The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) made changes designed to simplify and streamline Medicaid enrollment and renewal processes for all eligible individuals, with the expectation that more people would be able to enroll and retain Medicaid coverage, and the errors and expense associated with administering previously complex eligibility rules would decline. This presentation reviewed the specific changes and goals of ACA changes to enrollment and renewal processes and raised questions about how these processes are working and whether additional efficiencies could be introduced.