In fiscal year 2015, the Illinois Medicaid program will spend almost $13 billion in general and related funds, with about half coming from federal funds – $20 billion if all funds are counted.1 Despite this spending, the program is increasingly failing to meet the medical needs of Illinois’ most vulnerable population. The state’s recent Medicaid expansion to cover primarily able-bodied adults – triggered by the Affordable Care Act – compounds the problem of rapidly increasing costs in this program. Worse, it threatens the state’s long-term economic well-being and ability to deliver quality health coverage to those who need it most.