Medicaid has evolved from its modest beginnings to become the nation's primary health insurer for low-wage individuals. The program today covers nearly 70 million Americans, at a cost of roughly $440 billion (17 percent of the nation's overall health care bill). It pays for the young (nearly 50 percent of the nation's births) and the elderly (40 percent of the long-term care bill) and for the care rendered to poor and working families across the life span. As Medicaid has grown, so too has the complicated intergovernmental program partnership: there is ongoing intergovernmental bargaining over program eligibility, benefits, and reimbursement, and significant interstate variation in these and other program features. Perhaps surprisingly, however, there are relatively few in-depth qualitative analyses of the substance and the politics of the program and even fewer that examine in-depth program implementation in particular states. Block Granting...

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