If a social welfare recipient who lives in a city in New York State were asked who provides the benefits he receives or determines the conditions under which he receives them, he would probably say "the city." The reason for this answer is that he deals with a city agency and city personnel, and his bimonthly cheques are drawn on the local government treasury. If he complains, the city gets the blame; if he is satisfied, an unlikely situation, the city gets the credit. He is only dimly aware of the tripartite—federal, state, and local— system of financing, of the complicated formulas that determine federal and state reimbursement to the city for different categories of recipients, or of which level of government has the initial or final responsibility for establishing overall policies and detailed regulations.
In fact, both the federal and state governments carry larger shares of the financial costs, as well as the responsibility for overall policies governing the public assistance and Medicaid programs. But while some social programs are administered directly by state authorities, in New York, as in many other states, welfare and Medicaid as well as other programs such as food stamps, day care, and homemaker services are operated under a system briefly described as "state supervised—locally administered." This essay considers the role of the state government in determining welfare and Medicaid policy and administration. What has "state supervised—locally administered" meant in New York over the last decade? What have been the results of this welfare system? What have been the recent changes in the roles of the federal, state, and local governments, and what changes