Fundamental reform is needed in order to ensure the long-term fiscal sustainability of the Medicaid program. More than simply sustaining the program, the Commission believes that Medicaid can and must continue to provide quality care to promote the best possible health for all beneficiaries. Taken as a whole, the recommendations set forth in this report promote Medicaid’s long-term fiscal sustainability, while also emphasizing quality of care. Key principles that must be part of this transformation include recognizing the long-term value of investments in quality, supporting state flexibility, and changing how beneficiaries partner with the Medicaid program by encouraging personal responsibility for health care decisions and promoting and rewarding healthy behaviors. The Commission also believes that the health of beneficiaries will be improved through a more efficient Medicaid system that emphasizes prevention, provides long-term care services in the least restrictive appropriate environment, adopts interoperable forms of health information technology, coordinates care across providers and health care settings, and focuses on ensuring quality health care outcomes. Finally, although the Commission recommends several incremental measures to encourage individual planning for long-term care, the Commission also calls upon federal agencies and Congress to develop a fiscally sustainable plan for our nation’s future long-term care needs.