Third Party Administrator (TPA) to bill State Medicaid for Correctional Healthcare Services

The Solano County Sheriff’s Office (SCSO) is initiating a Request for Qualifications (RFQ) to identify and contract with a third-part administrator (TPA) of billing services who, on behalf of SCSO, will bill California’s Department of Health Care Services (DHCS) for specific healthcare services provided to inmates participating in the CalAIM JI Reentry Initiative. SCSO seeks a TPA capable of delivering the scope of services summarized in the RFQ.

The RFQ will be distributed to potential partners in February 2025. SCSO will invite 2-3 respondents to participate in interviews and provide demonstrations of their capabilities during the latter half of March 2025 or early April 2025. Based on RFQ responses, interviews, and demonstrations, SCSO will chose a vendor and begin contracting with the vendor by the end of April 2025 with the expectation that a contract will be finalized by the end of June 2025. The chosen vendor is expected to begin engaging in planning and preparation activities in July 2025 to support SCSO’s Justice-Involved Reentry Initiative targeted launch date of September 29, 2026.

The Medi-Cal Transformation (CalAIM) Justice-Involved Reentry Initiative allows eligible Californians who are incarcerated to enroll in Medi-Cal and receive a targeted set of services in the 90 days prior to their release. This initiative aims to ensure continuity of health care coverage and services between the time individuals are incarcerated and when they are released. It also provides these individuals reentering the community with the prescribed medications and durable medical equipment (DME) they need, as well as access to programs and services to support this critical transition. Participating correctional facilities and partners providing the targeted set of services related to this initiative may bill DHCS on a fee-for-service (FFS) basis for reimbursement, and their healthcare partners providing the targeted set of services related to this initiative may bill DHCS on a fee-for-service (FFS) basis for reimbursement.

The SCSO is actively participating in this initiative and expects to go-live September 29, 2026. California’s Department of Health Care Services (DHCS) requires all correctional facilities to complete a readiness assessment six (6) months prior to their respective targeted go-live dates. Like most correctional facilities in California and across the country, the SCSO doesn’t submit claims to obtain reimbursement for healthcare services Therefore, the SCSO seeks to partner with a third-party administrator (TPA) versed in billing a State Medicaid Agency for specific healthcare services provided to inmates 90 days prior to release from jail.