In 2006, the state of Florida's Medicaid program began implementing a pilot reform program in 5 counties, 2 of them being the state's largest counties. In addition to transitioning Medicaid beneficiaries from traditional fee-for-service Medicaid to managed care plans, the reform sought to empower beneficiaries to take control of their health through several innovative programs. Implementation of the reform was challenging because of the large number of beneficiaries in transition, the number of providers participating in the Medicaid program, the large number of health plans that elected to participate in the reform, the large advocacy community, and a short time frame given for implementation. This case study of the Florida Medicaid Reform experience illustrates how public agencies can implement change to the Medicaid program. Findings and conclusions offer the public health community a better understanding of the resources and processes required for implementing similar reforms and programs in the future. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.