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July 19, 1995

MedicaidThe Role of the States

Author Affiliations

From the National Academy for State Health Policy, Portland, Me.

JAMA. 1995;274(3):267-270. doi:10.1001/jama.1995.03530030087041

MEDICAID is a federal program, but because it is administered by the states, it is they who are often held directly accountable by providers and beneficiaries for the program's shortcomings, even when those shortcomings are part of federal law. For states, frustration with the federal program rests largely in three areas: (1) eligibility requirements that are cumbersome to administer and restrict coverage only to certain groups among the poor; (2) reimbursement rate protections for hospitals and nursing facilities that result in disproportionate reductions in fees paid to physicians, home care, and other provider groups when budgets must be constrained; and (3) requirements that the program must provide "cookie cutter" services statewide to any and all persons eligible for Medicaid. States point out that from 1987 through 1992, the federal government imposed no fewer than 30 new mandates on them related to program eligibility, reimbursement, and services.1 Many of those

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