There is also concern about whether government can continue to direct resources toward this problem. The Medicaid program itself provides benefits to a diverse population with quite varied health care needs. 57 It is used to finance the treatment of AIDS patients, nursing home care for the elderly, and institutionalized services for disabled adults. Although women and children comprise the largest segment of the Medicaid recipient population, they are neither the fastest growing nor the most expensive coverage group. The aged, blind, and disabled population is growing at a faster rate, and it already consumes the largest percentage of all program expenditures. 58 Obviously this means that fewer and fewer resources can be devoted to maternal and child health care.
The preceding problem is so serious that states are questioning their ability to provide health care for all those in need. Medicaid is already the largest single item in most state budgets. Faced with budget deficits and revenue crises, states are taking a closer look at the scope and coverage of their Medicaid programs. 59 A few, such as Oregon, whose story Howard Leichter chronicles in Chapter Six, are experimenting with ways of "rationing" Medicaid services or targeting only those who are truly in need. Other states are considering cutting back the eligibility and service expansions they pursued in the 1980s in order to avoid shortfalls in Medicaid spending. 60
It is unlikely that the states will abandon their commitment to low- income families, pregnant women, and children. They are, however, being forced to make difficult policy choices concerning whom they will cover and how they will administer program services. The policy choices that the states are now making, particularly concerning the size, scope, and focus of their Medicaid programs, will have a profound effect on the future well-being of America's women and children.