Medicaid-the need for reform

Recent administration proposals to address the rising cost of Medicaid will do little to contain costs or truly reform the program. The primary issues are the large differences among state Medicaid programs in coverage and benefits and the programs high and rising costs. In this paper, we describe and develop several options for Medicaid reform that would expand coverage, provide fiscal relief to states, shift responsibility for some or all of the cost of dual eligibles to the federal government, and eliminate or restructure the disproportionate share programs. A number of other issues are addressed, including Medicaid cost containment and the federal matching rate structure.