The Affordable Care Act was supposed to simplify Medicaid’s myriad programs across the country to provide a more uniform medical safety net for poor Americans in every state.
It hasn’t worked out that way. In fact, Medicaid programs now vary more widely state to state and even within states than they did before. Some states have scaled back their Medicaid programs, while others have expanded to new groups of people. Among those that have expanded, many are pursuing new policy experiments instead of expanding their existing programs. This may result in confusion — for administrators and clients alike.