Forum Session

Where You Stand Depends on Where You Sit: Perspectives on Medicaid Fiscal Integrity and Intergovernmental Relationships
September 15, 2006


Judith D. Moore


This Forum session reviewed a new report by the National Academy for State Health Policy (NASHP), “Moving Beyond the Tug of War: Improving Medicaid Fiscal Integrity.” The report, based on a one-day meeting of state and federal Medicaid officials and other experts, describes the tensions that have developed over the last 25 years between federal and state Medicaid program administrators around the financing of the program. The Medicaid program, which in 2004 spent over $115 billion in state and $172 billion in federal funds, supports health care coverage for over 55 million vulnerable people. The NASHP report identifies a cycle of federal action and state response, a cycle that intensifies the difficulty of delivering care to needy people and breaks trust between federal and state partners, making Medicaid reform and change more complex. Speakers offered their insights about the report and commented on the different perspectives, attitudes, and views held by federal and state decision makers and administrators, as well as the potential actions that might be taken to break the cycle and potentially defuse the ongoing intergovernmental stalemate.


Alan Weil, JD, Executive Director, National Academy for State Health Policy; Timothy M. Westmoreland, JD, Visiting Professor of Law, Georgetown University Law Center; Barbara C. Edwards, Principal, Health Management Associates

With Comments from Key Congressional Staff

Related Materials

For further information, see the related NASHP report, “Moving Beyond the Tug of War: Improving Medicaid Fiscal Integrity” (or summary brief); statement of Mr. Westmoreland before the Committee on Finance, U.S. Senate, June 28, 2005; and two National Health Policy Forum publications: "Medicaid's Disproportionate Hospital Share Program: Complex Structure, Critical Payments" (Background Paper, September 14, 2004) and "Medicaid Financing" (The Basics, January 5, 2016).

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