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Modernization in Medicaid MMIS

Benefits of Modular Modernization in Medicaid MMIS

September 28, 2023


Medicaid Management Information Systems (MMIS) play a critical role in the effective management and delivery of health services to Medicaid beneficiaries. To increase the efficiency, responsiveness, and sustainability of these systems, Medicaid agencies are increasingly a modular approach to the modernization of Medicaid IT systems, often referred to as a Medicaid MMIS upgrade or Medicaid Enterprise Systems (MES) transformation. With this strategic approach, instead of tackling upgrades to Medicaid IT systems on a massive scale, upgrades are broken down into well-defined modules to implement incremental upgrades as opposed to large scale changes that affect many aspects of the MMIS system. This approach states to increase functionality, adapt to a changing regulatory environment, and the improve user experience while minimizing disruption.

Here are some benefits of using a modular modernization in Medicaid MMIS:

Flexibility and Agility: Modular modernization allows for more flexibility and agility in the context of Medicaid Management Information Systems (MMIS) by breaking down the system into smaller, more manageable components or modules. 

Here's how this approach enhances flexibility and agility:

  • Targeted Updates: Modular upgrades allow specific modules to be independently upgraded or replaced. As a result, needs based changes, adjustments or improvements-based changes, adjustments or improvements can be made without having to rebuild the entire MMIS. This approach allows states to react quickly to changing needs or priorities.
  • Adaptation to Changing Needs: Medicaid programs must often adapt to new rules, regulations, and technology. Modular modernization allows states to prioritize the most critical modules for upgrades, allowing MMIS to quickly adapt to changing requirements and regulations without impacting the entire system.
  • Reduced Implementation Time: Updating individual modules takes less time than replacing the entire MMIS. This results in faster deployment of improvements and capabilities, allowing states to respond quickly to new challenges or opportunities.
  • Iterative Development: The modular redesign is based on an iterative development approach in which improvements are made incrementally. This allows states to release feature updates more frequently and gather user feedback to further improve future modules. This iterative process increases the system's responsiveness to user requests.
  • Enhanced Scalability: Medicaid programs are often subject to fluctuations in demand due to changes in the number of beneficiaries or external factors. Modular modernization allows states to adapt specific modules to different workloads, ensuring the system remains responsive and efficient.
  • Easier Integration of New Technologies: New technologies can be seamlessly integrated into specific modules instead of trying to integrate them into the entire MMIS system. This approach allows states to take advantage of the latest innovations without disrupting the entire system.
  • Risk Mitigation: Traditional full system scans are riskier due to their complexity and the risk of unforeseen problems. Modular modernization reduces risk by allowing states to spot and mitigate problems in the smallest components before they spread.
  • Vendor Collaboration: By partnering with several providers of different modules, states can benefit from the expertise of specialized providers. This collaboration encourages innovation and can lead to more efficient solutions for each module.
  • Incremental Benefits: Each updated module comes with its own set of benefits and upgrades. This allows states to reap the benefits sooner and provides impetus to continue their modernization efforts.
  • Staggered Investment: Modular modernization spreads out the investment over time, making it more manageable for state budgets. This financial flexibility allows states to pursue upgrades as funding becomes available as opposed to waiting for the approval of larger budget allocations.
  • Minimized Disruption: Upgrading a specific module doesn't disrupt the entire system. This means that critical services can continue without interruption, ensuring beneficiaries and providers are not negatively impacted during the modernization process.

Reduced Risk:Modular modernization of complex systems such as Medicaid Management Information Systems (MMIS) can significantly reduce risk compared to a large-scale system replacement. Here's how modular modernization helps in reducing risk:

