Between 1981 and the early 1990s, the Medicaid program grew substantially, in part because, for the first time in the program’s history, eligibility for medical assistance was severed from eligibility for income-maintenance payments. Program participation had always been reserved for the “deserving poor,” and these were originally defined as persons excluded from market relationships through no fault of their own. The Medicaid expansion of the 1980s, however, created a new constituency of poor, and not-so-poor, persons whose actual or predictable medical problems promised a calculable return on program funds.

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