Trends in Medicaid Eligibility: 1975 to 1985

Prologue: Only 40 percent of Americans with incomes below the federal poverty level receive assistance from the Medicaid program. A variety of pressures such as federal budget cuts, differing state priorities, a growing elderly population, and rapidly increasing acute and long-term health care costs all have exerted their influence on the federal/state program originally designed to increase access to care for the indigent One trend that has emerged over the past decade is the shift of Medicaid funds away from the poor population to the elderly with chronic care and nursing home needs. This tension for limited funds between two worthy populations was highlighted in a recent report from the American Hospital Association, Medicaid Options: “In terms of expenditures, Medicaid largely, and increasingly, has become a secondary insurance program for the elderly, blind, and disabled, rather than a primary insurance program for the poor.” Here, Brian Burwell and Marilyn Rymer of McGraw-Hill's SysteMetrics discuss this trend and others in the Medicaid program from 1975 to 1985. They note that while Medicaid is commonly perceived as an entitlement program available to all who qualify, it is fast becoming a fixed-resource program creating competition between eligible groups. Burwell is a senior research analyst at the Boston-based consulting firm, which specializes in health care financing analysis. Rymer, an acknowledged expert in Medicaid issues, is a division director at SysteMetrics. She has researched Medicaid policy for over fifteen years.