Wednesday’s Medicaid Reform meeting hosted by CSG-ERC Health Policy Committee highlighted the variety of approaches states are taking to address their unique challenges. All states are committed to move away from volume-based payment models toward building value. All states were also committed, and have devoted significant resources, to quality improvement and delivery reform to build programs that are centered on patients. But states face different challenges, cultures and capacity. The all-day meeting at the Boston State House included Medicaid officials, legislators, staff, federal officials and other stakeholders. We heard from Bailit Health researchers about their recent survey of Medicaid reforms across the US. The survey found that states are moving into value-based purchasing because of strong pressure from CMS, internal strategic priorities, budget constraints, and active policymakers. State Medicaid programs are moving more slowly and tentatively into financial risk models than the private sector because of the unique nature of the program, its providers and members. We also heard from NESCSO, a non-profit organization funded by New England states to support state Health and Human Service Agencies. NESCSO provides staff training, information exchange, and collaborative solutions such as joint purchasing of services to support reform. NESCSO is planning to bring panels of federal health officials to states. To start the lively Policymakers’ Roundtable discussion we heard from Medicaid officials from NY, MA, RI, VT and CT. Discussion focused on what has worked and where the challenges still are. One member noted that “Medicaid reform is not like flipping a switch. It’s more like slowly turning up a dimmer.” We heard about new DSRIP opportunities, Accountable Care Organization development and regulation, underservice protections, multipayer collaboration, aligning quality targets, addressing social determinants of health, re-focusing programs on members’ needs, strengthening primary care and care coordination. The main request from participants to CSG-ERC for the future was to continue opportunities to meet and share resources. Slides and other documents will be posted online soon.