  • Smaller Scope and Complexity: Modular modernization involves updating or replacing specific modules or components of the MMIS, rather than the entire system. This reduces the scope and complexity of each project, making it easier to manage and control potential risks.
  • Isolated Impact: When a specific module is being upgraded or replaced, the impact is isolated from that module. This means that if issues arise, they are contained within that module and do not affect the entire MMIS. This isolation minimizes the risk of system-wide failures.
  • Incremental Implementation: Modular modernization follows an incremental approach, where changes are implemented in smaller phases. Each phase is thoroughly tested before deployment, reducing the likelihood of major errors that could disrupt the entire system.
  • Early Issue Detection: By focusing on smaller modules, issues and challenges can be detected and addressed earlier in the process. This allows for more effective risk mitigation strategies to be put in place before problems escalate.
  • Better Testing and Quality Assurance: Testing and quality assurance efforts can be more focused and rigorous for individual modules. This ensures that each module is thoroughly tested, reducing the chance of unexpected issues arising during or after deployment.
  • Improved Vendor Management: Working with specialized vendors for specific modules allows for better vendor management. Vendors with expertise in particular areas can be chosen, reducing the risk of delays or subpar performance.
  • Maintained Critical Services: During modular modernization, critical services can be maintained while specific modules are updated. This ensures that essential functions of the MMIS continue to run smoothly, reducing disruption and risk to beneficiaries and providers.
  • Preserved Data Integrity: With a modular approach, there's less chance of data corruption or loss during upgrades. The focused nature of the upgrades reduces the risk of unintentional changes to data in other parts of the system.
  • Easier Rollback: In the event of an issue during an upgrade, it's easier to roll back changes to a specific module than to revert an entire MMIS overhaul. This ability to quickly revert to a known working state reduces downtime and risk.
  • Continuity and Experience:Since modules are upgraded individually, system administrators and users can maintain their familiarity with most parts of the system. This familiarity contributes to smoother operations during the upgrade process.
  • Cost Control: The modular approach allows for better cost control, as budgets can be allocated to specific modules rather than a massive overhaul. This mitigates the risk of budget overruns and financial strain.
  • Stakeholder Buy-In: Stakeholders, including beneficiaries and providers, are more likely to support modular modernization due to reduced disruption and risk. This buy-in contributes to smoother implementation and reduced resistance to change.

Cost-Effectiveness:A modular modernization in the context of complex systems such as Medicaid Management Information Systems (MMIS) can offer good added value compared to a complete system replacement. This is how a modular renovation achieves profitability:

  • Focused Investment: Modular modernization allows states to focus their investments on specific modules or components that require modernization. This focused approach ensures resources are deployed where they are needed most, rather than investing in a complete system replacement that may include functional components.
  • Reduced Upfront Costs: A complete system replacement often requires a significant upfront investment, including hardware, software, and implementation costs. With modular remediation, these costs are broken down into smaller, more manageable parts, making it easier for states to budget and fund each phase of a remediation project.
  • Smaller Implementation Teams: Modular upgrades typically require smaller deployment teams than full system replacements. This reduces staffing costs and the need for extensive training and onboarding of new team members.
  • Lower Risk of Budget Overruns: Controlled scope and budget of individual modules in a modular retrofit reduces the risk of over-budget, which is most common in large-scale system replacements
  • Reduced Disruption to Operations: Because critical services can continue to run while modules are updated, there are fewer interruptions to day-to-day operations. This helps avoid potential lost revenue and operational inefficiencies that can result from system failures during a full replacement.
  • Incremental Funding: Modular upgrade allows for additional funding as each module is upgraded. Countries can allocate resources based on their immediate needs and budgetary availability, making it easier to secure the funds needed without making large upfront commitments.
  • Maximized Lifespan of Existing Investments: Modular modernization allows countries to use existing IT infrastructure and investments that are still functional. This minimizes the need to replace high-performance components, thereby reducing costs.
  • Avoidance of Sunken Costs: A complete system replacement often means doing without existing systems and investments. Modular modernization allows countries to avoid canceling previous investments, resulting in an improvement in overall financial value.
  • Better Return on Investment (ROI): A modular upgrade can provide a faster return on investment because the benefits of each module upgrade are realized more quickly. This allows countries to demonstrate added value and improvements to stakeholders in less time.
  • Adaptive Resource Allocation: When priorities or budgets change, states can adjust the allocation of resources to different modules based on their importance and available funding. This adaptability contributes to overall profitability.
  • Improved Cost Control: The modular approach allows for better cost control as each module’s budget is managed separately. This minimizes the risk of unforeseen costs that might arise in the event of a large-scale system replacement.
  • Long-Term Sustainability: Modular modernization promotes long-term sustainability as it allows states to continue investing in system improvements over time. This approach keeps the MMIS up to date and operational without requiring massive regular investments.

