In the mid-1990’s, New York State faced a Medicaid crisis and the new governor at the time, George Pataki, created the Comprehensive Medicaid Task Force, to study Medicaid and make cost-containment recommendations. At the same time, CGR and the New York State Association of Counties (NYSAC) studied the underlying problems of Medicaid in New York State and published recommendations for reform in 1995 that were used extensively in Task Force debates. Once again, in 2003, New York State faces a Medicaid crisis. The report is based upon cross-state comparisons with eleven other benchmark states, and cross-county comparisons within New York. In addition to utilizing the available statistical data, CGR’s recommendations incorporate our experience based on having conducted Medicaid management studies in several New York counties.