The Affordable Care Act provided funding to allow states to upgrade their Medicaid and CHIP enrollment and renewal systems. States have implemented electronic application, eligibility determination, and renewal systems in different ways, on different timelines, and with different levels of success. Urban Institute researchers conducted case studies of two states (Colorado and Washington) with high rates of “real-time” Medicaid eligibility determinations and automated Medicaid renewals to identify potential best practices and lessons learned that California policymakers and health coverage advocates could use to help strengthen the state’s Medicaid systems. This report describes the approaches used by Colorado and Washington to increase administrative efficiencies and reduce barriers for consumers seeking to apply for and renew enrollment in their state Medicaid programs. Lessons learned from this study may be instructive for policymakers in California and other states across the country.