Medicaid managed care was designed to control costs and coordinate care by outsourcing public health coverage to private managed care companies. But in Colorado, as in many other states, this model has funneled billions of tax dollars to a small group of out-of-state corporations, many backed by private equity, while patients face delays, denials, and shrinking provider networks. This brief outlines who profits, how the system works, and why stronger guardrails are urgently needed. It offers a legislative model as well as clear, actionable policy recommendations to rein in corporate overreach and restore accountability to a system meant to serve Coloradans, not shareholders.