Incentives will likely play an increasing role in a new Medicaid system. The Medicaid Reform Commission is starting to draft its recommendations for the Legislature. Commission members have suggested using both positive and negative incentives to alter behavior. Commission Chairman, Senator Charlie Shields of St. Joseph, says people will act in their best interest, both to improve their health and protect their pocketbook. Shields suggests giving Medicaid recipients a break on their co-pays if they go through smoking cessation or weight-loss programs. Others say penalties should be assessed if they refuse to improve their health. Other suggestions include requiring Medicaid recipients to have primary care physicians and firms doing business with the state to provide employee health care. The Commission continues to meet Thursday.