The American Health Care Paradox: An Exhaustive Analysis of the Medicaid Program

Introduction: A Lifeline and a Lightning Rod

The question “is Medicaid bad” is deceptively simple.

It probes at the heart of one of the most complex, contentious, and consequential public policy programs in the United States.

Answering it requires moving beyond political rhetoric and simple binaries to engage in a deep, evidence-based evaluation of a system that is simultaneously a lifeline for millions and a lightning rod for criticism.

This report seeks to provide such an analysis, dissecting the program’s immense value against its significant structural challenges.

Medicaid, together with the Children’s Health Insurance Program (CHIP), stands as the single largest source of health coverage in the United States, providing essential medical care to over 80 million Americans.¹

It is the foundational safety net for the nation’s most vulnerable populations: one in four children, low-income families, pregnant women, seniors requiring long-term care, and individuals with disabilities.¹

The program’s financial footprint is equally vast, accounting for nearly one out of every five dollars spent on healthcare in the U.S. and half of all spending on long-term services and supports.⁴

This report will argue that Medicaid is neither monolithically “good” nor “bad.” It is an indispensable pillar of the American social safety net that provides life-saving health coverage and critical financial protection.

A vast body of research demonstrates its positive impact on health outcomes, mortality rates, and economic stability for its beneficiaries.

However, the program’s effectiveness is often compromised by a complex federal-state structure that creates profound geographic inequities, chronic underfunding relative to other payers that strains the provider network, significant administrative burdens that create barriers to care, and persistent political debates that threaten its stability.

The “goodness” or “badness” of Medicaid is therefore contingent on the perspective from which it is viewed—beneficiary, provider, or taxpayer—and, most critically, on the specific policy choices made at both the federal and state levels.

To understand Medicaid is to understand a paradox: a program of immense proven value that is perpetually hampered by its own design and the political environment in which it operates.

Section I: The Architecture of a Safety Net: Understanding Medicaid’s Structure and Evolution

To evaluate Medicaid, one must first understand its fundamental architecture.

Its history, governance, funding mechanisms, and the scope of its coverage create the framework within which all of its successes and failures occur.

The program’s design as a “cooperative federalism” partnership is its defining feature, granting it the flexibility to adapt to local needs while simultaneously embedding deep-seated inequalities into the fabric of American healthcare.

The Origins and Historical Trajectory

Medicaid was signed into law on July 30, 1965, by President Lyndon B.

Johnson as Title XIX of the Social Security Act, a companion to the Medicare program.⁶

In its initial form, it was a relatively modest program designed to provide medical insurance to individuals and families receiving cash assistance, effectively linking healthcare access to the nation’s welfare rolls.⁶

Over the subsequent decades, however, a series of legislative actions by Congress fundamentally transformed Medicaid from this narrow origin into the broad-based health insurer it is today.

Congress incrementally expanded federal minimum requirements and provided new coverage options for states, progressively severing the strict tie between Medicaid eligibility and cash assistance.⁹

This evolution occurred through several key milestones:

• In 1967, Congress established the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, creating a comprehensive and unique standard of care for all enrolled children under age 21.¹¹
• In 1972, eligibility was expanded to cover individuals with long-term disabilities and those over 65, linking it to the Supplemental Security Income (SSI) program and establishing Medicaid’s critical role in long-term care.⁶
• Throughout the 1980s and 1990s, eligibility was further expanded for low-income children and pregnant women, independent of their welfare status.⁹
• The Balanced Budget Act of 1997 created the State Children’s Health Insurance Program (CHIP), now known as the Children’s Health Insurance Program, to cover children in families with incomes too high for traditional Medicaid but too low to afford private insurance.⁶
• The most significant expansion came with the Patient Protection and Affordable Care Act (ACA) of 2010, which created a new pathway for states to cover nearly all nonelderly adults with incomes up to 138% of the federal poverty level (FPL).¹ A 2012 Supreme Court ruling in
  National Federation of Independent Business v. Sebelius made this expansion optional for states, a decision with profound consequences for the program’s reach.⁹
• During the COVID-19 pandemic, a “continuous enrollment” provision enacted by Congress led to a historic increase in enrollment, highlighting the program’s ability to respond to national crises, followed by a period of “unwinding” and disenrollment after the provision ended in 2023.⁹

This historical arc reveals a deliberate, albeit piecemeal, transformation.

A program that began as a small appendage to welfare has become the nation’s largest health insurer, covering one in four children and over 60% of all nursing home residents.³

While not all states participated initially, by the 1980s, every state had opted into the program, cementing its status as a permanent and essential feature of the U.S. health system.⁹

This evolution has also shifted the program’s function.

By expanding coverage to children and pregnant women, Medicaid transformed from a simple safety net for the poor into a long-term investment vehicle in the nation’s health and economic productivity, a return on investment that is often not realized for decades.

Year	Landmark Legislation/Event	Key Change/Impact
1965	Social Security Act Amendments	Medicaid (Title XIX) created as a health insurance program for individuals on cash assistance.6
1967	Social Security Amendments	Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children established, ensuring comprehensive care.11
1972	Social Security Amendments	Eligibility expanded to include people with long-term disabilities and the elderly receiving SSI, establishing Medicaid’s role in long-term care.6
1980s	State Adoption	All states opt-in to the Medicaid program, making it a truly national, albeit state-administered, system.9
1997	Balanced Budget Act	Children’s Health Insurance Program (CHIP) created to cover children in low-income working families not eligible for Medicaid.6
2010	Affordable Care Act (ACA)	Creates a pathway for states to expand Medicaid to nearly all nonelderly adults with incomes up to 138% of the FPL.1
2012	NFIB v. Sebelius Supreme Court Decision	The ACA Medicaid expansion is made effectively optional for states, creating a major source of geographic disparity in coverage.9
2020	COVID-19 Pandemic Response	A continuous enrollment provision leads to massive growth in coverage, demonstrating the program’s role as a public health stabilizer.9
2023	End of Continuous Enrollment	The “unwinding” of the continuous enrollment provision begins, leading to millions of disenrollments and renewed focus on eligibility systems.9

Cooperative Federalism in Action: A Complex Partnership

Medicaid is defined by its structure as a joint federal and state program.¹

This model, often termed “cooperative federalism,” creates a dynamic and often tense partnership.

The federal government, through the Centers for Medicare & Medicaid Services (CMS), establishes the foundational rules and requirements that all state programs must follow.¹⁶

CMS is responsible for providing policy guidance, approving state plan amendments (SPAs) and waivers that allow states to modify their programs, and overseeing state compliance.¹⁶

Within this federal framework, states possess significant flexibility to design and administer their own unique Medicaid programs.¹⁴

Each state designates a single state agency to manage its program day-to-day.¹⁶

These agencies determine many of the optional benefits offered, set provider payment rates, and choose the delivery system model—such as traditional fee-for-service or contracting with private managed care organizations.²¹

This state-level autonomy is a hallmark of the program, allowing it to be tailored to local needs, priorities, and political climates.⁶

However, this same flexibility is the primary driver of the profound variation in Medicaid from one state to another, creating what is effectively a patchwork of 50-plus different programs under one national umbrella.

