How much responsibility for providing health care to the poor should be devolved from the federal government to the states? Any answer to this critical policy question requires a careful assessment of the Medicaid program. Drawing on the insights of leading scholars and top state health care officials, this volume analyzes the policy and management implications of various options for Medicaid devolution. Proponents of devolution typically express confidence that states can meet the challenges it will pose for them. But, as this book shows, the degree to which states have the capacity and commitment to use enhanced discretion to sustain or improve health care for the poor remains an open question. Their failure to attend to issues of politics, implementation, and management could lead to disappointment. Chapters focus on such topics as Medicaid financing, benefits and beneficiaries, long-term care, managed care, safety net providers, and the appropriate division of labor between the federal government and the states. The contributors are Donald Boyd, Center for the Study of the States; Lawrence D. Brown, Columbia University; James R. Fossett, Rockefeller College; Richard P. Nathan, Nelson A. Rockefeller Institute of Government, State University of New York, Albany; Michael Sparer, Columbia University; James Tallon, United Hospital Fund; and Joshua M. Weiner, the Urban Institute.

Exploring the consequences of federal devolution on state budgets, this work deals with three major areas of concern: the effect of moving large numbers of welfare recipients into labour markets; the planned federal reforms in the health care field; and trends in federal aid.

A critical look at state-dominated health care.

No developed nation relies exclusively on the private sector to finance health care for citizens. This book begins by exploring the deficiencies in private health insurance that account for this. It then recounts the history and examines the legal character of America's public health care entitlements - Medicare, Medicaid, and tax subsidies for employment-related health benefits. These programs are increasingly embattled, attacked by those advocating privatization (replacing public with private insurance); individualization (replacing group and community-based insurance with approaches based on individual choice within markets); and devolution (devolving authority over entitlements to state governments and to private entities). Jost critically analyzes this movement toward disentitlement. He also examines the primary models for structuring health care entitlements in other countries - general taxation-funded national health insurance and social insurance - and considers what we can learn from these models. The book concludes by describing what an American entitlement-based health care system could look like, and in particular how the legal characteristics of our entitlement programs could be structured to support the long-term sustainability of these vital programs.

Explore significant—but often-overlooked—aspects of aging policy! This unique addition to the literature on aging policy will help you understand devolution—the decentralizing of service provision—and the roles that state/local government and private organizations now play in addressing the needs of our aging population. It will show you how to initiate innovations and make positive changes in aging policy through state and local initiatives, collaborations between the federal government and other government agencies, public/private collaboration, and strictly private initiatives. From the editors: “Around the world, the ground rules are being questioned about the role of national governments in addressing domestic needs. During the twentieth century in countries throughout the world, central governments assumed major responsibilities for a wide variety of human needs. Whether the concern was income security, health, housing, or education, interventions were premised upon convictions that a strong public sector role was essential and that major involvement of national governments was needed. More recently, a significant pattern [devolution] has emerged in many countries wherein these responsibilities have shifted away from national governments to regional and local governments as well as from the public to the private sector.” Thoughtfully divided into five sections that illustrate distinctly different forms of devolution, this book first provides an essential overview of devolution and then examines its implications for vital aspects of service provision to the elderly. In the United States in recent years, the single greatest focus for devolution has been the transformation of income security protections for poor families. The federal Aid to Families With Dependent Children program has been replaced by the Temporary Assistance to Needy Families program. Devolution and Aging Policy examines that change and other important facets of the current climate of devolution, including: Medicaid-financed long-term care state sponsorship of services in retirement communities the implications of the Workforce Investment Act for the access of older workers to training at a state level to upgrade their work skills public/private sector collaboration in long-term care insurance long-term care ombudsman programs what state governments can do to help elders make use of information technology property tax credits for seniors that are given in exchange for volunteering on the municipal level how an HMO can encourage and stimulate service coordination and more!

The story of Medicaid comes alive for readers in this strong narrative, including detailed accounts of important policy changes and extensive use of interviews. A central theme of the book is that Medicaid is a "weak entitlement," one less established or effectively defended than Medicare or Social Security, but more secure than welfare or food stamps. In their analysis, the authors argue that the future of Medicaid is sound. It has the flexibility to be adapted by states as well as to allow for policy innovation. At the same time, the program lacks an effective mechanism for overall reform. They note Medicaid has become a source of perennial political controversy as it has grown to become the largest health insurance system in the country. The book's dual emphasis on politics and policy is important in making the arcane Medicaid program accessible to readersand in distinguishing policy grounded in analysis from partisan ideology. This second edition features a new preface, three new chapters accounting for the changes to the Affordable Care Act, and an updated glossary.