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Study Finds Wide Variation in Medicaid Programs

By Mary Agnes Carey, CQ HealthBeat Associate Editor

April 18, 2007 -- State Medicaid programs vary widely in terms of eligibility requirements, benefits, and performance, according to a report released Wednesday by the group Public Citizen.

The 10 worst programs—ranked in order from 50 to 41—are Mississippi, Texas, Idaho, Oklahoma, South Dakota, Indiana, South Carolina, Colorado, Alabama, and Missouri, the report concluded.

The top states—ranked from 1 to 10—are Massachusetts, Nebraska, Vermont, Alaska, Wisconsin, Rhode Island, Minnesota, New York, Washington, and New Hampshire.

The report, which Public Citizen said is the most extensive analysis and ranking of state Medicaid programs, ranked states on the extent to which they surpass federal coverage mandates, and then divided the scores into four categories: eligibility, scope of services, quality of care, and provider reimbursement. The report updates a 1987 Public Citizen analysis and uses 2004 and 2005 Medicaid data compiled by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured and other data gathered by Public Citizen.

Sidney Wolfe, a co-author of the report and director of Public Citizen's Health Research Group, said it is "inexcusable" to have such wide variances between state Medicaid programs and Congress should act to correct inequities.

"Unless this gets done the program will keep getting worse and worse . . . disparities will worsen," he said during a telephone briefing with reporters.

Dennis Smith, director of the Centers for Medicare and Medicaid Services' Center for Medicaid and State Operations, said Wednesday the report "misses the fundamental nature of Medicaid and 40-year history that states have authority to administer program within [a] federal framework." Smith also said that all of the Medicaid changes included within a budget-savings bill (PL 109-171) that became law last year "have been fully realized" and once implemented will allow states to "create programs that are more aligned with today's Medicaid populations and the health care environment."

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