Medina Dam was completed in 1913 in a privately financed project, creating the lake to supply irrigation water for local agricultural use.

Due to drought conditions lasting up until July 2015, recreational fish species had disappeared.

[1][2] As part of the 2010–13 Southern United States drought, the lake water levels dropped below 5% capacity.

This is due to constant drought and irrigation as many experts claim it may take years of rain to replenish the reservoir.

[11] Due to declining lake levels, many area farmers have to turned to using groundwater for irrigation.

In June 2024, Medina Lake had dropped down to 2.4% capacity, with Lakehills and the surrounding areas suffering an economic depression as a result along with depreciated home values and a rise in homelessness.