Faster Implementation: Modular modernization offers several advantages that contribute to faster implementation compared to traditional complete system replacements. Here's how modular modernization helps in achieving quicker implementation:

  • Focused Scope: Modular modernization involves updating or replacing specific modules or components of a system rather than the entire system. This narrower scope allows project teams to concentrate their efforts on a smaller set of tasks, reducing complexity and accelerating implementation.
  • Smaller Workloads: With a modular approach, the workload for each module is more manageable, allowing development, testing, and deployment activities to proceed more swiftly. Smaller workloads also facilitate better resource allocation and task coordination.
  • Parallel Development: Modules can often be developed and tested in parallel, allowing different teams to work on different components simultaneously. This parallel development accelerates the overall project timeline.
  • Reduced Testing Time: Testing efforts can be more focused and efficient in a modular approach. Each module can be tested thoroughly in isolation, resulting in faster identification and resolution of issues before deployment.
  • Shorter Learning Curves: For project team members, learning the specifics of one module can be quicker and less intensive than learning an entirely new system. This shorter learning curve speeds up development and implementation activities.
  • Incremental Deployment: Modular modernization involves deploying updates or replacements for individual modules as they are ready. This incremental deployment approach allows states to start realizing benefits sooner and avoid waiting until the entire system is ready for launch.
  • Less Complex Integration: Integrating individual modules is generally less complex than integrating an entirely new system. This simplifies the integration process and reduces potential delays.
  • Rapid Feedback Loop: Incremental deployment and user feedback cycles are shorter in modular modernization. Users can provide feedback on specific modules more quickly, enabling timely adjustments and improvements.
  • Prioritized Upgrades: Modules can be upgraded based on their priority or criticality. This allows states to address urgent needs or regulatory changes promptly, resulting in faster compliance and enhanced functionality.
  • Reduced Risk of Project Creep: The focused nature of module upgrades helps prevent scope creep, where project requirements expand beyond the original plan. This prevents delays caused by changing project goals.
  • Earlier Benefits Realization: As each module is deployed, the associated benefits are realized sooner. This helps demonstrate the value of the modernization effort to stakeholders and beneficiaries.
  • Continuous Improvement: As modules are upgraded individually, states can continuously improve the MMIS. This iterative process of improvement accelerates over time, resulting in a more agile and efficient system.

Improved User Experience: Modular modernization can significantly contribute to an improved user experience in complex systems like Medicaid Management Information Systems (MMIS). Here's how modular modernization helps enhance user experience:

  • Targeted Enhancements: With modular modernization, specific modules that directly impact user interactions can be prioritized for upgrades. This ensures that enhancements are targeted where they matter most to users, leading to a more user-centric experience.
  • User-Centered Design: Upgrading individual modules allows for a user-centered design approach. User feedback and preferences can be incorporated into module upgrades to create interfaces and workflows that align with user needs and preferences.
  • Streamlined Workflows: Modules can be redesigned to optimize workflows and streamline processes for users. This results in more intuitive navigation and reduced steps to complete tasks, enhancing overall efficiency.
  • Customization and Flexibility: Modular modernization can introduce more flexibility and customization options for users. Different modules can be tailored to specific user groups, accommodating various preferences and roles.
  • Reduced Learning Curve: Upgrading individual modules can lead to a reduced learning curve for users. Changes are introduced in smaller increments, making it easier for users to adapt to new features and functionalities.
  • Consistency in Design: Module upgrades can include consistent design elements, such as standardized interfaces and terminology. This consistency across modules improves usability and reduces confusion for users.
  • Faster Response to User Needs: Since module upgrades can be deployed more quickly than full system replacements, user feedback and requests can be addressed faster, enhancing user satisfaction.
  • Minimal Disruption: Upgrading individual modules reduces the risk of disrupting the entire system and causing inconvenience to users. This continuity ensures that users can continue their work with minimal interruption.
  • Timely Compliance with Regulations: Modules that require compliance with new regulations or policies can be upgraded more promptly. This ensures that users have the necessary tools to meet regulatory requirements without delays.
  • Better Performance: Upgraded modules can offer improved performance, responsiveness, and stability. This translates to faster load times, smoother interactions, and less frustration for users.
  • User Training Efficiency: Training efforts can be focused on specific modules, making training more efficient and effective. Users only need to learn about the changes relevant to their tasks, reducing the time and resources required for training.
  • Incremental Improvements: Over time, as additional modules are upgraded, the cumulative effect of these improvements leads to a more comprehensive and consistently enhanced user experience.
  • User Engagement: Involving users in the feedback and testing process for individual modules fosters user engagement and a sense of ownership in the modernization process. This can lead to better acceptance of changes and a more positive user experience.