An individual’s access to healthcare can thus be determined as much by their zip code as by their medical need.

The Mechanics of Funding: FMAP and the Flow of Dollars

The financing of Medicaid is a cornerstone of the federal-state partnership.

Unlike many other federal grants, federal Medicaid funding is an open-ended entitlement to states; there is no pre-set cap on the amount of federal matching funds a state can receive (with the exception of U.S. territories).⁴

This structure is critical, as it allows federal funding to automatically expand to meet increased need during economic downturns or public health emergencies.²⁵

The federal government’s share of Medicaid costs is determined by the Federal Medical Assistance Percentage (FMAP).¹⁵

The FMAP formula is designed to be equalizing, providing more assistance to states with less economic capacity.

It is calculated based on a state’s per capita income relative to the national average, meaning that states with lower per capita incomes receive a higher federal match rate.⁴

By law, the FMAP cannot be less than a statutory floor of 50%.

In fiscal year 2025, the FMAP ranged from this 50% floor in wealthier states like California and New York to 77% in Mississippi.²⁷

Congress can also establish “enhanced” FMAP rates to incentivize states to cover specific populations or services.²⁶

The most significant example is the enhanced FMAP for the ACA expansion population, for which the federal government pays 90% of the costs, a much higher share than the state’s regular FMAP.⁹

States must finance the remaining non-federal share of their Medicaid expenditures.

This is done primarily through state general revenues, such as income and sales taxes.²⁴

States also utilize other funding sources, including taxes levied on healthcare providers (e.g., hospitals or managed care plans) and funds transferred from local governments.⁴

Who and What Is Covered: The Patchwork of Eligibility and Benefits

Medicaid eligibility is a complex web of financial and non-financial criteria.

For most children, pregnant women, and non-disabled adults, financial eligibility is determined using a methodology based on Modified Adjusted Gross Income (MAGI).¹

For individuals who are aged (65 and older), blind, or disabled, eligibility is generally tied to the rules of the SSI program.¹

Beyond income, individuals must also meet non-financial criteria, such as being a resident of the state and a U.S. citizen or a qualified non-citizen.¹

The program mandates that states cover certain populations but gives them the choice to cover others:

• Mandatory Populations: Federal law requires all states to cover certain groups, including children up to at least 133% of the FPL, pregnant women, and most individuals who qualify for SSI.¹
• Optional Populations: States have the option to cover many other groups. The largest and most significant optional group is the ACA expansion population of adults with incomes up to 138% of the FPL.¹ The decision of whether to cover this group is the single greatest source of variation in Medicaid eligibility across the country, creating a “coverage gap” in non-expansion states where adults may earn too much to qualify for traditional Medicaid but too little to receive subsidies for private insurance on the ACA marketplace.²⁹ State-specific examples from Florida, Georgia, and Alabama show how eligibility categories can differ significantly based on these state choices.³⁰

Similarly, the benefits package is a mix of mandatory requirements and state options:

• Mandatory Benefits: All states must provide a core set of benefits that includes inpatient and outpatient hospital services, physician services, laboratory and X-ray services, and home health services, among others.³³
• Optional Benefits: States can choose to cover a wide array of additional services, such as prescription drugs, dental care, vision services, and physical therapy.³³ This is a primary source of variation in the generosity of state programs. For example, while most states offer some adult dental benefit, the scope can range from comprehensive care to emergency-only services for pain relief.³⁴
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT): This benefit for children under 21 is a uniquely powerful federal requirement. It mandates that states provide any medically necessary service listed in the Social Security Act, even if that service is an optional benefit for adults in the state’s plan. This creates a comprehensive standard of care for children that is unparalleled in the U.S. insurance system.¹¹

The result of this complex architecture is a program that is not one thing, but many.

It is a system whose very design generates tension between national standards and state autonomy, leading to a landscape where the promise of healthcare for the vulnerable is fulfilled unevenly across the country.

Section II: The Beneficiary Experience: Access, Outcomes, and Financial Security

For the more than 80 million Americans enrolled, Medicaid is not an abstract policy but a tangible reality that shapes their health, financial stability, and life opportunities.

An evaluation of the program must therefore be grounded in the beneficiary experience.

The evidence reveals a clear duality: Medicaid provides profound, life-saving benefits compared to being uninsured, yet enrollees often face significant hurdles in translating their coverage into timely, high-quality care.

The Overwhelming Case for Coverage: Health and Mortality

When compared against the alternative of being uninsured, the benefits of Medicaid coverage are substantial and well-documented.

A large and growing body of research demonstrates that gaining Medicaid coverage leads to significant improvements in health.

Landmark studies, including the Oregon Health Insurance Experiment (a randomized controlled trial), have found that Medicaid increases the use of healthcare services across all types of care, improves self-reported health status, and reduces rates of clinical depression.³⁵

Most critically, Medicaid coverage is associated with reduced mortality.

While early studies were sometimes limited by statistical power, a wave of rigorous research following the ACA’s Medicaid expansion has provided strong evidence of this life-saving effect.

Multiple large-scale studies comparing expansion and non-expansion states have found that Medicaid expansion was associated with significant relative reductions in all-cause mortality, with estimates ranging from a 3.6% to a 9.4% decline.³⁶

These mortality reductions have been observed for specific conditions as well, including certain types of cancer, cardiovascular disease, and liver disease.³⁷

During the COVID-19 pandemic, mortality rates from chronic illnesses rose more slowly in Medicaid expansion states, suggesting a protective effect of coverage during a public health crisis.³⁶

These statistics are brought to life through the personal stories of beneficiaries.

Individuals with complex health needs, from cerebral palsy to diabetes to cancer, describe Medicaid as the essential lifeline that allows them to access life-sustaining medications, surgeries, and therapies they would otherwise be unable to afford.³⁸

For many, such as a woman whose cataract surgery restored her vision and ability to drive, Medicaid is not just a health program but a key to maintaining independence and quality of life.³⁹

Financial Protection: The Bulwark Against Medical Debt

Beyond its direct health benefits, Medicaid serves as a crucial form of financial protection.

In the American healthcare system, a serious illness can be financially ruinous even for those with private insurance, due to high premiums, deductibles, and other cost-sharing.

Medical debt is a pervasive problem and a leading driver of financial instability for U.S. families.⁴¹

Medicaid provides a powerful shield against this risk.

Federal law strictly limits the out-of-pocket costs that can be charged to beneficiaries.

Most enrollees pay no premiums and only nominal (or no) copayments for services.¹⁴

This ensures that cost is not a barrier to seeking necessary care, a sharp contrast to the experience of many with private plans who report delaying or skipping care due to cost.⁴³

Research confirms that Medicaid coverage can lower an enrollee’s out-of-pocket medical spending by over 50%.⁴⁴

For families living on the economic margins, this protection is paramount.

