Medicaid, the joint Federal-State program that was created to provide health care for the poor, celebrated its 40th birthday in 2006. There was no party for the program.1 In Florida and around the nation, Medicaid is growing at a long-term, unsustainable rate and threatens both state and federal budgets. It represented 2 percent of GDP in the year 2000 and is projected to rise to 9 percent by 2075.2 This rate of growth, combined with other unfunded liabilities in Social Security and Medicare, could require a devastating doubling of Federal taxes and enormous increases in state funding. Indeed, the program is now larger than education in many state budgets.3 In fact, the latest estimate from the Medicare Trustees (Medicaid is legislatively part of Medicare) show the present value of the nation’s long-term unfunded liabilities to be $89,000,000,000,000.00. To spell it out, that’s eighty-nine trillion dollars.