Tom Betlach, the Director of Arizona's Medicaid program, AHCCCS, deserves to be commended for his candid presentation in this January 24, 2011 op-ed in the Arizona Republic. The article outlines the difficult choices that Arizona's Medicaid agency faces in this tough fiscal environment. Clearly, Arizona is not alone among the states, with many others across the country wrestling with similar choices. States that have demonstrated their willingness to expand coverage have earned the attention of their federal partners as they search for local solutions to best serve their citizens.