In this report, SHARE grantee Genevieve Kenney, with co-authors Jennifer Pelletier and Julia Costich, details policy changes in Kentucky's Medicaid program that were implemented under authority granted by the Deficit Reduction Act of 2005 (DRA).  This authority allowed the state greater flexibility in benefit design, cost-sharing, care coordination, health promotion, and chronic disease management.  The authors evaluate the impacts of Kentucky's Medicaid policy changes, along with the political, regulatory, and institutional environment that influenced these impacts.