Health Affairs, 22, no. 1 (2003): 89 doi: 10.1377/hlthaff.22.1.89 © 2003 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Medicaid: Challenges Beneath The Surface

PROLOGUE

Medicaid: Challenges Beneath The Surface

States jumped onto the Medicaid financial bandwagon. Here was a way to get the federal government to ante up sizable sums of money for areas that were previously the states’ jurisdiction. This spurred tremendous growth in Medicaid as a payer for these populations. On the disability side, Bruce Vladeck notes that the number of disabled beneficiaries in Medicaid has doubled over the past twenty-five years. On the mental health side, Richard Frank, Howard Goldman, and Michael Hogan report that Medicaid represented only about 12 percent of spending on mental health in 1971 and nearly 20 percent in 1997. While this growth in Medicaid coverage is viewed generally as positive, the evolution from primarily categorical funding to Medicaid funding has also had unintended consequences. For instance, state mental health authorities feel that they entered into somewhat of a Faustian bargain by shifting costs to Medicaid, while giving up some of their responsibilities for regulating and managing local services.

Vladeck, a political scientist, brings wide-ranging insight to his comments on Medicaid and the disabled population, born of his experience as administrator of the Health Care Financing Administration from 1993 to 1997. Frank, Goldman, and Hogan team up to provide a sweeping look at the impact of Medicaid on the broader mental health safety net. Frank and Goldman are leading economists in the mental health arena; Goldman is also a professor of psychiatry; and Hogan is a state mental health policymaker, directing Ohio’s Department of Mental Health since 1991. Hogan also chairs President Bush’s New Freedom Commission on Mental Health, and Goldman serves as editor for the commission’s report. An interim report released 1 November 2002 by the commission found the U.S. mental health system "in disarray" and said that half of people who need mental health treatment do not receive it because of barriers to care. Indeed, the paper by Frank, Goldman, and Hogan in this issue raises concerns that the Medicaidization of state mental health care has left some groups of low-income people with unmet needs.

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