Under health reform, Medicaid will expand in 2014 to cover an additional 16 to 20 million beneficiaries. This population will include a significant percentage of childless adults with urgent and complex health care needs, who are likely to shift between subsidy programs over time. This brief, prepared by the Center for Health Care Strategies, draws from current state programs that have dealt with this challenge successfully. The experiences described herein can help states develop policies and procedures that foster seamless coordination of care during coverage transitions between Medicaid managed care organizations and qualified health plans in the exchanges. A companion matrix includes excerpts of sample contract language related to coverage transitions in existing programs.