The New York State (NYS) Medicaid program has long been recognized as among the nation’s most expensive programs, both in terms of total expenditures and the unit cost of services provided. With New York’s Medicaid program being a major component of its budget, the rising cost of the program has been a significant concern for the State. Also, like many other states, New York faces significant budget shortfalls, increased demand for public services, and significant responsibilities for implementing provisions of the Patient Protection and Affordable Care Act (ACA).