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Introduction to State Health Policy

Medicaid in a Nutshell


Martha King, Program Director, Health Care Program, National Conference of State Legislatures, Denver, CO.

In this session, Martha King, Program Director for the Health Care Program of the National Conference of State Legislatures, examined the key role that legislators play in overseeing the Medicaid Program, the largest single budget item in many States. Medicaid is a health care coverage program for low-income individuals designed by each State within Federal guidelines and paid for with State and Federal funding.

The goals of this session were to:

  • Highlight basic facts about Medicaid, including State-specific information about beneficiaries, expenditures, and services.
  • Address the flexibility that States have to tailor their programs through various options to cover certain populations and services.
  • Identify new developments and trends in the program.
  • Identify resources for additional information.

Ms. King presented a brief overview of Medicaid and spent some time clarifying the populations covered, State expenditure levels, mandated versus optional services, and certain State-specific data. She often referred to the National Conference of State Legislators Medicaid Notebook, which presents considerable Medicaid data in a State-specific format.

Ms. King also highlighted recent Federal changes that will likely have a great impact on Medicaid over the next several years. These changes have occurred in an effort to contain Medicaid costs, which have increased significantly since the mid-1990s. The need for cost containment is a critical issue facing all states. Some of the Federal changes to the Medicaid program include:

  • Expansions to mothers and children.
  • Welfare reform.
  • The Balanced Budget Act of 1997 (BBA).

Finally, she discussed the major shift toward enrolling Medicaid recipients into managed care arrangements. Ms. King emphasized that the contract written between Medicaid agencies and managed care organizations is a critically important tool for meeting the program's goals. She underscored that the contract is the primary foundation necessary for States to provide access to quality care for Medicaid beneficiaries.


King M, Christian SM. Medicaid Survival Kit. 1996 National Conference of State Legislatures, Denver, Colorado.

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