A “Customary and Necessary” Program — Medicaid and Health Care Reform

The recently passed U.S. health care reform law envisions a health care system that rests atop a four-legged stool consisting of employer-sponsored health plans, coverage purchased through state-based exchanges, Medicare, and Medicaid. Each leg faces important challenges, none more than Medicaid. Numerous issues confront the “new” Medicaid. Will states be able to achieve full coverage for eligible persons and align their operations smoothly with those of other coverage sources? Will coverage be adequate to the population's need? Will providers participate, and will the safety net be sustained? And perhaps above all, will states continue to operate Medicaid programs and share . . .