Beneficiary stories frequently highlight this role, with individuals stating that without Medicaid, they would have faced bankruptcy, been forced to go into debt, or had to make impossible choices between paying for medication and paying for food.³⁸

The Access Challenge: The Gap Between Coverage and Care

Despite the clear value of having a Medicaid card, possessing coverage does not always guarantee access to care.

This gap between coverage and care is a central and valid criticism of the program.¹⁰

Medicaid patients consistently report greater difficulty accessing care than their privately insured counterparts.

Numerous studies have documented these access barriers.

Compared to individuals with private insurance, Medicaid enrollees are more likely to be denied appointments, particularly for specialty care, and experience significantly longer wait times when they do secure one.⁴⁶

A notable study found that children with Medicaid seeking specialty care were denied appointments 66% of the time, compared to just 11% for children with private insurance.⁴⁷

These challenges are not uniform across all services.

Case studies from states that expanded Medicaid under the ACA show that while access to primary and specialty care is generally reported as good, significant challenges persist in finding dental and behavioral health providers who participate in the program.⁴⁸

Qualitative research with new enrollees reveals that confusion about how to navigate the system and negative interactions with providers can discourage them from seeking care, even when they need it.⁴⁹

Recognizing these difficulties, many states have established ombudsman programs specifically to help beneficiaries resolve problems with health plans and providers.⁵⁰

A Tale of Two Systems: The Nuance of Outcome Comparisons

Critics of Medicaid often point to studies that show Medicaid patients have worse health outcomes for certain conditions, such as some cancers or post-surgical recovery, when compared to privately insured patients.⁴⁶

While these findings are often factually correct, their interpretation requires significant nuance.

The comparison itself can be misleading because the two populations are fundamentally different at baseline.

The Medicaid population, by definition, has lower income and is more likely to have co-existing health conditions, disabilities, and social risk factors (like housing or food insecurity) that negatively impact health, independent of their insurance type.

The privately insured population is, on average, wealthier, healthier, and faces fewer of these barriers.

Therefore, a more scientifically valid and policy-relevant comparison is between having Medicaid coverage and having no insurance at all.

On this measure, the evidence is overwhelming: Medicaid is vastly superior.

As the Oregon Health Insurance Experiment demonstrated, gaining Medicaid coverage increases access to care, improves self-reported health, enhances financial security, and virtually eliminates catastrophic medical expenditures compared to being uninsured.³⁶

The program successfully moves people from a state of high medical and financial vulnerability to one of coverage and protection, even if that coverage does not provide the same level of provider access as high-cost private plans.²⁹

Long-Term Intergenerational Impact: The Power of Childhood Coverage

Perhaps the most profound and often overlooked benefit of Medicaid is its long-term impact, particularly when provided during childhood.

A robust and growing body of economic and health research demonstrates that childhood Medicaid coverage is a powerful investment in human capital that pays dividends for decades.

Studies using longitudinal data that follows children into adulthood have found that increased eligibility for Medicaid in childhood is associated with a range of positive long-term outcomes.

These include better health in adulthood (fewer hospitalizations and a lower incidence of chronic conditions like high blood pressure and diabetes), higher educational attainment (including increased rates of college enrollment), and improved economic self-sufficiency (higher earnings, lower reliance on disability benefits, and higher tax payments).⁵¹

The economic returns on this investment are striking.

The non-partisan Congressional Budget Office (CBO) has analyzed these long-term effects and estimates that for every additional year of Medicaid coverage provided to a child, the positive long-term fiscal effects—in the form of increased future tax revenues and decreased spending on other government transfer programs—could offset between 50% and 200% of the program’s initial cost.⁵¹

This reframes spending on childhood Medicaid not as a simple cost, but as a societal investment with a quantifiable, and often positive, return.

This evidence reveals a core paradox in the beneficiary experience.

For an individual, Medicaid is highly effective at providing the two most fundamental benefits of insurance: improved health outcomes compared to being uninsured and robust financial protection from the high cost of care.

However, the program is significantly less effective at providing the same level of convenient and timely access to providers that is often associated with private insurance.

Furthermore, the program’s greatest value may lie in its long-term, intergenerational benefits, a reality that transforms the fiscal debate from one of short-term costs to one of long-term investment in the nation’s future health and prosperity.

Section III: The Provider Perspective: Reimbursement, Administrative Burdens, and Participation

The experience of healthcare providers—physicians, hospitals, and clinics—is a critical and often determinative factor in Medicaid’s success.

For the program to function, there must be a sufficient number of willing providers to deliver care to enrollees.

However, from the provider perspective, Medicaid is a system fraught with financial and administrative challenges that actively discourage participation.

This strain on the provider network is a primary driver of the access problems faced by beneficiaries.

The Economics of Participation: The Reimbursement Gap

The most frequently cited reason for low provider participation in Medicaid is the program’s low reimbursement rates.¹⁰

Across the country, Medicaid consistently pays providers significantly less than other major insurers for the same services.

• Compared to private insurance, Medicaid physician payment rates are, on average, only 56% of what commercial plans pay.⁴⁶ In some states with large Medicaid programs, such as California and New York, reimbursement can be as low as 38% and 29% of private rates, respectively.⁴⁷
• Compared to Medicare, Medicaid’s fee-for-service (FFS) rates for physician services are also generally lower.⁵⁷ While commercial rates for physician services are about 129% of Medicare rates, Medicaid rates often lag behind the Medicare benchmark.⁵⁷

This payment disparity creates a difficult financial proposition for physician practices, particularly small, independent offices with high overhead costs.⁵⁹

Treating Medicaid patients can often mean losing money on each visit.

While research shows that increasing Medicaid fees can improve physicians’ willingness to accept new patients, these payment bumps are often temporary—as was the case with a temporary ACA provision—or insufficient to close the substantial gap with Medicare and private insurance rates.⁵⁸

The “Hassle Factor”: A Tax on Participation

Compounding the problem of low pay is the immense administrative burden associated with the Medicaid program, a phenomenon often referred to as the “hassle factor”.⁵⁹

This is not merely an issue of inconvenient paperwork; it represents a significant and quantifiable financial penalty for providers who participate in the program.

A groundbreaking study from researchers at the University of Chicago and the National Bureau of Economic Research quantified this burden by analyzing billing data.

The findings were stark:

• A full 25% of Medicaid claims are denied for at least one service upon their initial submission by a physician’s office. This denial rate is dramatically higher than that for Medicare (7.3%) and commercial insurers (4.8%).⁶⁰

Each denial forces a provider’s office into a costly and labor-intensive process of appealing, resubmitting, and haggling with the insurer or state agency to get paid for care that has already been delivered.

The study concluded that the combination of claims that are never ultimately paid and the administrative cost of chasing down payments results in physicians losing an estimated 17% of their potential Medicaid revenue to these billing problems.⁶⁰

This finding is critical, as it suggests that the “administrative tax” is quantitatively just as important as low fee schedules in explaining physicians’ reluctance to treat Medicaid patients.

