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5 Colum. J.L. & Soc. Probs. 62 (1969)
Medicaid: The Patchwork Crazy Quilt

handle is hein.journals/collsp5 and id is 68 raw text is: Medicaid: The Patchwork Crazy Quilt The original federal Medicaid program was enacted in 1965. The program was designed to expand existing welfare coverage by pro- viding federal matching funds to the states to help individuals whose income and resources are insufficient to meet the costs of. medical services. 1 In the four years since its inception, Medicaid has suffered ex- tremely severe growing pains. Expenditures required to finance the plan were surprisingly high. The classes of persons covered and the types of services provided have varied substantially from state to state. Too many doctors and hospitals have been unwilling to partic- ipate in the program. Congressional amendments in 1967 have merely compounded many pre-existing problems. The time is ripe for a critical and soul-searching look at federal and state Medicaid programs. This article examines the preceding four years of experience under Medicaid, and attempts to demonstrate the immediate and pressing need for a basic restructuring of the present Medicaid program. I. TITLE XIX: THE FEDERAL MEDICAID PROGRAM A. LEGISLATIVE HISTORY The agitation over half a century for universal health insurance finally resulted in the Kerr-Mills Act of 1960.2 Under Kerr-Mills federal funds were made available to the states to provide medical care for persons 65 years of age and older who had insufficient means to pay medical bills. However, many states did not participate in the Kerr-Mills program, while most of the states that did participate had only limited programs.3 Amid growing clamor that all aged persons be included in the pro- gram, Congress, in response to the shortcomings of Kerr-Mills,4 en- acted the Social Security Amendments of 1965.5 One section of these amendments established the federal Medicare program to enable those age 65 and older to receive quality medical care. Since Medicare is 1. Social Security Amendments of 1965, 42 U.S.C. § 1396 (Supp. I, 1966). 2. Social Security Amendments of 1960, 42 U.S.C. §§ 301-04, 306, 1308 (1964). 3. Comment, Furor Over Medicaid, 3 COLUM. J.L. & Soc. PROB. 158, 161 (1967). See also note 23 infra. 4. Id. at 160-63. 5. Social Security Amendments of 1965, 42 U.S.C. §§ 1395-96 (Supp. I, 1967). 6. Social Security Amendments of 1965, 42 U.S.C. § 1395 (Supp. I, 1967). Expanded protection is available under Medicare for persons willing to pay a monthly premium of $3.00. See Furor Over Medicaid, supra note 3, at 161.

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