Journal of General Internal Medicine

, Volume 33, Issue 7, pp 999–1001 | Cite as

Concise Research Report: The Future of Medicaid: State Legislator Views on Policy Waivers

  • Jane M. ZhuEmail author
  • Manik Chhabra
  • David Grande
Concise Research Reports


As the Medicaid program is defined increasingly at the state level, state legislators will have growing influence on the direction of a program that now covers 72.4 million low-income adults and children.1 While Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, the Trump administration has made it easier for states to receive Medicaid waivers,2 including fast-track approvals and longer demonstration approval periods. The combination of greater state flexibility and reductions in overall funding could produce substantial shifts in state Medicaid policy; the recent approval of Kentucky’s Section 1115 waiver, which included work eligibility requirements, may be a precursor to impending program changes rather than an outlier. Understanding state legislator views of the Medicaid program and proposed changes is therefore critical to addressing future policy directions.


Using the National Conference of...


medicaid health reform health insurance state health policy 



We would like to thank David Asch, Janet Weiner, and Rebecka Rosenquist for their review of prior drafts, Kira Flemke for administrative and logistical contributions, and Christopher M. Aderman for graphics assistance.

Funding Information

This study was funded by the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Keehan SP, Stone DA, Poisal JA, et al. National health expenditure projections, 2016–25: price increases, aging push sector to 20 percent of economy. Health Aff Proj Hope 2017;36:553–63.CrossRefGoogle Scholar
  2. 2.
    Price TE, Verma S. Secretary price and CMS administrator verma letter [Internet]. 2017. Accessed 21 Mar 2018. Available from:
  3. 3.
    Musumeci MB, Hinton E, Rudowitz R. Section 1115 medicaid expansion waivers: a look at key themes and state specific waiver provisions [Internet]. Menlo Park, CA and Washington, DC: Kaiser Family Foundation; 2017 Accessed 21 Mar 2018. Available from: Scholar
  4. 4.
    Pagel C, Bates DW, Goldmann D, Koller CF. A way forward for bipartisan health reform? democrat and republican state legislator priorities for the goals of health policy. Am J Public Health 2017;107(10):1061–3.CrossRefGoogle Scholar
  5. 5.
    Compilation of the Social Security Laws. Sec. 1901. [42 U.S.C. 1396] [Internet]. Accessed 21 Mar 2018. Available from:

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  1. 1.Division of General Internal Medicine University of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  2. 2.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA

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