16.5% of personal health spending

Each state administers it under federal guidelines but as they choose

The Evolution of the Program

Initially desigend to vary from state to state--generally even if you are poor you don’t qualify--have to fall into a medical category or loose all your money

The Expansion of Medicaid

Medicaid pays for both long term and short term care

1980s expanded to include people above the poverty level (particularly pregencies)

The Explosion in Costs

Exteremly rapid growth--mandated federal support means that increasingly more of the federal grant money to states is going into Medicaid

Reasons: more eligible people, increases in cost, growing role of courts deterrmining eleigibility

Donations by Providers and Taxes

financial trickery to get more federal money--now illegal

Access and Quality of Care

Use services at a higher rate than the non-Medicaid patterns

Most states pay hospitals on a prospective payment system and physicians on a relative-value scale

Managed Care

Becomming more common, but not very popular

Conclusiosn

Does a good job of catching those who fall through the cracks--but they have to fall quite far first