KHPA has been engaged for the past two years in a comprehensive effort to review and improve each major component of Medicaid and SCHIP. The overall purpose of the Medicaid Transformation Process is to provide a regular and transparent program reviews to monitor, assess, diagnose, and address policy issues in each major program area within Medicaid. The preparation of these reviews is designed to serve as the basis for KHPA budget initiatives in the Medicaid program on an ongoing basis. The following recommendations are based on findings from 14 program reviews completed in 2008; they address issues related to decreasing expenditures, addressing reimbursement, expanding coverage, and enhancing program oversight. An additional 12 reviews will be completed for 2009.