The Center for Health Care Strategies performs substantial research on Medicaid and other underserved populations. The Center has published an updated look at the characteristics of Medicaid patients. (CHCS Report) This new version includes pharmacy data and looked back further at diagnostic data. Forty-five per cent of Medicaid enrollees have three or more chronic conditions. Almost half have a psychiatric illness. About 5% of Medicaid patients account for 50% of overall Medicaid costs. Most of these are in fee-for-service Medicaid. Patients in managed care Medicaid plans tend to receive intensive management for chronic disease. That is the method by which many of these plans make money, even though they may pay providers higher rates than the fee-for-service Medicaid program does. The report is a reminder of the opportunity for savings through better care management for a relatively small number of patients, not just in Medicaid but in all payment programs. Several methods of caring for these patients with multiple chronic conditions have been developed and are being tested, and one primary objective of any reform legislation should be to encourage if not mandate their use. The savings would likely pay for expanded access.