A new policy brief and evaluation from the Center for Health Care Strategies reports on a Commonwealth Fund–supported project exploring the business case for quality improvement in Medicaid. Over a three-year period, three health care organizations managed to improve care for Medicaid beneficiaries with high-risk childhood asthma. But they did not achieve a financial return on their investment—the savings accrued from improved quality did not exceed the interventions’ costs. The brief and related evaluation provide lessons for policymakers to consider amid growing pressure to demonstrate rapid savings from quality improvement initiatives.