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: