In this study, the project team will use nationally representative Medicaid claims data to: 1.Estimate the proportion of Medicaid spending on primary care by state, and examine state variation by beneficiaries’ race/ethnicity and managed care enrollment status. 2.Estimate access to primary care services by state, and analyze variation primary care access by state, as well as by beneficiaries’ race and ethnicity and managed care enrollment status. 3.Examine the association between primary care spending and access to care with health care quality. Data for this study will come primarily from the 2016-2018 Centers for Medicare and Medicaid Services T-MSIS Analytic Files. Analysis will include Medicaid beneficiaries in the 50 U.S. states and D.C. States will be excluded if data is deemed to be of poor quality.