This is an unprecedented time for health IT in the United States, and the backbone of achieving lower costs, better health outcomes, and system interoperability relies on an enterprise view. In response to the CMS release of Medicaid Information Technology Architecture (MITA) 3.0, the NASCIO Health Care Working Group has formulated guidance to states as they navigate Medicaid IT transformation. NASCIO continues to be an advocate for enterprise solutions and view the MITA framework as a way state CIOs can decouple legacy systems and break down existing silos in state government. State CIOs grasp the importance of modernizing the Medicaid enterprise in a way that is flexible, interoperable, and takes into consideration emerging technologies like cloud computing. In addition to emphasizing conformity to the MITA vision, the report calls attention to emerging security threats in the states and the importance of protecting personally identifiable information and personal health information.