The situation
Medicaid platform modernizations are among the hardest programs in state government: federal compliance requirements, a supplier ecosystem that no single party controls, and a beneficiary population that cannot absorb an outage. This one spanned more than ten concurrent workstreams and more than fifteen stakeholder organizations — state agency teams, system integrators, and vendor partners — each with its own priorities, reporting habits, and definition of done. Programs like this don't usually fail loudly; they drift into missed dependencies and negotiated-green status reports until go-live exposes everything at once.
What I did
The engagement ran on the same discipline described in the Sapper Method: diagnose where coordination was actually breaking, stabilize the operating rhythm, then drive delivery to a clean go-live. The center of gravity was governance — building the complete CMS-compliant governance infrastructure the program needed, and making it something the fifteen-plus organizations would actually use rather than route around.
- Stood up complete CMS-compliant governance infrastructure — decision forums, escalation paths, and reporting standards that satisfied federal oversight without drowning the workstreams in ceremony.
- Coordinated modernization across 10+ concurrent workstreams, with dependency mapping and RAID discipline connecting them into a single view of program risk.
- Aligned 15+ stakeholder organizations behind one operating cadence — one version of the truth, weekly, with named owners on every risk and dependency.
The outcome
The platform went live with zero critical defects — the number a Medicaid program is actually judged on, because every critical defect at go-live is a beneficiary who can't get care and a headline the agency has to answer for. The governance infrastructure remained in place after go-live: a delivery system the agency runs, not a consultant dependency.