In this Health Affairs Blog post, Children's Hospital Association president and CEO Mark Wietecha argues that the fragmented Medicaid system must evolve to better meet the needs of medically complex children, and points to regional care networks and national data support as two viable tools for containing costs while improving care for this population. Medicaid has become essential healthcare payor for children, supporting coverage for more than 30 million children, including two million with medical complexity - a population projected to double over the coming decade. Representing 6% of Medicaid's pediatric population, they use some 40% of the spending. Wietecha says the program's structure as a state-based program doesn't readily support broader regional and national care, meaning that families traveling across state lines for care face challenges in coordinating care, payment and paperwork. The state-based nature of Medicaid also means there's no national clinical database to inform improvement work in the quality and cost of care for medically complex children. He references a Health Affairs article that presents a business case for change and discusses the findings within the broader context of healthcare reform.