An interesting paradox arises from this.

From the perspective of the government program, Medicaid’s administrative costs are among the lowest of any health payer, typically running just 4% to 6% of claims paid.⁶¹

This is often touted as a sign of efficiency.

However, the provider-side data suggests that this internal program efficiency is achieved by externalizing immense administrative complexity and cost onto the provider community.

The system as a whole becomes highly inefficient, with the friction and cost of this externalized burden ultimately borne by patients in the form of reduced access to care.

Consequences of Systemic Strain: A Two-Tiered System

The combined effect of low reimbursement and high administrative burden has a direct and predictable consequence: low provider participation.

This creates what many have described as a two-tiered healthcare system, where Medicaid patients have fewer care options than those with other forms of insurance.

• National surveys show that only about 71% to 74% of physicians accept new Medicaid patients, a figure that stands in sharp contrast to the 85% to 88% who accept new Medicare patients and the 90% to 96% who accept new privately insured patients.⁵⁷
• The problem is even more acute for certain specialties. Only 36% of psychiatrists, for example, accept new Medicaid patients, a critical access barrier given Medicaid’s role as the nation’s largest payer for behavioral health services.⁶²

This lack of broad participation forces Medicaid enrollees into a smaller, more concentrated set of providers.

These are often large hospital outpatient departments or community health centers, which have a mission to serve this population, or practices pejoratively labeled “Medicaid mills”.¹⁰

While these safety-net providers are essential, this concentration has its own negative consequences.

Because these Medicaid-centric practices operate on lower revenue streams, they are often less able to invest in quality-improving infrastructure, such as modern Electronic Health Record (EHR) systems.

This dynamic threatens to widen the quality gap between the care available to Medicaid patients and that available to the rest of the population over time.⁵⁶

The provider perspective thus reveals a system under immense strain.

The policy choices regarding payment and administration have created a difficult environment for providers, which in turn fuels the access challenges for beneficiaries.

The following table starkly illustrates the structural disadvantages Medicaid providers face within the broader U.S. healthcare system.

Metric	Medicaid	Medicare	Private Insurance
Overall Physician Acceptance Rate (New Patients)	~74% 57	~88% 57	~96% 57
Psychiatrist Acceptance Rate (New Patients)	36% 62	62% 62	62% 62
Average Physician Reimbursement (as % of Private)	~56% 46	Higher than Medicaid 57	100%
Initial Claim Denial Rate	25% 60	7.3% 60	4.8% 60
Patient Out-of-Pocket Costs	Nominal/None 34	Premiums/Deductibles 43	High Premiums/Deductibles 43

This comparison makes it clear that addressing Medicaid’s access problems requires a two-pronged approach.

Simply debating reimbursement rates is insufficient.

Meaningful policy reform must also focus on simplifying administration and reducing the hidden “hassle tax” that drives providers from the program and leaves patients searching for care.

Section IV: The Fiscal and Economic Dimension: State Budget Strain and Economic Engine

The fiscal impact of Medicaid is one of the most intensely debated aspects of the program.

For state governments, it represents both a significant budgetary pressure and a powerful economic engine.

For the broader healthcare economy, particularly hospitals, it is a financial anchor that reduces the burden of caring for the uninsured.

Understanding these dual roles is essential to a complete evaluation of the program’s worth.

The “Pac-Man” of State Budgets

There is no denying that Medicaid is a massive expenditure for states.

It is often described by governors and state administrators as the “Pac-Man” of state budgets, consuming a large share of available revenue each year.¹⁰

On average, Medicaid accounts for nearly 30% of total state expenditures (a figure that includes the large federal share).²⁶

When considering only the funds that states generate themselves (e.g., from taxes), Medicaid is typically the second-largest category of spending, behind only K-12 education, comprising about 19% of general fund expenditures.⁵

This large fiscal footprint means that Medicaid is perpetually at the center of state budget negotiations.

In fiscal year 2023, states collectively spent $294 billion of their own resources on the program.⁶⁴

When states face budget shortfalls, the size of the Medicaid program makes it a frequent target for cuts, which can include reducing provider payment rates, limiting optional benefits, or tightening eligibility rules.⁶³

The sheer scale of the expenditure creates constant pressure on state finances and forces difficult trade-offs with other priorities like higher education, transportation, and public safety.¹⁰

The Economic Engine

While Medicaid is a major expenditure, it is simultaneously the single largest source of federal funds flowing into state economies.⁴

This infusion of federal dollars has a powerful “multiplier effect,” meaning that every federal dollar spent on Medicaid generates more than a dollar’s worth of economic activity within the state.⁶⁵

The mechanism for this is straightforward.

Federal Medicaid funds flow to healthcare providers like hospitals and clinics, who then use that revenue to pay salaries, purchase supplies from local vendors, and invest in infrastructure.⁶⁵

This directly supports jobs, not only in the healthcare sector but also in related industries like construction and retail.

The employees in these sectors then spend their income, further stimulating the local economy.

This increased business and consumer activity, in turn, generates higher state and local tax revenues, helping to offset the state’s initial investment in the program.⁶⁵

The economic benefits of this federal investment are substantial.

One analysis projected that a proposed $880 billion cut to federal Medicaid funding over ten years would result in the loss of over 1 million jobs and a $95 billion decrease in the nation’s GDP.⁶⁵

This demonstrates that viewing Medicaid solely through the lens of state expenditure is a fundamentally incomplete analysis.

It is also a critical driver of state economic health.

A Financial Lifeline for Hospitals: Reducing Uncompensated Care

One of the most significant economic benefits of Medicaid is its role in reducing uncompensated care costs for hospitals.

Uncompensated care is treatment that hospitals are legally obligated to provide but for which they receive no payment from an insurer or patient.

It consists of both charity care and bad debt, and it places immense financial strain on hospital budgets.⁶⁷

By providing coverage to low-income individuals who would otherwise be uninsured, Medicaid dramatically reduces these costs.

The impact of the ACA’s Medicaid expansion provides the clearest evidence of this effect.

Studies consistently show that in states that expanded Medicaid, hospitals experienced sharp declines in uncompensated care costs as their proportion of uninsured patients fell and their proportion of Medicaid-covered patients rose.⁶⁷

• One major study found that between 2013 and 2015, uncompensated care costs in expansion states fell from 3.9% to 2.3% of total hospital operating costs, translating to an estimated savings of $6.2 billion for hospitals in those states.⁶⁷
• This effect was most pronounced for safety-net and rural hospitals, which serve the highest proportion of low-income and uninsured patients and are often the most financially vulnerable.⁶⁷

Conversely, proposals to cut federal Medicaid funding or roll back expansion are projected to have a devastating impact on hospital finances.

