In 1995, the Robert Wood Johnson Foundation (RWJF) launched the Medicaid Managed Care Program, coordinated by the Center for Health Care Strategies (CHCS), to help states explore the new frontier of managed care. Back then, states were looking to invest public dollars more prudently and improve health care for not quite 40 million Medicaid beneficiaries.

Today, Medicaid is again at a pivotal juncture, poised to expand its role in many states across the nation, and for the first time, establish a major source of coverage for the uninsured in the U.S. To mark the conclusion of the Medicaid Managed Care Program and explore the implications of an expanding Medicaid program, CHCS engaged 20 of the nation’s leading Medicaid experts for conversations on the program’s past and future.

We asked our interviewees to reflect on Medicaid’s progress over the last two decades and consider future implications, particularly as the program expands. We also invited them to envision what an ideal Medicaid program might look like and, given the constraints and realities of today’s delivery system, where state and federal partners need to focus efforts to achieve their model vision. This resulting high-level report explores how far Medicaid has come, why it currently matters more and more for millions of Americans, and where it must focus to address quality and cost challenges in the coming years.