Optimizing care procedures to boost patient health outcomes and ROI for health systems Since its inception in the 1960s, Medicaid managed care has now been adopted in various forms by 48 US states, with private insurers (both nonprofit and for-profit) covering an increasing number of beneficiaries. Despite its widespread adoption, there is a need for payment reform with stronger quality monitoring and alignment among states, plans, and providers to enhance value. The Centers for Medicare and Medicaid Services is now moving forward with initiatives that increase providers’ downside risk. This whitepaper will shed light on the changing Medicaid landscape. We delve deeper into important findings of Medicaid policies and enrollments. It will also reveal the impact of government interventions as well as the opportunities and challenges for Medicaid providers. Lastly, it will disclose strategies to prepare for the change and improve spending, access, and quality outcomes for beneficiaries.