; and (II) the establishment and maintenance of a stakeholder engagement group that regularly solicits and incorporates into the State's Medicare and Medicaid coordination or integration strategy input from the Consumer Advisory Council and other relevant stakeholders (as defined in paragraph (1)) in the State. (x) Development of a workforce needs assessment to identify the needs of the full-benefit dually eligible population, including strategies to ensure adequate compensation for the workforce. (B) Limitations No payment may be made under this subsection for expenditures on an activity that the State carried out before the date of enactment of this subsection. (5) Payments to States (A) In general Subject to subparagraph (B), for each fiscal quarter during which a State has in effect a Dual Coordination and Integration Plan approved under paragraph (3), the Secretary shall pay to the State an amount equal to 50 percent (or, during the first 20 full fiscal quarters during which the plan is in effect, 80 percent) of the amounts expended by the State during the quarter on activities described in paragraph (4) that are in accordance with such plan. (B) Limitations (i) Use of planning grant funds A State shall not be eligible for a payment under this paragraph until the State has expended the full amount of the planning grant awarded to the State under paragraph (2). (ii) Non-duplication of payment