Medicaid is the largest single source of health insurance in the U.S. and has become a growing share of both state and federal budgets. Medicaid’s spending growth and complex financing rules have created opportunities for large corporations with political influence, such as hospital systems, nursing homes, and managed care organizations, to increase their payments and drive-up federal costs. By enhancing transparency, curbing excessive spending, and modernizing program oversight and administration we can improve care and coverage while protecting taxpayers from growing costs.