Over the last several years, Louisiana’s Medicaid program has grown by leaps and bounds, expanding the program to more than 400,000 able-bodied adults over the last two years and fundamentally hurting the individuals Medicaid was primarily designed to help. Reforming Medicaid should involve re-orienting the program’s focus on the vulnerable populations for which it was originally designed, while modernizing the delivery of care in ways that can lower costs and improve health outcomes for patients.