The Medicaid program was enacted in 1965 as a joint federal and state government program to provide health care for the nation's poorest people. Rising health costs over the three decades since its implementation have caused policy-makers repeatedly to examine ways to rein in expenditures. State governments began experimenting with managed care programs for their Medicaid populations decades ago, but due to greater federal government flexibility in recent years, the number of state Medicaid managed care programs has exploded. Less than 10 percent of the Medicaid population was enrolled in some form of managed care before 1992. Over 54 percent of the Medicaid population is now enrolled in managed care, according to the most recent Health Care Financing Administration figures.