Medicaid Managed Care: State Medicaid Agency Technical Assistance Request Form
State Medicaid agencies may use this form to request technical assistance with Medicaid managed care design,
implementation, operations, and oversight. State Medicaid agencies should send the completed form via email
to ManagedCareTA@cms.hhs.gov.
For questions about the technical assistance process, please contact
rlester@mathematica-mpr.com.
Please note: This form is for state Medicaid agency TA requests only. We are not able to provide TA to non-state
Medicaid agency requesters.
Name ___________________________________________________________________________________
Title ____________________________________________________________________________________
Agency name _______________________________________________________________________________
State ___________________________________________________________________________________
Phone __________________________________________________________________________________
Email ___________________________________________________________________________________
1. Check one or more boxes below that best describe your TA needs:
Managed Care Program Planning & Procurement
☐ Federal Managed Care Authorities and Waiver
Applications
☐ Rate Setting and Risk Adjustment
☐ MCO Contracting and Purchasing
☐ Stakeholder Engagement
Access, Quality and MCO Financial Monitoring and
Oversight
☐ Developing Standards and Measuring Provider
Network Adequacy
☐ Quality Measurement, Reporting, and Improvement
☐ MCO Financial Oversight
☐ Monitoring and Enforcing MCO Compliance with
Contract Provisions
☐ Ensuring Program Integrity and Preventing Fraud
and Abuse in MCOs
Benefit Design & Specialized Services and Populations
☐ Behavioral Health Services
☐ Behavioral and Physical Health Integration
☐ Dual Eligibles and Managed Care
☐ Managed Long-Term Services and Supports
☐ Other, i.e. dental, transportation, pharmacy
Beneficiary Enrollment, Education, and Rights
☐ Beneficiary Education/Information
☐ Contracting with Enrollment Brokers
☐ Developing and Implementing Auto-
Enrollment/Auto-Assignment Strategies
☐ Managing Grievances and Appeals
Data
☐ Analyzing Data for Performance Measurement
☐ Developing or Implementing Information
Technology and Systems
☐ Encounter Data Collection and Validation
☐ Other
2. Briefly describe the question or problem facing your state and the information or TA needed:
