Medicaid and Devolution: A View from the States

How much responsibility for providing health care to the poor should be devolved from the federal government to the states? Any answer to this critical policy question requires a careful assessment of the Medicaid program. Drawing on the insights of leading scholars and top state health care officials, this volume analyzes the policy and management implications of various options for Medicaid devolution. Proponents of devolution typically express confidence that states can meet the challenges it will pose for them. But, as this book shows, the degree to which states have the capacity and commitment to use enhanced discretion to sustain or improve health care for the poor remains an open question. Their failure to attend to issues of politics, implementation, and management could lead to disappointment. Chapters focus on such topics as Medicaid financing, benefits and beneficiaries, long-term care, managed care, safety net providers, and the appropriate division of labor between the federal government and the states. The contributors are Donald Boyd, Center for the Study of the States; Lawrence D. Brown, Columbia University; James R. Fossett, Rockefeller College; Richard P. Nathan, Nelson A. Rockefeller Institute of Government, State University of New York, Albany; Michael Sparer, Columbia University; James Tallon, United Hospital Fund; and Joshua M. Weiner, the Urban Institute.