Managed Medicaid is the centerpiece of Louisiana's health reform initiative, Louisiana Health First, which has finally taken shape after years of planning. State officials are betting that a coordinated, structured Medicaid program, giving beneficiaries a choice of plans, will provide residents better health outcomes for less money than the present fee-for-service, one-size-fits-all program. Meanwhile, health plans in Louisiana, Georgia and Alabama are bracing to respond to the recession. Though there were no major losses in enrollment or income as of July 2008, when the latest data was reported, rising unemployment and financial losses are bound to have an impact. Brokers report more interest in CDHPs, individual plans and HMOs. Even as the state of Alabama continues to battle pharmaceutical giants for Medicaid fraud, it has had to muscle up to a new behemoth, the Centers for Medicare & Medicaid Services. The state filed an injunction against the federal agency after it demanded that Alabama cut it in for a lion's share of the court winnings, even before the state recovered them.