One analysis estimated that proposed cuts would add $443.4 billion to hospitals’ uncompensated care costs over a decade, with essential safety-net hospitals bearing a disproportionate share of that burden.⁷⁰

Another study projected that eliminating the enhanced federal funding for the ACA expansion would lead to an $80 billion decrease in healthcare spending and a nearly $19 billion increase in uncompensated care costs in a single year.⁷¹

The Countercyclical Stabilizer

A unique and vital feature of Medicaid’s design is its role as a countercyclical program.²⁴

Unlike private insurance, which is often tied to employment, Medicaid enrollment is based on income.

During an economic downturn, when people lose their jobs and their employer-sponsored insurance, they can turn to Medicaid.

The program is designed to automatically expand to meet this increased need due to its open-ended federal funding and continuous open enrollment policies.²⁵

This creates a crucial economic stabilizing effect.

Just as state tax revenues are falling due to the recession, the federal government automatically injects more Medicaid dollars into the state’s economy, cushioning the economic blow.²⁵

This was clearly demonstrated during the COVID-19 pandemic and the Great Recession, when Congress enacted temporary increases in the FMAP to further bolster state budgets and ensure the safety net could respond to the surge in need.⁹

This fiscal architecture reveals that the debate over Medicaid’s cost is far more complex than a simple line item in a budget.

The program functions as both a fiscal anchor, weighing down state budgets with its large expenditures, and an economic engine, driving employment and growth with a massive infusion of federal funds.

Any policy discussion that focuses solely on the “cost” of Medicaid without accounting for its immense economic benefits—particularly its role in stabilizing the healthcare sector and the broader economy—is fundamentally flawed.

Section V: Navigating the Policy Labyrinth: Expansion, Work Requirements, and the Future of Medicaid

The structure and performance of Medicaid are not static; they are continuously shaped by major policy decisions at the federal and state levels.

Three areas of policy have been particularly consequential in recent years: the Affordable Care Act (ACA) expansion, the debate over work requirements, and the shift toward managed care delivery systems.

Furthermore, the program’s role in responding to public health emergencies has underscored its importance as a flexible tool for national crises.

These policy debates are not academic; they directly determine who gets covered, what care they receive, and how the program functions.

The ACA Expansion: A Landmark Reform

The ACA’s provision allowing states to expand Medicaid eligibility to adults with incomes up to 138% of the FPL represents the most significant change to the program since its inception.

As of March 2024, 41 states and the District of Columbia had adopted the expansion, leading to dramatic gains in health insurance coverage.⁹

The effects of expansion have been overwhelmingly positive according to a vast body of research encompassing over 600 studies ⁶⁸:

• Coverage and Access: Expansion states saw significant reductions in their uninsured rates, particularly among low-income adults.⁷² This led to improved access to care, greater utilization of services, and better affordability of care.³⁷
• Health Outcomes: As discussed previously, expansion is linked to improved self-reported health, better management of chronic conditions, and significant reductions in mortality rates.³⁶
• Economic Impact: Expansion has proven to be an economic benefit for states and providers. It has led to state budget savings by offsetting state costs in other areas, generated overall economic growth, and dramatically reduced uncompensated care costs for hospitals and clinics, strengthening the financial stability of the healthcare safety net.⁶⁵

However, the 2012 Supreme Court decision making expansion optional created a deep and persistent geographic divide.

In the states that have not expanded, millions of low-income adults fall into a “coverage gap”—they earn too much to qualify for traditional Medicaid but not enough to be eligible for subsidies to purchase private insurance on the ACA marketplaces.²⁹

This policy choice has left nearly half of the nation’s remaining uninsured population concentrated in a handful of non-expansion states.⁶⁶

The ACA expansion thus serves as the clearest illustration of how a single policy decision can dramatically alter the “goodness” or “badness” of Medicaid’s impact within a state.

Work Requirements: A Contentious Debate

In recent years, one of the most contentious policy debates has centered on proposals to require certain Medicaid enrollees to work, volunteer, or attend school as a condition of eligibility.

Proponents argue that such requirements promote self-sufficiency and “community engagement”.⁷³

However, the evidence from states that have attempted to implement these policies, as well as analyses of national proposals, suggests they are counterproductive and harmful.

• Most Enrollees Already Work or Cannot: The premise of work requirements is largely flawed. Data shows the vast majority of non-disabled adult Medicaid enrollees are already working (often in low-wage jobs without health benefits), are caregivers for family members, are ill or disabled themselves (but do not meet the strict criteria for federal disability benefits), or are in school.⁷³
• Coverage Loss, Not Employment Gain: The primary outcome of work requirements is not increased employment but significant loss of health coverage. In Arkansas, the first state to fully implement the policy, over 18,000 people lost their Medicaid coverage in a matter of months, not because they weren’t working, but primarily due to confusion and insurmountable administrative hurdles in reporting their work hours through a faulty online portal.⁷⁶ Rigorous studies found the policy caused a spike in the uninsured rate with no significant corresponding increase in employment.⁷⁶
• High Administrative Costs: Implementing the complex systems needed to track work hours, process exemptions, and manage disenrollments is enormously expensive for states. Georgia’s limited work requirement program cost over $40 million in its first year, with nearly 80% of the funds going to administrative and consulting fees rather than to healthcare for the small number of people who enrolled.⁷⁶
• Negative Health and Financial Impacts: Losing Medicaid coverage due to work requirements has been linked to poorer medication adherence, delays in necessary care, and increased medical debt for those affected.⁷⁶

The evidence strongly indicates that work requirements function not as a tool to promote work, but as an administrative barrier designed to reduce Medicaid rolls, leading to worse health outcomes and higher administrative costs without achieving their stated goal of increasing employment.⁷⁴

The Shift to Managed Care

Today, the dominant delivery system for Medicaid is not the traditional fee-for-service model but capitated managed care.

As of 2022, 75% of all Medicaid beneficiaries were enrolled in comprehensive Managed Care Organizations (MCOs).⁷⁸

Under this model, states pay private insurance companies a fixed per-member, per-month fee (a capitation payment) to provide all or most of a beneficiary’s care.

The goals are to improve care coordination, enhance quality, and create budget predictability for states.⁴⁴

However, the evidence on the effectiveness of MCOs is mixed and presents a complex picture:

• Budget Predictability: For states, MCOs have been successful in making costs more predictable, as the financial risk of higher-than-expected healthcare utilization is shifted to the private plans.⁴⁴ Payments to MCOs now account for over half of all Medicaid spending nationally.⁴
• Access and Quality Concerns: The evidence that managed care improves access and quality is limited and mixed.⁷⁸ A major concern is the use of prior authorization to control costs. A 2023 government report found that Medicaid MCOs denied prior authorization requests at a rate of 12.5%, more than double the rate in Medicare Advantage, raising serious questions about whether plans are inappropriately denying needed care.⁷⁸
• Oversight Challenges: The shift to MCOs creates significant oversight challenges for state and federal governments. Ensuring that plans maintain adequate provider networks, deliver high-quality care, and use public dollars appropriately requires robust monitoring and transparency, which can be difficult to achieve.⁷⁸

A Tool for Public Health Emergencies

Medicaid’s flexible structure makes it an indispensable tool for responding to public health crises.

