When Florida officials announced last week that the federal government had extended the state's Medicaid reform test program for three years, they failed to note the many strings attached. Florida Agency for Health Care Administration Secretary Elizabeth Dudek declared herself "pleased" at Washington's "approval to continue this effective pilot program." Whether it has been effective is debatable. The Centers for Medicare and Medicaid Services took 18 months to approve the state's request suggesting that there were concerns. Also, the CMS based the extension on several "special terms and conditions."