A few years ago, states such as Tennessee and Oregon experimented trying to expand services to the working poor and other uninsured populations. Today most states simply are looking to cut costs. Budget pressure Lobbyists for the poor worry states face their own budget pressures, which will force cuts in service. State officials say their efficiency can bring savings and better services. Sixteen states plan Medicaid reductions in their 1997 budgets.
Some states are in dire straits.
New York, with the nation's most generous Medicaid program, switched to managed care so fast it had to scale back. For many states, the cutback of choice is managed care - the system of managing health care by emphasizing primary over specialty care, outpatient visits over hospitals and advance payments over fees for individual services. But while continuity of care is good, choices of doctors and hospitals are limited. And some managed-care firms fail to live within their budgets. And while managed care works effectively for children and welfare recipients who make up more than two-thirds of Medicaid beneficiaries, it's tougher to save money on more than 10 million elderly and disabled who require frequent treatment.