This presentation previews the June 2019 report to Congress chapter on improving return on investment (ROI) for state Medicaid program integrity activities. As far back as 2012, the Commission pointed to the need for the Secretary to determine which state program integrity activities are most effective. Chapter 3 of the June report reviews the findings of a 2018 study commissioned by MACPAC to collect information on states’ ability to calculate ROI for a range of activities. The Commission approved two recommendations that are included in this chapter, to improve information available to states about the design and implementation features of successful program integrity strategies, as well as provide states with greater flexibility to put strategies in place that work.