Its ability to quickly absorb newly eligible people and its open-ended federal funding allow it to function as a critical safety net during emergencies when other systems fail.²⁵

• The COVID-19 Pandemic: The federal continuous enrollment provision kept millions of Americans covered during the economic turmoil of the pandemic, preventing a massive spike in the uninsured rate.⁹ States also used emergency waiver authorities to expand benefits, such as telehealth, and streamline operations.¹³
• The Opioid Crisis: Medicaid has become the single most important platform for combating the opioid epidemic. It is the nation’s largest payer for substance use disorder treatment, covering nearly 40% of all adults with an opioid use disorder.⁸¹ The ACA’s Medicaid expansion played a central role, dramatically increasing access to treatment in states that adopted it.⁸³ Research has linked expansion to a 6% reduction in total opioid overdose deaths.⁸⁴

These policy areas demonstrate that the performance of Medicaid is not fixed.

It is highly malleable, capable of producing profoundly positive outcomes when policies like the ACA expansion broaden its reach, and profoundly negative outcomes when policies like work requirements restrict it.

Its utility as a public health tool further underscores its value beyond that of a simple insurance program, positioning it as a key piece of national crisis-response infrastructure.

Conclusion: Reconciling the Paradox

The question “is Medicaid bad” cannot be answered with a simple affirmation or denial.

To do so would be to ignore the vast and often contradictory body of evidence that defines the program.

The analysis presented in this report reveals that Medicaid is a paradox: it is a fundamentally essential program with profound, life-saving benefits, yet it is also a deeply flawed system whose effectiveness is continually undermined by structural weaknesses and political volatility.

The evidence overwhelmingly supports the conclusion that, for its beneficiaries, Medicaid is an invaluable lifeline.

Compared to the alternative of being uninsured—the reality for most enrollees—the program dramatically improves access to healthcare, reduces mortality, provides critical treatment for chronic and acute conditions, and offers robust protection against the financial ruin of medical debt.

For children, it is a long-term investment in human capital, yielding decades of returns in the form of better health, higher educational attainment, and greater economic productivity.

From the perspective of the healthcare system and state economies, Medicaid is a financial pillar, reducing the burden of uncompensated care for hospitals and acting as a powerful economic engine and automatic stabilizer.

However, these immense benefits exist alongside significant and persistent failings.

The program’s design as a federal-state partnership, while allowing for flexibility, has created a fractured and inequitable system where an American’s access to care is dictated by their state of residence.

From the provider’s perspective, the combination of chronically low reimbursement rates and a staggering administrative burden creates a hostile operating environment, discouraging participation and directly contributing to the access problems faced by patients.

This forces many beneficiaries into a de facto second-tier system with fewer choices and longer waits for care.

Therefore, a more productive question than “is Medicaid bad” is “how can we mitigate the program’s inherent weaknesses to maximize its proven strengths?” The path forward does not lie in dismantling this essential safety net, but in undertaking targeted reforms to address its most critical failures.

Based on the extensive evidence reviewed, several key priorities emerge:

1. Resolve the Provider Crisis: Policy efforts must move beyond intermittent debates over fee increases and aggressively tackle the “administrative tax” on providers. This requires federal and state action to simplify billing, standardize and streamline prior authorization processes, and invest in modern information systems that reduce the friction and cost of participation. Making it easier and more financially viable for providers to treat Medicaid patients is the most direct path to improving beneficiary access.
2. Close the Coverage Gap: The continued existence of the Medicaid coverage gap in states that have not expanded eligibility is a national policy failure. Federal and state leaders must pursue solutions—whether through new financial incentives for states or alternative federal programs—to ensure that all low-income Americans have a pathway to affordable health coverage.
3. Commit to Long-Term Value: Policymakers must fully recognize and act upon the evidence that childhood Medicaid coverage is a high-return investment. Policies that promote stable, continuous coverage for children, such as multi-year continuous eligibility, should be protected and expanded, as their long-term societal benefits far outweigh their short-term costs.
4. Strengthen Oversight and Accountability: As managed care remains the dominant delivery system, federal and state oversight of MCOs must be strengthened. This includes enforcing network adequacy standards, increasing transparency around prior authorization denials, and ensuring that capitation payments are linked to quality outcomes, not just cost containment.
5. Reframe the Public Debate: The political discourse surrounding Medicaid must evolve. It must shift from a narrow and misleading focus on the program as a short-term “cost” to a more accurate and evidence-based understanding of its multiple roles: as a life-saving health insurer, a critical form of financial protection, a long-term investment in the nation’s human capital, a vital economic stabilizer for states, and an essential piece of public health infrastructure.

Ultimately, Medicaid is a reflection of the nation’s complex and often contradictory priorities.

It is a testament to a collective commitment to care for the vulnerable, yet it is also a product of a fragmented political system that tolerates deep inequities.

The program is not inherently “good” or “bad”; it is an indispensable tool whose ultimate value is determined by the policy choices we make.

