Academic journal article Frontiers of Health Services Management

The Commentaries: A Summary

Academic journal article Frontiers of Health Services Management

The Commentaries: A Summary

Article excerpt

The three commentaries that follow offer a remarkable range of perspectives on the development, current status, and future of the Medicaid program. Each writer endorses Emily Friedman's vision but then builds on his or her own experience to extend our understanding of Medicaid's unique role. These writers represent a rich diversity of backgrounds-one has worked as a state-level administrator for Medicaid and other medical programs, the second is an experienced health system executive representing the provider side, and the third now serves as president of a health services research and policy organization.

Jacquetta Ellinger is Deputy Administrator for Programs, Division of Medical Programs within Illinois' Department of Public Aid. She is well experienced with the Medicaid bureaucracy and the policy conflicts, confusion, and complexity that Friedman attributes to it. While Ellinger contends that Medicaid often provokes "more consternation than respect," she is still able to view this highly political program with a degree of optimism. For example, she notes that Medicaid has incorporated more of a public health orientation over the past decade, indicating a progressive evolution. On the other hand, Ellinger reminds us the outcomes assessment in Medicaid is fraught with difficulties, as constantly changing eligibility guidelines lead to on-again off-again enrollment patterns.

Ellinger has no real answer to the "what would be better?" question but notes that the services and coverage for Medicaid are defined by law and largely out of the control of program administrators and providers. She sees little hope that Friedman's wish for a less politicized Medicaid program will be achieved-too much money is at stake and an entire infrastructure of services is now linked to Medicaid dollars.

As a healthcare executive, William G. Gonzalez, FACHE, has years of experience providing Medicaid services and working with Medicaid recipients. He would expand Friedman's Medicaid "wish list," arguing that limiting Medicaid to healthcare services really ignores the basic issues. The direct correlation between poor health and unemployment, he contends, suggests that employment services should be included. The frequent allegations of Medicaid recipients being noncompliant might be solved, he argues, if basic transportation and child care services were more regularly covered. …

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