The economy has inspired fewer bold moves and more fiscal caution in the TriState health insurance market, both in government and the private sector. Connecticut is experiencing a seismic shift in its Medicaid program that is changing the role of managed care organizations. While some of their members are opting to have a primary care practitioner coordinate their care, the MCOs are almost certainly headed for non-risk-based Medicaid contracts that will limit their role to administration. The Medicaid pharmacy program is also undergoing belt-tightening, which will affect the prescribing of mental health drugs. In the private insurance market, carriers will find organic growth hard to come by, although a few managed to eek out some growth in early 2009. Some 400,000 Health Net customers looking for a new carrier, and most are expected to go to UnitedHealthcare, which acquired Health Net’s northeast licenses. New York is quickly becoming a state of medical homes, with the addition of the Adirondack region and the state’s Medicaid program. Meanwhile, state employee and retiree benefit plans make changes in vendors in the search for cost savings, and pharmaceutical companies are opposing attempts to restrict their marketing activities in New York and New Jersey.