Michael Birnbaum interviews Deborah Bachrach about her three-year tenure as director of the nation's largest Medicaid program. Bachrach, who served under Governors Spitzer and Paterson, had previously spent over a decade as a partner in a New York law firm, navigating and shaping health policy for clients whose patients depended on Medicaid. Reviewing the ambitious Medicaid agenda that she helped lead, Bachrach reflects on expanding eligibility and increasing enrollment, designing and implementing payment reforms, and struggling with how best to rationalize program administration. Enactment of national health reform, finalized shortly after the interview was conducted, makes Bachrach's experiences and insights particularly timely and relevant: Medicaid in New York is now less of an outlier and more of a model for states across the nation as they face implementation of major coverage expansions for their low-income residents.

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