The "New Federalism" Approach to Medicaid: Empirical Evidence that Ceding Inherently Federal Authority to the States Harms Public Health

ince its inception in 1965, the Medicaid program has been at the center of a pendulous dance between the federal and states' governments that jointly control its funding and administration.Strong federal oversight and policy control marked the Medicaid program initially.However, from its inception the Medicaid program allowed states considerable flexibility through various waiver programs.'From 1981 to roughly 1990, the states increasingly gained the power to exercise discretion in administering Medicaid to their neediest citizens.2 In 1990, the