State of Hawaii Department of Human Services

Buyer seeks an organization to provide Medicaid Ombudsman services to eligible Medicaid beneficiaries and participating providers. The Ombudsman will assist beneficiaries with issues related to access to care, quality of care, and limitations to care. Services include providing information, navigating the grievance system, and resolving concerns between beneficiaries/providers and health plans. The Ombudsman must maintain independence from health plans and operate a Hawaii-based call center with website support.

• 4/11/2025 - Orientation Conference
• 4/21/2025 - Written Questions Due
• 5/2/2025 - Notice of Intent to Propose
• 5/9/2025 - Proposal Due Date
• 5/23/2025 - Contract Award
• 7/1/2025 - Contract Effective Date

• Must not be affiliated with QI health plans or FFS contractors
• Must be capable of statewide service delivery
• Must meet Hawaii compliance requirements
• Must maintain liability insurance requirements

• Provide call center services for Medicaid beneficiaries and providers
• Assist with resolving access to care, quality of care issues
• Help navigate through grievance and appeal systems
• Develop working relationships with health plans to resolve issues
• Create website with resources and direct communication function
• Submit regular reports on beneficiary and provider concerns
• Track language needs and specific call information
• Educate beneficiaries about managed care system navigation
• Conduct follow-up within two weeks of initial contact
• Operate independently from QI health plans