities and medical conditions that prevent compliance, without
substantial upgrades to computer systems and software as well as expansion of the workforce to process
these enrollments and verifications will only exacerbate the system disfunction that is resulting in loss of
coverage for procedural reasons.
One of the core functions of a public health organization such as the City of St. Louis Department of
Health is to link people to needed personal health services and assure the provision of healthcare when
otherwise unavailable (Equitable Access). The services to be offered under this RFP should be designed
to fulfill this core public health function.
The purpose of this RFP is to promote and ensure the fairest, most efficient means to obtain the benefits
of the most qualified, responsive, and responsible proposal. Hereinafter, organizations interested in
submitting a proposal in response to this RFP shall be referred to as "Respondents."
The City of St. Louis is not obligated to award funds to any provider, nor is the City of St. Louis liable for
any costs incurred by the organizations in the preparation of applications. Nothing in this RFP, nor in any
application in response to this RFP, is intended to be, nor should anything be construed as, an offer of
engagement. Selection of a Respondent shall not be construed as an offer of engagement unless and until
a contract is fully negotiated and fully executed by all parties. The City retains the right to award parts of
the available funds to several Respondents, not to issue any funds, and/or to re-solicit applications.
The City reserves the right to reject any and all applications submitted and to waive any and/or all non-
material irregularities pertaining to the submission of the application. Additionally, any and all projects
elements, requirements and schedules are subject to change and modification. The City also reserves the
right to modify, suspend, or terminate at its sole discretion any and all aspect(s) of the RFP process to
obtain further information from any and all Respondents, and to waive any defects as to form or content
of the RFP or any responses by any Respondents. All submitted materials will become the property of the
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City, may become public documents at any time during the awarding process, and will become public
documents at the conclusion of the awarding process. Any and all documents submitted by Respondents
may become public if and when they are submitted to any advisory or legislative public body, or pursuant
to the Missouri Sunshine Law. By applying to this RFP, each Respondent acknowledges having read this
RFP in its entirety and agrees to all terms and conditions set out herein.
II. Contact Person & Questions
Please direct all communications regarding this RFP with a clearly marked subject heading of "RFP -
MEDICAID RENEWAL AND WORK REQUIREMENTS NAVIGATION SERVICES" to:
Craig Schmid at the following email address: schmidc@stlouis-mo.gov
No contact with other City employees or personnel is permitted.
Questions must be submitted no later than June 16, 2026 unless the Department of Health provides an
addendum to this RFP as part of rolling acceptance of applications to expend all funding. The Department
of Health will maintain a list of all organizations or individuals requesting copies of this RFP and will
ensure that copies of all questions and responses shall be made available in writing to each organization
on such list, when requested. Answers will also be publicly posted at https://www.stlouis-
mo.gov/government/procurement/index.cfm#rfp .
Questions should be asked in consecutive order, from beginning to end, following the organization of
this RFP. Each question should begin by referencing the RFP page number and section number to which
it relates. All contacts and questions must be submitted in writing to the designated contact person by
sending an e-mail to him with a clearly marked subject heading of "RFP - MEDICAID RENEWAL
AND WORK REQUIREMENTS NAVIGATION SERVICES".
Respondents should not otherwise contact the City directly, in person, by telephone, facsimile, or by e-
mail, concerning this RFP.
Contact with the City after the submission of an application is limited to status inquiries only and such
inquiries are to be directed only to the above-named individual by email with a clearly marked subject
heading of "RFP - MEDICAID RENEWAL AND WORK REQUIREMENTS NAVIGATION
SERVICES". Any further unsolicited contact or information about the RFP to the City or any of its
personnel will be considered an impermissible supplementation of the Respondent's application.
III. Submission
Respondents must submit an application via one email to schmidc@stlouis-mo.gov with a clearly marked
subject heading of "RFP - MEDICAID RENEWAL AND WORK REQUIREMENTS
NAVIGATION SERVICES" electronically timestamped no later than 4:00 p.m. (CDT) on June 24,
2026 and only in standard (8 x 11-inch letter sized) in both Microsoft Word and PDF formats. Late or
incomplete proposals will not be accepted. Applicants must adhere to the following:
Must be in the English language.
Page number limits as set forth below in VII. CONTENTS OF PROPOSAL.
Double spaced with one-inch margins.
Use 12-point Times New Roman or Calibri font.
Number each page at the bottom, except for the cover page.
Use 8.5 inch by 11-inch page size that can be photocopied
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Do not assume that the reader knows your organization or program. Issuing a RFP does not obligate the
City of St. Louis Department of Health to award a contract to any provider, nor is the City of St. Louis
Department of Health liable for any costs incurred by the organizations in the preparation of proposals.
The City of St. Louis Department of Health retains the right to award parts of the contract to several
bidders, not to select any bidders, and/or to re-solicit proposals.
IV. Required Qualifications & Certifications
Respondent must demonstrate:
1) The organization has at least five (5) years of experience in successfully working with
City of St. Louis residents to provide legal services and/or access to healthcare services
that includes enrolling them in Medicaid.
2) The organization has a demonstrated history of documenting its services for persons
at or below 200% of Federal Poverty level.
3) The organization has all insurance coverages, permits, licenses and professional
credentials necessary to perform the services specified in this RFP.
V. Method of Compensation
Any agreement entered into pursuant to this RFP will provide compensation on a reimbursement basis,
based on documentation of navigation services to assist Medicaid qualifying residents of the City of St.
Louis with semi-annual (every 6 months) renewals and verifications by Medicaid Expansion persons
(ages 19-64, earning 138% or below of Federal Poverty Level) of 80 hours per month of qualifying
activities (e.g. work, education, community service, workforce training, certain caregivers, and inmates)
or exemption because of certain verified disabilities and medical conditions that prevent compliance --
all as required by the Reconciliation Act of 2025 (a/k/a H.B. #1, One Big Beautiful Bill) (Public Law
119-21).
Respondents are encouraged to propose a flat rate for each documented eligible Medicaid enrollment,
each documented eligible Medicaid renewal, and each documented eligible verification of qualifying
activities.
Any contracts will be funded by the Health Care Trust Fund (Fund 1110; Center 700020).
The approximate award ceiling during the project period (estimated September 1, 2026 through August
31, 2027) is up to One Million Two Hundred Thousand Dollars ($1,200,000.00). At the City's sole
discretion, this Agreement may be extended for four (4) additional one-year renewal periods. All such
renewals must be executed in writing and are subject to the appropriation and availability of funds.
During the course of any contract, monthly payments will be made to the Selected Respondents upon
receipt and approval of proper invoicing, deliverables, documentation, and reporting.
1. Invoices and Detailed Transaction Reports for payment shall be submitted to DOH, and payment
shall be conditioned upon receipt of appropriate, accurate, and acceptable invoices submitted in a
timely manner within 15 days following the end of the month in which services were rendered with
supporting documentation as required by DOH, including, but not limited to:
1.1. A report on an Excel Spreadsheet (or other equally flexible format) so that protected health
information and personally identifiable information of Recipient Beneficiaries served by this
funding can be hidden and protected in columns, containing as a minimum:
Names of Recipient Beneficiaries;
Full mailing address of Recipient Beneficiaries, including zip code and apartment
number, where applicable;
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Numbers of persons in the household of Recipient Beneficiaries;
Last 4 digits of Social Security Number of Recipient Beneficiaries;
Level of income;
Total amount of assets;
Any Equity in Home
1.2. Receipts and invoices for all eligible expenses, including as listed in Contractor's
Approved Budget
1.3. Timesheets, time documentation, payroll register documentation support showing hours
worked/paid performing service within the contract scope of work being invoiced and
descriptions of which services within the contract scope of work were provided during those
hours.
1.4. Proof of enrollment and/or renewal in Medicaid and/or Medicaid Adult Expansion
Verification of qualifying activities (e.g. work, education, community service, workforce
training, certain caregivers, and inmates) or exemption because of certain verified disabilities
and medical conditions that prevent compliance.
VI. Scope of Services
DOH asks that applications take into consideration the communities most at risk and/or impacted when
applying.
Respondent in their Project application must clearly demonstrate:
1) how they will assure that they have policies and processes in place to confirm the eligibility
of City of St. Louis Resident Recipient Beneficiaries for Medicaid enrollment and renewal
and as meeting verification requirements for qualifying activities (e.g. work, education,
community service, workforce training, certain caregivers, and inmates) or exemption
because of certain verified disabilities and medical conditions that prevent compliance.
2) how they will assure they can document the enrollment or renewal of City of St. Louis
Resident Recipient Beneficiaries for Medicaid and/or meet verification requirements for
qualifying activities.
3) how they will assure they can report monthly on an Excel Spreadsheet (or other equally
flexible format) so that protected health information and personally identifiable
information of Recipient Beneficiaries served by this funding can be hidden and protected
in columns, containing as a minimum:
a) Names of Recipient Beneficiaries;
b) Full mailing address of Recipient Beneficiaries, including zip code and apartment
number, where applicable;
c) Numbers of persons in the household of Recipient Beneficiaries;
d) Last 4 digits of Social Security Number of Recipient Beneficiaries;
e) Level of income;
f) Total amount of assets;
g) Any Equity in Home
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4) how many eligible City of St. Louis Resident Recipient Beneficiaries for Medicaid they
will enroll; how many they will renew; and how many for whom they will complete
meeting verification requirements for qualifying activities (e.g. work, education,
community service, workforce training, certain caregivers, and inmates).
5) how they will engage with community to recruit potential City of St. Louis Recipient
Beneficiaries who may be eligible for Medicaid enrollment, renewal and/or may need to
meet verification requirements for qualifying activities.
6) how they will assure they have fiscal procedures in place for:
a) separation of duties; and
b) avoiding supplanting funds from other funding sources and duplication of
payments.
7) how the project will fulfill the scope of work priorities, described in this Scope of
Services.
VII. Required Application Contents
A. Cover Sheet: Complete and attach the Cover Sheet, attached as Appendix 1.
B. Transmittal Letter/Abstract: Respondents shall provide a transmittal letter/abstract
providing the name and a brief description of the organization. The letter must briefly
summarize the Respondent's ability and willingness to perform the services sought under
this RFP. (1-page limit)
C. Organization Information, Background, and Capability: Provide a thorough
description of the organization, its contact information, and its qualifications for the
requested services. Describe the organization's strengths, capabilities and experience in
performing these services. See Sections IV. and VI. (3-page limit, part of the Narrative
15-page limit)
D. Program Narrative - Response to Section VIII: In this section, Applicants must
respond to all criteria listed and provide the required attachments. The narrative must not
exceed 15 pages in total length. The required attachments do not count toward your 15-
page limit.
E. Project Team: Provide the name, title, telephone number and e-mail address of the
persons who will function as the Project Team involved in this project and whether they
will be paid staff or volunteers. (4-page limit; part of the 15-page Narrative limit). Attach
resumes (not part of Narrative 15-page limit, but need to be no more than 4 pages double-
spaced or 2 pages single-spaced)
F. Addressing Services: Provide a description of how the organization intends to
perform the specific services requested above, including a thorough description of the
proposed approach to the project and how Respondent will achieve the VI. Scope of
Services. (part of Narrative 15-page limit)
G. Budget: Include details regarding the proposed costs for the services listed in the
Scopes of Services. Respondents must submit a detailed project budget. (part of Narrative
15-page limit)
H. Proof of Non-Profit Status: Please provide proof of registration with the Missouri
Secretary of State as a non-profit organization.
I. Verification of License/Taxes: In this section, Respondents must affirmatively
verify that the organization has a current business license and is current with tax
remittance. Respondents must provide a copy of its current City of St. Louis business
license (or waiver letter from License Collector).
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J. Living Wage Acknowledgment and Acceptance Declaration. Respondents shall
submit with their application the Living Wage Acknowledgment and Acceptance
Declaration, attached as Appendix 3. See Section X.
