Medicaid is the largest single item in the New York State budget, comprising 34 percent of the $156 billion State budget adopted in April, so taxpayers have a major stake in ensuring its efficient operation. The State’s Department of Health and its Medicaid Redesign Team have developed and implemented strategies that have yielded significant quality improvements and savings, but much more is needed. Longer-term improvements will be more difficult to achieve and yet will be crucial to maintaining the sustainability of this vital service at a time of ever-rising health care costs.