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Though originally envisioned for seven specific mandatory populations and services, the program has grown through the inclusion of eight additional optional populations and services. States are required to cover mandatory groups—such as elderly on Supplemental Security Income, pregnant women and children younger than six in families below 133 percent of the Federal Poverty Level—as a condition of participation in the program. They may pick which optional groups and services to cover, such as pregnant women above 133 percent FPL. Medicaid now funds services commonly broken down into several broad groups: children (50 percent of enrollment), adults (22 percent), elderly (10 percent) and the blind and disabled (18 percent).
As the program’s scope and enrollment has grown, so has the program’s share of state and federal budgets. The increasing fiscal pressures of the program—the U.S. Government Accountability Office projects will grow annually by 7.2 percent over the next decade—when coupled with the recent economic downturn brought a renewed interest in reforming Medicaid.
As both state and federal governments move forward with reform propositions, organizations such as National Academy for State Health Policy, National Conference of State Legislatures and National Governors Association are doing the same. Some groups focus on patient care while others focus on economic viability. Each offers family physicians, their friends and advocates an opportunity to shape the future a program upon which so many patients rely.