The Centers for Medicare & Medicaid Services (CMS) is committed to modernizing the Medicaid Enterprise Systems (MES) to improve interoperability, promote modularity, and drive better health outcomes for Medicaid beneficiaries. This commitment involves a strategic shift towards standards-based, modular solutions and cloud-based technologies, moving away from monolithic systems. These forthcoming IT standards are part of a larger initiative to shape and evolve a reusable and modern Medicaid technology ecosystem. This evolution is guided by federal regulations, including those at 42 CFR Part 433 and Part 95, which govern Medicaid cost allocation and system requirements.
As part of this effort, CMS is launching a new MES IT Standards initiative to establish clear, outcome-driven technical standards for data exchange, system integration, and technical architecture. The program aims to align state-level MES implementations with modern technology paradigms and commercial best practices. In accordance with the first part of CMS’ five phase approach, CMS is releasing a Request for Information (RFI) designed to gather insights that will shape the initiative's foundation and ensure that the forthcoming standards are realistic, effective, and respectful of the federal-state partnership.
This initiative is not a one-time effort but an ongoing and evolving commitment, one that CMS will continually refine based on experience and stakeholder input, to provide states and vendors with clear expectations and direction, holding them accountable for delivering and continuously improving modern, streamlined systems that achieve real-time data exchange, reduced silos, improved resource efficiency, and stronger capacity to implement critical policy changes, ultimately improving the Medicaid beneficiary experience and access to care.
CMS seeks feedback from all MES stakeholders to inform the development and implementation of the MES IT Standards Program. We invite input from State Medicaid Agencies, MES technology vendors, systems integrators, Standards Development Organizations (SDOs), healthcare providers, and other industry experts. The goal of this RFI is to gather specific, actionable information to ensure the program effectively addresses the most significant barriers to MES transformation. We seek to understand which elements of the current ecosystem are working well, which require improvement, and how CMS can best support states and vendors in transitioning to a more standardized, interoperable, and cost-effective future.
