Perspective:

Medicaid is the basis of a major expansion of publicly funded health insurance authorized by the Affordable Care Act (ACA). Since federal and state governments share administrative and funding responsibilities for the program, striking acceptable balances has been a source of contention since Medicaid was created in 1965. Recently, the Supreme Court announced that among the questions it would review in legal challenges to the ACA will be that of whether Congress exceeded its authority by expanding Medicaid and obligating states to take this step or risk losing all federal Medicaid payments. It is beyond a doubt that Medicaid patients with the most complex conditions could gain by enrolling in well-run managed care plans that provide more integrated, readily accessible services than the uncoordinated fee-for-service model. But getting there will be one of Medicaid’s greatest challenges over the next decade, and physicians will have to play a leading role to achieve cost-effective, integrated care for not just Medicaid patients, but all our patients.