Most states send out RFPs that Medicaid MCOs must complete to win Medicaid bids. Winning or losing a bid determines if plans get to operate a Medicaid business in that state until the next bid, usually in three to five years. Not all plans have the same level of risk going into bids. National plans, or plans in multiple lines of business, are insulated (to a degree) if they lose a bid, while smaller Medicaid plans may need to win their bid to maintain operational status.