Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs to the nation’s largest health insurer. The occasion of Medicaid’s 50th birthday is a fitting time to consider that evolution, not to reminisce, but to help chart the path forward. Medicaid is a complex program with a complex history, and understanding its role in the U.S. health system is essential to ensuring that it is performing at optimal levels for its beneficiaries, as well as for states, taxpayers, and the myriad healthcare providers, health plans, and others touched by the program. In a four-part series supported by The Commonwealth Fund, Cindy Mann, Deborah Bachrach and Elizabeth Osius of Manatt Health Solutions examine Medicaid’s evolution and consider its role in the new coverage paradigm established by the Affordable Care Act (ACA).

Medicaid as Health Insurer: Evolution and Implications -

On January 1, 2014, a new healthcare coverage paradigm took hold in the nation. A transformed Medicaid program became, along with the insurance marketplaces and the Children’s Health Insurance Program, one of three programs offering a continuum of subsidized coverage for people who lack affordable insurance through the workplace. The Affordable Care Act (ACA) solidified Medicaid’s health insurance credentials, moving it farther along a path it had been traveling for three decades— from its origins in the welfare system to the nation’s largest health insurer. And yet, efforts to bring Medicaid back to its welfare roots continues to haunt the program—as evidenced by recent proposals by some states to impose work requirements and eligibility time limits and to resist expanding eligibility to cover so-called “able-bodied” adults. Medicaid is a complex program that has looked different at different times in its history; appreciation of its role today has implications for Medicaid and the entire healthcare system.