Rapidly growing Medicaid expenditures, which constitute over 20 percent of state budgets, are now an urgent action item for state legislatures. Many states are considering cutbacks and new ways to control cost. All are demanding increased federal funding. What are the causes of this latest Medicaid crisis? Are there forces beyond the states' control, such as rising healthcare costs, increasing poverty, and federal mandates? Or have the states brought this crisis on themselves? Michael S. Greve provides his answers to these questions based on a study of differences in state Medicaid expenditures in good and bad economic times.