Medicaid has grown by millions of lives in recent years, largely as a result of Medicaid expansion under the Affordable Care Act. Several states are again considering whether to expand Medicaid eligibility under the ACA. Still other states are eyeing potential waivers from the new leadership at CMS that has promised to provide states flexibility to restrict eligibility, add wellness requirements, or increase recipient cost-sharing. This report explores MCO growth, plan penetration, pharmacy control by MCOs, state-based care coordination efforts, and the impact of the potential changes to the ACA, and includes updated Decision Resources Group enrollment data.