Works cited

1. Eligibility Policy | Medicaid, accessed August 13, 2025, https://www.medicaid.gov/medicaid/eligibility-policy
2. Medicaid State Fact Sheets – KFF, accessed August 13, 2025, https://www.kff.org/interactive/medicaid-state-fact-sheets/
3. Medicaid: A Brief History of Publicly Financed Health Care in the …, accessed August 13, 2025, https://www.chcs.org/resource/medicaid-a-brief-history-of-publicly-financed-health-care-in-the-united-states/
4. Medicaid Financing: The Basics – KFF, accessed August 13, 2025, https://www.kff.org/medicaid/issue-brief/medicaid-financing-the-basics/
5. Medicaid 101 – KFF, accessed August 13, 2025, https://www.kff.org/health-policy-101-medicaid/
6. History | CMS, accessed August 13, 2025, https://www.cms.gov/about-cms/who-we-are/history
7. Annual Statistical Supplement, 2015 – Medicaid Program Description and Legislative History, accessed August 13, 2025, https://www.ssa.gov/policy/docs/statcomps/supplement/2015/medicaid.html
8. Legislating Medicaid: Considering Medicaid and Its Origins – PMC, accessed August 13, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4194918/
9. How Has Medicaid Evolved Over Time? – Medicaid 101 | KFF, accessed August 13, 2025, https://www.kff.org/health-policy-101-medicaid/?entry=table-of-contents-how-has-medicaid-evolved-over-time
10. Perspectives on the Medicaid program – PMC, accessed August 13, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4195152/
11. Medicaid: A Brief History of Publicly Financed Health Care in the United States, accessed August 13, 2025, https://www.chcs.org/media/Medicaid-Timeline-Fact-Sheet_01.14.20v2.pdf
12. Medicaid.gov: The Official U.S. Government Site for Medicaid and CHIP Services | Medicaid, accessed August 13, 2025, https://www.medicaid.gov/
13. Medicaid’s Response to COVID-19 – MACPAC, accessed August 13, 2025, https://www.macpac.gov/topic/medicaids-response-to-covid-19/
14. What’s the difference between Medicare and Medicaid? – HHS.gov, accessed August 13, 2025, https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html
15. Financial Management | Medicaid, accessed August 13, 2025, https://www.medicaid.gov/medicaid/financial-management
16. Administration – MACPAC, accessed August 13, 2025, https://www.macpac.gov/medicaid-101/administration/
17. CMS: Home – Centers for Medicare & Medicaid Services, accessed August 13, 2025, https://www.cms.gov/
18. Center for Medicaid and CHIP Services, accessed August 13, 2025, https://www.medicaid.gov/about-us/Center-for-Medicaid-and-CHIP-Services
19. Medicaid | Medicaid, accessed August 13, 2025, https://www.medicaid.gov/medicaid
20. Federal Policy Guidance – Medicaid, accessed August 13, 2025, https://www.medicaid.gov/federal-policy-guidance
21. Medicaid – State of Michigan, accessed August 13, 2025, https://www.michigan.gov/mdhhs/assistance-programs/medicaid/portalhome/beneficiaries/programs/medicaid
22. Florida State Medicaid Managed Care – Home Page, accessed August 13, 2025, https://www.flmedicaidmanagedcare.com/
23. Home – Medicaid: Utah Department of Health and Human Services – Integrated Healthcare, accessed August 13, 2025, https://medicaid.utah.gov/
24. How Do We Pay for Medicaid? – Commonwealth Fund, accessed August 13, 2025, https://www.commonwealthfund.org/publications/explainer/2025/mar/how-do-we-pay-for-medicaid
25. Medicaid’s Vital Role in Addressing Health and Economic Emergencies – Scholarship Commons, accessed August 13, 2025, https://scholarship.law.slu.edu/cgi/viewcontent.cgi?article=1631&context=faculty
26. Why Did They Do It That Way? Medicaid Financing, accessed August 13, 2025, https://medicaiddirectors.org/resource/why-did-they-do-it-that-way-medicaid-financing/
27. How Do States Pay for Medicaid? – Peterson Foundation, accessed August 13, 2025, https://www.pgpf.org/article/budget-explainer-how-do-states-pay-for-medicaid/
28. How to apply for Medicaid and CHIP | USAGov, accessed August 13, 2025, https://www.usa.gov/medicaid-chip-insurance
29. Medicaid Expansion under the Affordable Care Act. Implications for Insurance-related Disparities in Pulmonary, Critical Care, and Sleep, accessed August 13, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4225799/
30. Basic Eligibility | Georgia Medicaid, accessed August 13, 2025, https://medicaid.georgia.gov/how-apply/basic-eligibility
31. Medicaid Redetermination | Florida DCF, accessed August 13, 2025, https://www.myflfamilies.com/medicaid
32. Qualifying for Medicaid in Alabama, accessed August 13, 2025, https://medicaid.alabama.gov/content/3.0_Apply/3.2_Qualifying.aspx
33. Benefits – Medicaid, accessed August 13, 2025, https://www.medicaid.gov/medicaid/benefits
34. Benefits – MACPAC, accessed August 13, 2025, https://www.macpac.gov/medicaid-101/benefits/
35. ajph.aphapublications.org, accessed August 13, 2025, https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2025.308124#:~:text=Our%20findings%20showed%20that%2C%20compared,depression%2C%20and%20improved%20financial%20stability.
36. Does Medicaid Improve Health? | AJPH | Vol. 115 Issue 6, accessed August 13, 2025, https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2025.308124
37. Building on the Evidence Base: Studies on the Effects of Medicaid …, accessed August 13, 2025, https://www.kff.org/report-section/building-on-the-evidence-base-studies-on-the-effects-of-medicaid-expansion-february-2020-to-march-2021-report/
38. Medicaid Stories Library, accessed August 13, 2025, https://modernmedicaid.org/medicaid-stories-library/
39. Medicaid Stories – Catholic Health Association, accessed August 13, 2025, https://www.chausa.org/advocacy/medicaid/stories
40. Medicaid & Mental Health Stories | National Alliance on Mental Illness (NAMI), accessed August 13, 2025, https://www.nami.org/advocacy/advocate-for-change/protect-medicaid-protect-mental-health/medicaid-mental-health-stories/
41. State Protections Against Medical Debt: A Look at Policies Across the U.S. in 2025 – Commonwealth Fund, accessed August 13, 2025, https://www.commonwealthfund.org/publications/fund-reports/2025/jul/state-protections-against-medical-debt-look-policies-across-us
42. Medical Debt – NY Statewide Senior Action Council, accessed August 13, 2025, https://www.nysenior.org/medical-debt/
43. KFF Survey of Consumer Experiences with Health Insurance, accessed August 13, 2025, https://www.kff.org/affordable-care-act/poll-finding/kff-survey-of-consumer-experiences-with-health-insurance/
44. Medicaid managed care: Improving outcomes, enhancing access and managing costs, accessed August 13, 2025, https://www.healthaffairs.org/sponsored-content/medicaid-managed-care-improving-outcomes-enhancing-access-and-managing-costs
45. Other Impactful Stories – Arkansas Advocates for Children and Families, accessed August 13, 2025, https://www.aradvocates.org/stories/medicaid-the-lived-experience/other-impactful-stories/
46. Studies Show: Medicaid Patients Have Worse Access and Outcomes than the Privately Insured | The Heritage Foundation, accessed August 13, 2025, https://www.heritage.org/health-care-reform/report/studies-show-medicaid-patients-have-worse-access-and-outcomes-the
47. Medicaid: The Worst Medical Outcomes in America – Physicians for Reform, accessed August 13, 2025, https://www.physiciansforreform.org/minority-outreach/medicaid-worst-medical-outcomes-america/
48. Findings from the Field: Medicaid Delivery Systems and Access to Care in Four States in Year Three of the ACA | KFF, accessed August 13, 2025, https://www.kff.org/medicaid/issue-brief/findings-from-the-field-medicaid-delivery-systems-and-access-to-care-in-four-states-in-year-three-of-the-aca/
