State Medicaid agencies are under intense pressure: modernizing aging systems, meeting stricter Centers for Medicare & Medicaid Services (CMS) expectations, and delivering measurable outcomes—all while managing multiple initiatives at once. Many are discovering that success isn’t just about the systems they build, but how they organize the enterprise support behind them.

PCG’s new brief, Using Standalone Support Services APDs to Advance MITA-Aligned Medicaid Enterprise Modernization, explores how a growing number of states are turning to Standalone Support Services Advance Planning Documents (APDs) as a strategic lever for Medicaid modernization funding, governance, and execution.

From Project-Centric to Enterprise-Centric Support

Historically, Medicaid IT funding was tightly tied to single, large projects. Each project carried its own overhead: project management office (PMO), quality assurance (QA), procurement support, and Medicaid Information Technology Architecture (MITA) alignment efforts.

Rather than embedding these supports into each project APD, centralizing these functions in one enterprise APD treats them as shared services necessary to design, implement, and certify Medicaid Enterprise Systems (MES). This structure can simplify cost and create a clear “line of sight” between shared services and the outcomes, metrics, and Conditions for Enhanced Funding (CEF) that CMS expects to see evidenced through the APD and certification lifecycle.

Standalone Support Services APDs help states shift their focus from individual applications to enterprise business capabilities by enabling them to define, track, and manage outcomes and performance metrics across the Medicaid portfolio. By supporting enterprise reuse and interoperability, these APDs create the structure needed for consistent, scalable modernization. They also play a critical role in enabling core MITA-aligned activities, including State Self-Assessments (SS-A), business process and gap analysis, and enterprise architecture planning.

One of the most compelling advantages of this model is financial. When structured correctly, Support Services APDs can qualify for:

• 90/10 federal match for design, development, and implementation (DDI)
• 75/25 match for maintenance and operations (M&O) of certified systems

“One of our most important roles as consultants is sharing lessons learned between states, to help them get to success faster and less painfully,” said Nicole Alonzo, author of the brief. “Navigating project funding and federal oversight is a critical success factor for our clients, so I’m excited to share some insights on how to leverage federal funding to ensure more consistent, value-added project support for Medicaid agencies.”

Modernizing Medicaid systems isn’t just about building better technology, it’s about building enterprise capabilities that make modernization sustainable over time. Standalone Support Services APDs provide a clear path to do both by centralizing critical support functions, aligning modernization efforts with CMS expectations, unlocking enhanced federal funding, and ultimately accelerating delivery across the entire Medicaid portfolio.

State Spotlight: California’s Enterprise Approach

California’s Department of Health Care Services (DHCS) provides a leading example of this model in action. Through a dedicated Support Services APD, the state funds an MITA-aligned Enterprise PMO (EPMO) that supports governance, APD development, certification coordination, and portfolio management across dozens of initiatives.

By centralizing these capabilities, California has created a clear line of sight between enterprise services and program outcomes, strengthening both CMS engagement and the state’s ability to scale modernization consistently.

Learn more:

• Read Using Standalone Support Services APDs to Advance MITA-Aligned Medicaid Enterprise Modernization
• PCG’s Technology Solutions

About the Author

Nicole Alonzo, Director—Technology Consulting

Nicole Alonzo is a Director of Technology Consulting who consulting for public-sector technology projects nationwide. Her expertise includes project management, strategic planning, and procurement across programs such as Medicaid, Child Support, and Transportation. Before joining PCG, she led the Project Management Office for the Wyoming Department of Transportation and supported delivery of the $6 billion State Transportation Improvement Plan. She holds an MBA and is certified as a Project Management Professional (PMP), Certified Scrum Master (CSM), and Eclipse IV&V® Professional.