State Medicaid agencies are under enormous pressure to reduce costs while maintaining quality of care for Medicaid beneficiaries. In this podcast episode, Dr. Gordon Moore talks with Billy Millwee, former Texas Medicaid director and now consultant to Medicaid programs across the U.S. Mr. Millwee discusses his work to help state agencies understand value-based payment, pursue waivers, and address social determinants of health. Each state brings different ideas to the table. Which approach works best? By creating the right incentives, state Medicaids can bolster innovation to improve outcomes and lower costs.