Medicaid at Forty: Revisiting Structure and Meaning in a Post-Deficit Reduction Era

Document Type

Journal Article

Publication Date



Journal of Health Care Law & Policy


Volume 9, Issue 1

Inclusive Pages



Deficit Reduction Act of 2005


This article focuses on the Deficit Reduction Act of 2005 (DRA), which runs counter to the core philosophy under which Medicaid has operated for four decades and which now jeopardizes Medicaid coverage as a legally enforceable federal right. The article begins with a description of the origins of Medicaid and follows its transformation into a successful and powerful health program. Public perception of Medicaid deteriorated further due to financing "scandals," prompting the Bush Administration to promulgate far-reaching reforms under §1115 of the Social Security Act, despite the protests of state officials. Rosenbaum evaluates the negative, long-term impact of these reforms. Among these reforms includes the DRA, which fundamentally alters many aspects of the traditional Medicaid program, including the direct reduction of eligibility in terms of the nature, structure, and extent of coverage of Medicaid enrolled individuals.