Inclusion Criteria:  CCOs/CCO STAFF: Serving a majority of counties that are predominantly rural based on 2010 Rural-Urban Commuting Area (RUCA) codes (codes 4-10) CCOs/CCO STAFF: Willing to participate in data collection activities (e.g., producing claims data, interviews) CLINICS: Clinics will be eligible for the cluster randomization if there are 30 or more patients eligible for screening CLINICS: Are classified as rural according to RUCA (Codes 4-10) or Oregon Office of Rural Health designations CLINICS: Are served by CCOs agreeing to participate in the project CLINICS: Willing to implement the intervention into their clinic for the study CLINIC STAFF/PROVIDERS: Employed as a clinician or ancillary staff member in a participating clinic CLINIC STAFF/PROVIDERS: Willing to participate in data collection activities (e.g., interviews, observation, surveys) PATIENTS: Attributed to participating clinic PATIENTS: Are enrolled in Medicaid or dual eligible PATIENTS: Eligible for colorectal cancer (CRC) screening PATIENTS: For the subset of patients that will be invited to participate in key informant interviews, a 5th eligibility criteria is consented to participate COMMUNITY OR REGIONAL/ORGANIZATIONAL PARTNERS: (Includes endoscopy providers, community-based outreach workers, or leaders from regional or national organizations who participate in the pilot, pragmatic trial, or scale-up study) COMMUNITY OR REGIONAL/ORGANIZATIONAL PARTNERS: Involved in study activities (training, care delivery) COMMUNITY OR REGIONAL/ORGANIZATIONAL PARTNERS: Willing to participate in data collection activities (e.g., trainings, interviews, surveys) Elderly - Yes - we anticipate that a limited number of clinic and CCO staff, or community organization representatives may be elderly; we limit our patient recruitment to those aged 50-75 Rural - Yes Inner city - No Low income - Yes Disabled - Yes Chronic care - Yes End of life - Yes - This is possible, but we predict limited numbers because of the types of individuals we are recruiting: clinic and CCO staff, and patients who are not currently in hospice care Minorities - Yes  Exclusion Criteria:  CLINICS: Clinics are excluded if they have current or ongoing participating in other mailed fecal testing research projects in the Medicaid population PATIENTS: Are current for screening PATIENTS: Comorbid conditions that make patients poor candidates for screening based on clinical judgment (e.g., end-stage renal disease, enrollment in hospice) PATIENTS: Are not an established patient or for other reasons documented by the clinics All patients, clinic/CCO staff that we recruit will be at least 50 years of age or older