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Oklahoma's Medicaid program has been evolving for more than a decade, with lessons learned at every stage of the game by the Oklahoma Health Care Authority (OHCA), which administers the program. An examination of the program's progress offers terrific insights for all states into its mechanics and PMPM costs. In the early 1990s, Oklahoma's Medicaid program faced critical financial and access issues. Budget shortfalls had forced the state to reduce hospital, physician, and prescription drug coverage for adults, and access to primary and specialty care in rural areas was deteriorating in the face of declining physician participation.