Easier Integration: Modular modernization offers several advantages that make integration easier in complex systems like Medicaid Management Information Systems (MMIS). Here's how modular modernization helps facilitate seamless integration:

  • Modular Architecture: Modular modernization inherently involves breaking down the MMIS into smaller, self-contained modules. Each module can be designed and developed with integration in mind, ensuring compatibility with existing modules and external systems.
  • Clear Interfaces: Each module can have well-defined interfaces and APIs (Application Programming Interfaces) that facilitate communication with other modules and external systems. These clear interfaces simplify the integration process and minimize ambiguity.
  • Standardized Data Formats: Modular modernization often leads to the adoption of standardized data formats and communication protocols within modules. This consistency simplifies data exchange between modules and third-party systems.
  • Reduced Scope of Integration: Upgrading or replacing individual modules reduces the scope of integration efforts compared to overhauling the entire system. This targeted integration approach minimizes the risk of integration complexities.
  • Parallel Integration Efforts: Different modules can be integrated in parallel, allowing multiple integration efforts to proceed concurrently. This accelerates the overall integration timeline.
  • Specialized Vendors: When specialized vendors are involved in developing and upgrading specific modules, they can contribute their expertise to ensure smoother integration with existing systems and data sources.
  • Focused Testing: Integration testing can be more focused on specific modules and their interactions. This allows for more thorough testing of integration points, reducing the chances of compatibility issues.
  • Data Mapping and Transformation: Modular modernization allows for more efficient data mapping and transformation between modules. This is particularly important when migrating data from older systems to new modules.
  • Scalability and Interoperability: A modular approach can enhance the scalability and interoperability of the MMIS. Modules can be added, removed, or scaled as needed without disrupting the entire system, making integration of new functionalities easier.
  • Flexibility for Third-Party Integrations: If external systems need to interface with the MMIS, modular modernization makes it easier to add specific integration points for third-party systems, accommodating different data exchange requirements.
  • Easier Upgrades: Upgrading individual modules can be done independently, which means that integration points can be updated and improved without affecting the entire MMIS. This facilitates smoother transitions to newer versions of modules.
  • Better Management of Dependencies: Modular modernization enables a clearer understanding of module dependencies, making it easier to manage and update these dependencies during the integration process.
  • Reduced Disruption: Since integration efforts are focused on specific modules, the risk of disrupting the entire system during integration is minimized. This ensures that critical services can continue with minimal interruption.

Minimized Disruption: Modular modernization offers several benefits that contribute to minimizing disruption in complex systems like Medicaid Management Information Systems (MMIS). Here's how modular modernization helps achieve reduced disruption:

  • Isolated Upgrades: Modular modernization involves upgrading or replacing specific modules one at a time, leaving other modules untouched. This isolation of upgrades ensures that disruptions are contained within the module being updated, minimizing the impact on the overall system.
  • Continued Operation: During the upgrade of a specific module, the rest of the MMIS can continue to operate without interruption. Critical services, data access, and user interactions remain functional, reducing disruptions to beneficiaries, providers, and administrators.
  • Incremental Changes: Since upgrades are implemented in smaller increments, users experience less sudden change and disruption to their established workflows. This allows them to adapt more smoothly to the evolving system.
  • Shorter Downtimes: Module upgrades can often be completed with shorter downtimes compared to large-scale system replacements. This reduces the time during which system access is restricted or unavailable.
  • Rapid Issue Resolution: If issues arise during the upgrade of a specific module, they can be addressed quickly due to the focused nature of the upgrade. This helps prevent prolonged disruptions caused by unresolved problems.
  • Smaller Risk Window: With modular modernization, the risk of overall system failure is significantly reduced. Since each module is upgraded individually, the risk window is smaller, leading to a more stable and reliable MMIS.
  • Predictable Rollbacks: If an issue occurs during the upgrade of a module, rolling back to the previous version is usually simpler and less disruptive than reverting an entire system replacement. This enables quicker recovery from unexpected challenges.
  • Reduced Training Overload: Users are only required to learn about the changes introduced by a specific module upgrade, rather than adapting to an entirely new system. This reduces the training burden and the potential for confusion.
  • Stakeholder Confidence: Minimal disruption and the ability to maintain services during upgrades instill confidence in stakeholders, including beneficiaries, providers, and administrators. This confidence contributes to smoother transitions and overall user satisfaction.
  • Less Change Resistance: Users are generally more accepting of changes when they occur in smaller increments. This reduces the likelihood of change resistance, which can lead to disruptions due to decreased user engagement.
  • Preservation of Data Integrity: Modular upgrades often involve fewer complex data migration and transformation processes, reducing the risk of data corruption or loss during the upgrade process.
  • Faster Time to Value: As each module upgrade is completed, its associated benefits are realized sooner. This allows stakeholders to see tangible improvements and value without waiting for a complete system replacement.

