We are submitting this response as practitioners with experience inside Medicaid Enterprise System modernization from three vantage points: as delivery practitioners on MES implementations, as strategy consultants who have developed MES modernization strategies with state Medicaid agencies, and as business strategy and Medicaid domain advisors embedded within state Medicaid agencies, working daily alongside state program staff, state IT, counties, and vendors on the practical mechanics of modernization.
That combination shapes this response. We have delivered requirements documents, provided go-live implementation support, written the APDs, sat in the certification reviews, watched procurements succeed and fail, and helped states diagnose why decades of technology investment have not produced the outcomes those investments promised. Most of what we have learned is published: strategy documents, video series, procurement templates, and working examples are linked throughout this response so CMS can evaluate the reasoning behind each recommendation.
This response is organized as a set of Start, Stop, and Continue recommendations rather than question-by-question answers, because the recommendations are interdependent and the format makes the underlying theory of change visible. Each recommendation lists the RFI questions it addresses, and Appendix A provides a question-to-recommendation cross-reference for readers processing responses by question label. Questions outside our direct experience are marked as no response.