Medicaid, enacted along with Medicare in 1965, was created to provide health care for certain categories of low-income Americans.[1] Over the past 50 years, the program has changed significantly. Not only has Medicaid eligibility expanded, so also has the scope of its care and services. Mounting fiscal, demographic, and structural challenges continue to strain the federal–state partnership on which Medicaid is based. These weaken the future of the program and those it was intended to serve.