VIII. Program Narrative
In no more than 15 pages, excluding attachments noted below, respond to the below criteria to describe
your organization's qualifications and proposed programming. You will be scored and evaluated on the
following criteria outlined below:
1. Organizational Description (30 points)
Description of the organization and how it meets the requirements listed in Section IV above.
2. Project Team (10 points)
List of Project Team members with:
i. Name(s) of the person(s) project team staff, whether paid or volunteer, and key
responsibilities;
ii. brief description of each person's qualifications and experience;
iii. description of the role for each project team member; state the background of each team
member, years of experience, length of employment with your organization, and experience
providing the deliverables as described herein;
iv. list of relevant and successfully completed projects by these team members;
v. organizational chart for the proposed project team, identifying each of the staff, and all
roles and areas of responsibility.
vi. list any subcontractors and the information listed above in 2.i.-v. (subcontractors are
required to comply with all provisions of a successful Respondent's contract).
3. Project Implementation Plan (50 points)
Comprehensive project implementation plan, inclusive of the staffing plan and operations plan, with a
detailed description of activities and services to be provided, and deliverables to be met. Provide a
description of how the organization intends to perform the specific services requested above in VI.
SCOPE OF SERVICES, including a thorough description of the proposed approach to the project.
4. Budget (10 points)
Budget for the proposed project. The costs associated with the proposed project should directly
reflect the action steps necessary to implement the activities and deliverables. The costs should not
reflect any intended activity not specifically indicated in the proposed implementation plan. Any In-
Kind Services and their association with the proposed project should be listed and justified. Does the
budget justification provide a basis for the level of service proposed? A budget proposed for the
services in this RFP must include explanations for the following line items (if applicable)
a. All personnel whose salaries will be paid in whole or in part with this RFP funding
opportunity;
b. Utility Vendor Payments
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IX. Application Evaluation & Selection Criteria (Scoring)
Evaluation
The evaluation of qualifications will be performed by an Evaluation Committee. The Evaluation
Committee will consider, at a minimum, the following, as related to the selection of organizations
qualified to perform the services requested above:
A. Specialized experience, qualifications and technical competence of the
organization, its principals, project manager and key staff;
B. Ability of the organization to provide innovative solutions.
C. Approach to the project and any unusual problems anticipated.
D. The capacity and capability of the organization to perform the work within the
time limitations.
E. Past record and performance of the organization with respect to schedule
compliance, cost control, and quality of work.
F. Proximity of the organization to the City.
G. Fees or fee structure as may be appropriate for the service to be provided.
H. Availability of financial and operating resources as required to complete the work;
I. Ability of the organization to meet statutory or ordinance requirements.
J. Other relevant criteria as may be developed by the Department of Health or the
Selection Committee with regards to future proposal requirements. One such relevant,
though not determinative, consideration will be the organization's commitment to the City
of St. Louis.
The Department of Health reserves the right to interview, or call for a presentation from, any Respondent
submitting a response. The Department of Health also reserves the right to discuss the proposals with any
or all Respondents. The Department of Health may request additional submission of information during
the negotiations of the contract.
Scoring
In evaluating applications, the Evaluation Committee will consider the non-exhaustive list of factors
above. To aid in selection, all applications will undergo the following evaluation process. An assessment
by an evaluation review committee will evaluate the proposal using the below point scores. The total
points possible are 100. Interviews of proposed finalists may occur at the discretion of DOH. Upon
recommendation of the Selection Committee, DOH reserves the right to interview one or more
organizations submitting proposals, request additional information as DOH may deem necessary, and/or
reject any or all proposals with or without cause.
Organization Description 30 Points
Project Team 10 Points
Project Implementation Plan 50 Points
Budget 10 Points
Total 100 Points
DOH will consider funding awards only to those applicants determined to be qualified following review
of the eligibility and completeness of each application received. DOH reserves the right to award less
than the intended amount for this funding round if a sufficient number of qualified applicants cannot be
identified.
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