49. New Medicaid Enrollees In Oregon Report Health Care Successes And Challenges – PMC, accessed August 13, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3962263/
50. Frequently asked questions – NC Medicaid Managed Care, accessed August 13, 2025, https://ncmedicaidplans.gov/get-answers
51. New CBO Study Explores the Long-Term Fiscal Benefits of Medicaid Coverage in Childhood, accessed August 13, 2025, https://ccf.georgetown.edu/2023/11/16/new-cbo-study-explores-the-long-term-fiscal-benefits-of-medicaid-coverage-in-childhood/
52. The Long-Term Impacts of Medicaid Exposure in Early Childhood: Evidence from the Program’s Origin – PMC, accessed August 13, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4785872/
53. Long-Term Impacts of Childhood Medicaid Expansions on Outcomes in Adulthood – PMC, accessed August 13, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7453338/
54. Exploring the Effects of Medicaid During Childhood on the Economy and the Budget, accessed August 13, 2025, https://www.cbo.gov/system/files/2023-10/59231-Medicaid.pdf
55. Exploring the Effects of Medicaid During Childhood on the Economy and the Budget: Working Paper 2023-07, accessed August 13, 2025, https://www.cbo.gov/publication/59231
56. Are Medicaid Patients Seen in Office-Based Practices Getting High …, accessed August 13, 2025, https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/medicaid-patients-office-practices-high-quality-primary-care
57. Evaluating the Effects of Medicaid Payment Changes on Access to Physician Services | MACPAC, accessed August 13, 2025, https://www.macpac.gov/wp-content/uploads/2025/01/Evaluating-the-Effects-of-Medicaid-Payment-Changes-on-Access-to-Physician-Services.pdf
58. The Effect of Medicaid Physician Fee Increases on Health Care Access, Utilization, and Expenditures, accessed August 13, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC5867180/
59. Study: Nearly A Third Of Doctors Won’t See New Medicaid Patients – KFF Health News, accessed August 13, 2025, https://kffhealthnews.org/news/third-of-medicaid-doctors-say-no-new-patients/
60. The Cost of Administrative Burdens: Providers Stop Accepting …, accessed August 13, 2025, https://harris.uchicago.edu/news-events/news/cost-administrative-burdens-providers-stop-accepting-medicaid-due-hassle-lost
61. Medicaid Administrative Costs, accessed August 13, 2025, https://www.thenationalcouncil.org/wp-content/uploads/2022/04/ES-MedicaidAdministrativeCosts-121305.pdf
62. Doctors less likely to accept Medicaid than other insurance – Healthcare Dive, accessed August 13, 2025, https://www.healthcaredive.com/news/doctors-less-likely-to-accept-medicaid-than-other-insurance/546941/
63. Balancing State Medicaid Budgets – National Conference of State Legislatures, accessed August 13, 2025, https://www.ncsl.org/health/balancing-state-medicaid-budgets
64. The Share of State Budgets Spent on Medicaid Posts Largest Annual Increase in 20 Years, accessed August 13, 2025, https://www.pew.org/en/research-and-analysis/articles/2025/06/16/the-share-of-state-budgets-spent-on-medicaid-posts-largest-annual-increase-in-20-years
65. How Does Medicaid Benefit States? – Commonwealth Fund, accessed August 13, 2025, https://www.commonwealthfund.org/publications/explainer/2025/may/how-does-medicaid-benefit-states
66. Economic and Employment Effects of Medicaid Expansion Under …, accessed August 13, 2025, https://www.commonwealthfund.org/publications/issue-briefs/2021/may/economic-employment-effects-medicaid-expansion-under-arp
67. The Impact of the ACA’s Medicaid Expansion on Hospitals’ Uncompensated Care Burden and the Potential Effects of Repeal – Commonwealth Fund, accessed August 13, 2025, https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2017_may_dranove_aca_medicaid_expansion_hospital_uncomp_care_ib.pdf
68. Recent Studies Show That Medicaid Expansion Has Improved the Financial Performance of Hospitals and Other Providers, In Line With Prior Research | KFF, accessed August 13, 2025, https://www.kff.org/affordable-care-act/press-release/recent-studies-show-that-medicaid-expansion-has-improved-the-financial-performance-of-hospitals-and-other-providers-in-line-with-prior-research/
69. What Does the Recent Literature Say About Medicaid Expansion …, accessed August 13, 2025, https://www.kff.org/affordable-care-act/issue-brief/what-does-the-recent-literature-say-about-medicaid-expansion-economic-impacts-on-providers/
70. Additional Hospital Uncompensated Care Costs Projected Under Proposed Senate Revisions to H.R. 1, accessed August 13, 2025, https://essentialhospitals.org/estimated-effects-of-h-r-1-on-hospital-uncompensated-care-costs-2/
71. Hospital Revenue Losses And Increased Uncompensated Care If Medicaid Funding Is Cut, accessed August 13, 2025, https://www.rwjf.org/en/insights/our-research/2025/03/hospital-revenue-losses-and-increased-uncompensated-care-if-medicaid-funding-is-cut.html
72. The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020 | KFF, accessed August 13, 2025, https://www.kff.org/affordable-care-act/report/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review/
73. Medicaid Work Requirements Continue to Be a Bad Idea – Medicare Rights Center, accessed August 13, 2025, https://www.medicarerights.org/medicare-watch/2025/02/06/medicaid-work-requirements-continue-to-be-a-bad-idea
74. Work Requirements in Medicaid: a Bad Idea – Families USA, accessed August 13, 2025, https://familiesusa.org/wp-content/uploads/2019/09/Work-Requirements-in-Medicaid-a-Bad-Idea_Perspective.pdf
75. Medicaid Myths and Misconceptions – BenefitU, accessed August 13, 2025, https://benefitu.org/news-and-information/medicaid-myths-and-misconceptions/
76. 5 Key Facts About Medicaid Work Requirements | KFF, accessed August 13, 2025, https://www.kff.org/medicaid/issue-brief/5-key-facts-about-medicaid-work-requirements/
77. Work Requirements Threaten Health and Increase Costs – Robert Wood Johnson Foundation, accessed August 13, 2025, https://www.rwjf.org/en/insights/our-research/2025/04/work-requirements-threaten-health-and-increase-costs.html
78. 10 Things to Know About Medicaid Managed Care | KFF, accessed August 13, 2025, https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/
79. Reconciling Practice and Theory: Challenges in Monitoring Medicaid Managed-Care Quality, accessed August 13, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4193533/
80. “Medicaid’s Vital Role in Addressing Health and Economic Emergencies” by Nicole Huberfeld and Sidney Watson – Scholarship Commons, accessed August 13, 2025, https://scholarship.law.slu.edu/faculty/630/
81. Medicaid’s Role in Fighting the Opioid Epidemic – Robert Wood Johnson Foundation, accessed August 13, 2025, https://www.rwjf.org/en/insights/our-research/2019/02/medicaid-s-role-in-fighting-the-opioid-epidemic.html
82. The Opioid Epidemic and Medicaid’s Role in Facilitating Access to Treatment | KFF, accessed August 13, 2025, https://www.kff.org/medicaid/issue-brief/the-opioid-epidemic-and-medicaids-role-in-facilitating-access-to-treatment/
83. The role of Medicaid in addressing the opioid epidemic – Brookings Institution, accessed August 13, 2025, https://www.brookings.edu/articles/the-role-of-medicaid-in-addressing-the-opioid-epidemic/
84. Medicaid Expansion Associated with Fewer Total Opioid Overdose Deaths Across the United States | NYU Langone News, accessed August 13, 2025, https://nyulangone.org/news/medicaid-expansion-associated-fewer-total-opioid-overdose-deaths-across-united-states