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Blog: NAMD Celebrates Medicaid’s 50th Anniversary

Last week, the nation celebrated the 50th anniversary of President Lyndon Johnson’s signing of the historic legislation that created Medicare and Medicaid. While the Medicare program has dominated public attention and federal budgets for many of the ensuing years, Medicaid has quietly become the nation’s largest health care safety net program. Historically, Medicaid has often struggled to attract attention because of its complexity — it fails the “bumper sticker test” of public policy. While Medicare can be easily described as “health care for seniors,” Medicaid’s roles and responsibilities are far more complex. Medicaid pays for nearly half the births in the country, covers approximately one third of all children, and is now covering many low-income adults. Medicaid is the largest payer of mental health services, of HIV/AIDS treatments, and by far the largest payer of long term care. And Medicaid has also been propping up the serious shortcomings of its twin sibling, Medicare. Medicaid spends more than 40 percent of its $500+ billion annual budget serving a relatively small number of Medicare beneficiaries, the dual eligibles. This complexity, exacerbated by often significant differences that exist across state lines, has relegated Medicaid to the back pages of national discourse for far too long.

But this is changing rapidly. A series of major legislative changes, from the Balanced Budget Act to the Deficit Reduction Act, and culminating in the Affordable Care Act, have worked to change the federal landscape for the program. As Medicaid continues to dominate state legislative and policy making discussions, there has never been a greater opportunity to talk about the good news stories happening across the nation. While some may call Medicaid a broken system, it is in fact the broader US health care system that has been systematically failing low-income seniors, individuals with disabilities, and many Americans with complex or multiple chronic conditions. Medicaid is at the forefront of reform, and using its leverage to mold the health care system into a much more effective, responsive and efficient solution for our nation’s health care needs.

Fifty years ago, Medicaid programs were passive bill payers, and success was defined as how quickly and effectively claims were paid. Today, Medicaid is an active purchaser of care, and an undeniable force for quality improvement and better health outcomes. Medicaid Directors are driving these changes in health care, primarily around the acceleration of delivery system and payment reforms. While Medicare received some well-deserved attention for its recent commitment to value-based insurance design, Medicaid’s many efforts around behavioral health integration, managed long term services and supports, and shared savings models (both within and apart from traditional managed care arrangements) have laid the groundwork for Medicare’s success.

At NAMD, one of the many ways we look to support state Medicaid Directors is to communicate the success of these state-led efforts to overhaul the US health care system, and to trumpet the value of an increasingly nimble and dynamic Medicaid program for the sickest, frailest, and most medically complex patients in the country. Please join us in celebrating what Medicaid has been able to achieve over the past 50 years, but also keep our focus on how the next 5 to 10 years will usher in unprecedented improvements in what is now not just the nation’s health care safety net, but also the largest health insurer in the country.

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