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.