Medicaid: Welfare Program of Last Resort, or Safety Net?

Peril to Medicaid exists on many different fronts. In 2017, Congress nearly succeeded in fundamentally altering Medicaid by capping federal expenditures on it, regardless of need, and ending eligibility for many Americans. Medicaid reimbursement to providers is also very much at risk, jeopardizing not only access to coverage for Medicaid beneficiaries, but access to care, as providers reduce or end their participation in the program. Meanwhile, both the Centers for Medicare and Medicaid Services (CMS) and a number of states are eager to make other, smaller-scale changes to the program. These changes, while narrower in impact, have substantial potential to reframe Medicaid from a broad safety net program for lower-income people who lack access to employer-sponsored health insurance, to a limited, short-term, stigmatized welfare program for the needy—one that is difficult to access and even more difficult to keep. This article will discuss these different and perilous fronts. In the process, it will suggest better and worse ways, as a matter of both law and public policy, to address the existential, financial, and political challenges facing Medicaid, its beneficiaries, and participating providers