Medicaid

In the United States, Medicaid is the primary social safety net that provides health care for the poor and other vulnerable populations. Interest group theory and federalism, state level sovereignty, are used to create a theoretical model that proposes factors, other than increasing health care cost, as growth determinants of Medicaid expenditure and enrollments. For over three decades driven by federalism state-level discretionary Medicaid waiver programs have been creating new and unsustainable entitlements. The role of Medicaid waivers is poorly understood and in need of scholarly attention. Due to a lack of federal oversight and other social and political factors, some of which will be discussed in this paper, it appears that discretionary Medicaid waiver programs put in place as a solution are contributing to the overall structural issues of Medicaid. The paper concludes with suggestions on needed research and some potential policy recommendations.