Medicaid's Next Metamorphosis

Medicaid’s transformation since its inception rivals the biological changes of metamorphosis, and that process is not yet over. Past metamorphoses are the change from a small program with eligibility linked to the states’ cash welfare benefits to one with national eligibility standards covering many not receiving cash benefits, from a traditional fee-for-service payment program to one dominated by capitated managed care arrangements, and under the ACA to a widely accepted component of a national system for near universal insurance coverage. An analysis of the forces behind these significant changes suggests that future transformations are likely, and four potential scenarios are presented and assessed.