Since the enactment of Medicaid and the State Children’s Health Insurance Program (CHIP), policymakers have debated program changes intended to stem program spending, change eligibility, allow greater state flexibility in program design and management, and improve access to higher quality care, among other objectives. Proposals have been offered across the political spectrum and include federal and state perspectives from presidents and governors. They reflect different objectives, ideas about the role of federal and state governments, and the particular policy discourse taking place at the time.
At the request of members of Congress, MACPAC undertook a review of major Medicaid reform approaches offered over the past several decades from presidents’ budgets, blue ribbon policy commissions, think tanks, governors’ associations and Medicaid commissions. These summaries are part of a broader effort to analyze and evaluate financing and other significant reforms in Medicaid policy.