A traditional MMIS project typically take years to complete; Medicaid regulations frequently change, increasing the project’s difficulty and risk; and delays drive already steep deployment costs even higher. The price tag on MMIS implementation ranges from $50 million to more than $150 million, making the system one of the largest IT investments for states. Fortunately, a confluence of factors is providing a new path forward for MMIS modernization – a path that focuses on a services-based approach to these traditionally complex systems. This handbook helps governments think about, plan for and acquire Medicaid management capabilities in preparation for a shift to MMIS-as-a-service. It showcases pioneering states that are laying the groundwork for MMIS-as-a-service and most importantly, it highlights how the Centers for Medicare & Medicaid Services (CMS) is supporting this transition.