The PDF explains why many states are modernizing Medicaid systems without full replacements, focusing instead on phased transformations through well-structured takeover RFPs. Legacy MMIS platforms, often over 20 years old, are costly, insecure, and unable to meet modern demands, contributing to over $40 billion in administrative spending annually. States can access 90 percent federal funding for modernization but often miss out by extending outdated contracts. A competitive takeover RFP can balance innovation with continuity, but most attract only incumbent bids. To improve competition, states should clarify scope, share detailed system data, standardize pricing, and prioritize long-term value.

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