Part 1: Introduction to Medicaid
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This chapter tells the story of Medicaid’s creation, from the early 1960s healthcare financing crisis to the program’s passage. It explores the key players, philosophical debates, and political battles that shaped the program, and sets the stage for the challenges and opportunities that Medicaid would face in the decades to come.
01 Weaving a Safety Net: Medicaid's Origins and Evolution Part 1: Introduction to Medicaid
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This chapter examines the complex structure and funding mechanisms of Medicaid, including the rise of managed care and use of waivers. It explores the historical expansions of Medicaid eligibility and the variations across states. The chapter also looks at emerging payment models involving value-based care and how the program’s fragmented nature can create barriers for beneficiaries accessing services.
02 The Medicaid Landscape: Structure, Funding, and EligibilityPart 2: Public Policy and Controversy
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This chapter explores the fierce debate surrounding Medicaid expansion under the Patient Protection and Affordable Care Act (ACA). It details the human benefits of expanded healthcare coverage, then dives into the political battle in North Carolina, highlighting the financial incentives that ultimately led to expansion. The chapter concludes by analyzing the impact of expansion on health outcomes, healthcare costs, and broader social and economic factors of Medicaid expansion.
03 The Medicaid Expansion Controversy: Politics, Policy, and OutcomesPart 2: Public Policy and Controversy
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This chapter critiques superficial Medicaid social needs screening tools and fragmented referrals, advocating instead for deeper collaboration between healthcare and community organizations to address root causes of poverty and difficulties navigating social services through approaches like housing investment and community health workers. It highlights examples of successful and unsuccessful programs and the increasingly robust research base describing strategies to reduce social risks among Medicaid recipients.
04 Beyond Checkboxes: Rethinking Social Needs in MedicaidPart 3: Access, Coordination, and Quality
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This chapter examines the stark care access disparities Medicaid patients face, citing limited specialist availability, administrative burdens disincentivizing provider participation, and prevalence of “ghost networks” falsely implying adequate coverage. It explores attempted remedies like the 340B drug discount program intended to bolster safety net providers, noting questionable impact on intended populations so far. The chapter concludes with a description of several strategies that have the potential to improve access to care for Medicaid beneficiaries and create a more equitable healthcare system.
05 Care Segregation and Network Inadequacy: Medicaid’s Network Challenges and Corrective AttemptsPart 3: Access, Coordination, and Quality
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This chapter explores worrisome primary care physician shortages and burnout, tracing root causes to inadequate prestige, compensation, and payer fragmentation that stifle the critical impact of primary care providers. It reviews the Comprehensive Primary Care Plus program results, and points to simpler, consistent multi-payer incentives as in Rhode Island that nurtured improvements to primary care infrastructure and outcomes.
06 Reinvigorating Primary Care, Care Access, and Coordination in MedicaidPart 4: Improving Population Health Access, Quality and Equity in Medicaid
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This chapter explores the history of mental health and substance use care in the US, from the institutionalization of those with behavioral health needs to community-based programs struggling with provider shortages. It highlights innovative approaches like Certified Community Behavioral Health Clinics and The Collaborative Care Model to integrate mental health expertise into primary care and improve outcomes related to overall healthcare and social costs and patient experience.
07 Bridging Gaps and Building Integrations in Behavioral HealthcarePart 4: Improving Population Health Access, Quality and Equity in Medicaid
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This chapter traces maternal mortality’s trajectory in the US and its impact on health disparities, highlighting evidence-based programs like the Centering Pregnancy program and the Nurse-Family Partnership that reduce the risk of maternal death and concurrently improve both perinatal and longer-term pediatric and adolescent health, social and economic outcomes. The chapter also describes broader supportive maternal policies found in peer nations, from universal paid family leave to early education investments.
08 Beyond Survival: Supporting Mothers and Children to ThrivePart 5: Conclusion and Future Directions
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As states explore Medicaid integration with Medicare to improve patient experiences and incrementally move toward universal health coverage, this concluding chapter reviews the complex barriers “dual-eligible” patients face today. It reviews challenges experienced in the Medicare Advantage program to illustrate the risks of fragmented systems and misaligned incentives that could undermine the push for a single, streamlined universal healthcare safety-net program.
09 Pursuing Universal Coverage: Cautionary Lessons from Medicare-Medicaid Integration and Medicare AdvantageEpilogue: A Vision for Strengthening Medicaid and Advancing Health Equity
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Epilogue