Abstract: The 1990s saw considerable change in the Medicaid program. At the beginning of the decade, Medicaid was still primarily a program that provided health care coverage to persons receiving cash assistance under the Aid to Families with Disabled Children (AFDC) or Supplemental Security Income (SSI) programs, although expansions of eligibility for low income pregnant women and children had already begun shifting the focus of coverage away from cash recipients. Health care providers were reimbursed directly for services rendered, and little was offered in the way of care management. While fee-for-service (FFS) reimbursement remains important, by the end of the decade State Medicaid programs had taken on a new role as purchasers of managed health care and case management services. At the same time, many States relaxed eligibility standards for Medicaid, extending coverage to higher income pregnant women and children or, in some cases, to the general low income uninsured population. In these States, Medicaid reform was a component of a broader effort to increase access to health insurance generally, and to encourage the development of managed care.
The States were not the only actors in the Medicaid reform arena. Congress enacted a number of reforms at the national level, including changes in the laws governing Medicaid payments to disproportionate share hospitals (DSH), welfare reform, repeal of the Boren Amendment and enactment of the State Children's Health Insurance Program (SCHIP).
As we enter the first decade of the 21st Century, these various reform movements continue to develop, and their full implications are not yet clear. One thing that is certain, however, is that Medicaid reform has thrown into relief the program's broad reach and its relationships to multiple constituencies. It has also highlighted the administrative, logistical, and political challenges inherent in any attempt to reform a large public program such as Medicaid. This special issue of the Health Care Financing Review features eight articles that examine various aspects of Medicaid reform, their impact and possible future directions for the reform movement. Together they provide an overall view of the impact, successes, and challenges of Medicaid reform, and the prospects for the future.
Publication Year: 2000
Publication Date: 2000-01-01
Language: en
Type: article
Indexed In: ['pubmed']
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Cited By Count: 14
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