Every state, including Texas, is struggling with the budgetary pressures associated with rapidly rising Medicaid spending. To its credit, the Texas Public Policy Foundation has been working for years to develop solutions to the growing Medicaid budget crisis. As part of its ongoing efforts to modernize the Medicaid program, the foundation reached out to me last year to prepare a report on what might be done to reform the long-term care component of Texas Medicaid. I was very pleased to work with my co-authors (Andrew Croshaw, Michael Deily, and Laura Summers) from Leavitt Partners on the project. Our goal was to develop recommendations that would allow the state of Texas to continue to provide vital services to patients even as the program would become more efficient and affordable for the state’s taxpayers, both in the short and long term.