Enhanced Vendor Relationships: Modular modernization in complex systems like Medicaid Management Information Systems (MMIS) can lead to enhanced vendor relationships by leveraging specialized expertise and fostering collaboration. Here's how modular modernization helps improve relationships with vendors:

  • Specialized Expertise: Modular modernization often involves working with different vendors that specialize in specific modules or components. Engaging vendors with expertise in certain areas ensures that each module is developed or upgraded with the highest level of technical proficiency.
  • Vendor Collaboration: Collaborating with multiple vendors promotes knowledge sharing and cross-functional expertise. Vendors can collaborate to ensure that their modules seamlessly integrate with one another, resulting in a more cohesive and efficient MMIS.
  • Clear Scope and Expectations: Engaging vendors for specific modules allows for clearer scope definition and expectations. Vendors can focus on delivering well-defined solutions, reducing the risk of misunderstandings or misalignments.
  • Effective Communication: With a modular approach, communication with vendors can be more focused and specific. Vendors can work closely with states to ensure that module requirements, milestones, and deliverables are well-understood and met.
  • Mutual Success Goals: Vendors contributing to specific modules have a vested interest in their success. This alignment of goals fosters collaboration and a shared commitment to achieving positive outcomes for the modules they are responsible for.
  • Quality Enhancements: Modular modernization encourages vendors to focus on delivering high-quality solutions for their designated modules. This emphasis on quality benefits both the state and the vendor, as it ensures that the module functions as intended.
  • Customization and Flexibility: Engaging specialized vendors allows for greater customization and flexibility in meeting specific module requirements. Vendors can tailor their solutions to align with the unique needs of the state's Medicaid program.
  • Innovative Solutions: Specialized vendors may bring innovative solutions and technologies to the table, enhancing the capabilities of individual modules. This innovation contributes to the overall modernization of MMIS.
  • Continuous Improvement: Collaborating with vendors over multiple module upgrades fosters a continuous improvement mindset. Vendors can learn from each project and apply insights to subsequent modules, driving innovation and efficiency.
  • Relationship Building: Working with vendors on a module-by-module basis allows for deeper relationship-building. Strong vendor relationships can lead to smoother negotiations, better problem-solving, and more efficient project management.
  • Vendor Accountability: Modular modernization enables better tracking of vendor performance for each module. Vendors are held accountable for delivering on their commitments, leading to a higher level of professionalism and service.
  • Shared Learning: Both the state and vendors can learn from each other during module upgrades. Knowledge transfer and shared experiences contribute to a more collaborative and productive working relationship.

Better Scalability: Modular modernization offers several benefits that contribute to better scalability in complex systems like Medicaid Management Information Systems (MMIS). Here's how modular modernization helps enhance scalability:

