In this book, Edward Alan Miller identifies factors that either facilitated or impeded the design and implementation of Rhode Island’s Global Consumer Choice Compact Medicaid Waiver in order to draw broader lessons for the Medicaid block grant debate and health and long-term care reform more generally. Evidence gathered from archival sources and in-depth interviews with key stakeholders exposes the role that provider capacity has played in the implementation process, including adult day care, assisted living, home maker, and other home- and community-based services. The impact of the Global Waiver on the nursing home sector is examined as well, in addition to new authority to obtain federal matching dollars for previously state-only funded programs. By providing a sophisticated understanding of factors enhancing or impeding state health reform, this book will contribute to improvements in the development and administration of policy development at both the state- and federal-levels.