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Access to care in CT’s public programs has always been a struggle; it is difficult to find a provider who takes Medicaid. In 2008 CT significantly raised Medicaid payment rates but a report by the CT Health Policy Project before, during and after the increase found that physician participation in the program didn’t improve. With enrollment growing recently due to the economy, an expected 140,000 new enrollees in 2014 due to national health reform, it is critical that CT improve provider participation. Focus groups and interviews with physicians and practice managers identified other significant barriers to participation including administrative hassles, billing and claims processes, audits, and poor communication with the state. Interviews with providers, practice managers and Medicaid agency staff from states with better provider participation rates, and often lower payment rates than CT, led to recommendations to improve access to care.