Medicaid and State Response to Federal Health Reform: What Lessons Can Be Learned from Oregon's Innovative State Model?

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Advisor: Sandy Barth PHD


The Medicaid program is a unique example of a federal/state partnership, administered by states under federal program standards and regulations, and funded through shared federal and state government responsibility for program costs. Program waivers and other individual state options give states flexibility to tailor the program to meet state-specific needs and constraints. The Medicaid expansion provision contained in the Patient Protection and Affordable Care Act (ACA) and the Supreme Court ruling making program expansion voluntary provides both the opportunity and the necessity for increased state-based response to health reform efforts. State-based health reform activities through Medicaid program changes, waivers and innovative strategies are likely to become more important in health reform than federal policies.

This qualitative, descriptive study reviews the evolution of Medicaid and examines the current Medicaid program through the lens of state response to the ACA's Medicaid expansion. The research classifies states on the basis of their Medicaid expansion plans and examines their plans in the context of political, economic, demographic, and health care infrastructure characteristics. A comprehensive examination of the development and evolution of the innovative Medicaid model in Oregon is the centerpiece of this paper, providing a framework for review of other state-based Medicaid reform initiatives. Oregon is one of the leaders in state-based health reform efforts and is currently in the midst of ambitious Medicaid health reform initiatives. The research examines Oregon's model and its impact on health care access, quality, and cost and considers the potential application of the Oregon model (or parts of it) to other states.

Presentation: 32 minutes