The past two decades have seen a shift in the predominant model by which public mental health services are funded, organized, and delivered. Medicaid now funds more than half of public mental health services administered by the states, and the proportion is expected to reach two-thirds by 2017. In this issue of Psychiatric Services, Jeffrey A. Buck, Ph.D., describes how the community model, in which planning and administration of services is centered in a state mental health authority, is being displaced by a model associated with state Medicaid programs. In the newer model, the approach to the organization and delivery of services is similar to that of a private-sector health plan. Dr. Buck discusses the changes that are likely to occur as administrators, policy makers, and interest groups increasingly understand the implications of the health plan model of state-based public mental health services. He warns that efforts to preserve organizational structures and practices that are more in line with the community model may result in a system in which major policy decisions are made by government agencies that have limited expertise in mental health issues and services (see page 969).