7 B.U. Pub. Int. L.J. 251 (1998)
The Trend toward Medicaid Managed Care: Is the Government Selling out the Medicaid Poor

handle is hein.journals/bupi7 and id is 259 raw text is: NOTES THE TREND TOWARD MEDICAID MANAGED CARE: IS THE GOVERNMENT SELLING OUT THE MEDICAID POOR?* Last year expenditures under Medicare amounted to $74 billion; Medicaid cost $25 billion; and the tax subsidy program [to employers who provide health insurance] resulted in about $32 billion in lost revenues. Yet with all this spending we still have children who receive no healthcare services; pregnant women who receive no prenatal care; disabled individuals who are forced to live away from their families and communities; families finan- cially devastated and tom apart because of illness; 37 million people with no health insurance at all; and senior citizens who have to impoverish themselves in order to receive long-term care. Our system is a disaster.' I. INTRODUCTION With the costs of the Medicaid program still rising, federal and state govern- ments alike are counting on managed care to ease their budgetary troubles. While strong evidence exists that managed care has the potential to save states a significant amount of money, states cannot pursue their cost-cutting objective to the exclusion of quality of care. The Medicaid population has different needs than the general population and therefore requires different treatment and ser- vices. Unfortunately, after receiving the necessary federal waivers from the Health Care Financing Administration,2 many states have rushed forward to im- plement Medicaid managed care programs with little consideration of those needs, only to later discover such problems as systemic fraud and abuse, dis- * The author dedicates this Note to her parents and sister, for all their love and support. ' John K. Iglehart & Jane K. White, Experiments with Medicaid: Cost Containment Versus Access, 68 HEALTH PROGRESS 26, 26 (1987) (quoting Sen. John H. Chafee, R-R.I., a member of the Senate Finance Committee which oversees Medicaid, from his statement on July 10, 1987, at a hearing on Medicaid and the Maternal and Child Health Care Block Grant). 2 Congress granted the Department of Health and Human Services (DHHS) the dis- cretion to grant Section 1115 waivers. DHHS delegated this authority to the Health Care Financing Administration (HCFA), the federal agency which administers Medicaid. See Suzanne Rotwein et al., Medicaid and State Health Care Reform: Process, Programs, and Policy Options, 16 HEALTH CARE FINANCING REv. 105, 105-06 (1995). 251

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