The details of Medicaid administration vary from state to
state; this variation is anticipated to increase with new
flexibility provided by Centers for Medicare &
Medicaid Services (CMS) (e.g., the addition of work
requirements). Based on interviews with 40 observers
across 28 states, Medicaid agencies have previously
solicited input from multiple stakeholders when
developing current managed care requirements, including
State Offices of Rural Health as well as provider groups.
After waivers take effect, CMS rules require annual
reports on spending and enrollment, and "periodic"
evaluation of waiver outcomes. These documents can be
used by rural health advocates to ensure that rural
beneficiaries benefit to the same extent as their urban
counterparts from new funding arrangements.