Today, 2.4 million New York State residents lack access to primary care. New York is third lowest in the nation in Medicaid payments for primary care, yet has the highest avoidable hospital use and cost and spends more on Medicaid than any other state in the nation. New York is applying for a "1115 Medicaid waiver," which could bring in $10 billion in federal funding over five years. New York must use a substantial portion of this funding for to ensure that every person has access to patient-centered, community-based primary care. Major primary care investment is essential to redesigning Medicaid and transforming our health care system.