  • Modular Architecture: Modular modernization involves breaking down the MMIS into smaller, self-contained modules. This modular architecture inherently supports scalability, as new modules can be added, or existing ones can be expanded as needed.
  • Focused Scalability: With modular modernization, specific modules can be scaled to accommodate increased demand without affecting other parts of the system. This focused scalability allows resources to be allocated where they are most needed.
  • Adaptive Capacity Planning: Scalability can be planned and implemented incrementally for individual modules, avoiding overprovisioning or underutilization of resources. This adaptive approach ensures that resources are used efficiently.
  • Efficient Resource Allocation: Scalability efforts can be more precise and efficient with a modular approach. Resources, such as computing power and storage, can be allocated based on the demands of specific modules rather than for the entire system.
  • Responsive to Fluctuations: Medicaid programs often experience fluctuations in caseloads and activity levels. Modular modernization enables states to quickly scale up or down based on these fluctuations, ensuring that the MMIS remains responsive and performs optimally.
  • Better Performance: Scaling individual modules allows for better performance optimization. Modules can be optimized independently, resulting in improved response times and user experiences.
  • Reduced System-wide Impact: When scaling is needed, it can be achieved for specific modules without affecting the rest of the MMIS. This minimizes the risk of unintended disruptions to critical services.
  • Customized Scaling Strategies: Different modules may require varying levels of scalability. With modular modernization, states can implement tailored scaling strategies based on the specific requirements of each module.
  • Integration with New Technologies: New technologies, such as cloud computing or containerization, can be integrated into specific modules to enhance scalability. This allows states to take advantage of cutting-edge solutions for specific areas.
  • Cost-Effective Growth: Scaling individual modules is generally more cost-effective than scaling an entire system. This targeted approach ensures that resources are invested where they have the most impact.
  • Improved User Experience: Scalability efforts can improve user experience by ensuring that the MMIS remains responsive even during peak usage times. Users can access services and information without delays or slowdowns.
  • Resilience and Redundancy: Modular modernization can also include redundancy strategies within specific modules to ensure high availability. This enhances resilience against failures and supports uninterrupted service.

Long-Term Sustainability: Modular modernization offers several advantages that contribute to the long-term sustainability of complex systems like Medicaid Management Information Systems (MMIS). Here's how modular modernization helps ensure long-term sustainability:

  • Incremental Investment: Modular modernization allows states to invest in specific modules over time, spreading out the financial commitment. This approach ensures that resources are available for continuous upgrades and improvements, promoting long-term sustainability.
  • Continuous Improvement: With modular modernization, improvements can be made iteratively. As new technologies, best practices, and user needs emerge, individual modules can be upgraded to incorporate these advancements, keeping the MMIS current and effective.
  • Adaptation to Changes: The healthcare landscape and regulatory environment evolve over time. Modular modernization allows the MMIS to adapt to changing requirements and regulations through targeted module upgrades, ensuring ongoing compliance and relevance.
  • Efficient Budget Allocation: Since investments are allocated to specific modules, states can allocate funds more efficiently based on the priority of upgrades and the availability of resources. This cost-effective approach contributes to the long-term financial sustainability of the MMIS.
  • Reduced Technical Debt: Modular modernization helps reduce technical debt—the accumulation of outdated technology and practices. By consistently upgrading individual modules, states can avoid a situation where the entire system becomes outdated and difficult to maintain.
  • Preservation of Data and Functionality: Upgrading modules instead of replacing the entire system ensures that valuable data and critical functionalities are preserved. This continuity is vital for the ongoing operation of the MMIS and the services it supports.
  • Support for Future Integration: Modular modernization often results in modules designed with clear interfaces and standardized data formats. This design philosophy facilitates easier integration with new technologies, third-party systems, and future upgrades.
  • Risk Management: With focused module upgrades, states can identify and address risks in a more targeted manner. This risk management approach enhances the overall stability and reliability of the MMIS, contributing to its long-term sustainability.
  • User Satisfaction: Continuous improvements through modular modernization led to an enhanced user experience. Users benefit from updated functionalities, streamlined workflows, and responsive services, leading to higher user satisfaction and continued usage.
  • Easier Talent Retention: As technical teams work on specific modules, they become subject matter experts in those areas. This specialized knowledge retention prevents loss of expertise and contributes to long-term sustainability.
  • Alignment with Business Goals: Modular modernization allows states to align upgrades with evolving business goals and program priorities. This alignment ensures that the MMIS remains aligned with the strategic direction of the Medicaid program.
  • Minimized Disruption: By avoiding complete system replacements, modular modernization reduces the potential for major disruptions to services. This ensures that beneficiaries, providers, and administrators can continue accessing critical functions without interruption.


Modular modernization strategies for Medicaid Management Information Systems marks a significant advance in the upgrade of Medicaid IT systems. By breaking down large and complex upgrade projects into well-defined and manageable modules, states are able to reduce risk, control cost, and ensure a more favorable outcome from upgrade projects.

Tags:  Medicaid