Since its inception 50 years ago, Medicaid has evolved from a small welfare program into an integral part of the nation’s health insurance system, now covering more than one in five low-income children and adults. As Medicaid coverage has expanded and stabilized, states are making strides to improve the cost and quality of the care provided to Medicaid enrollees. And, because Medicaid is the single largest payer in every state, governors are using Medicaid to drive multipayer reforms, including adoption of value-based payment methodologies and advancement of population health models.

As Congress and the new administration consider proposals to repeal the Affordable Care Act’s  Medicaid expansion and implement limits on federal Medicaid funding through block grants and per capita caps, Manatt Health, in a new issue brief for the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, details how much states have accomplished to drive value in and through their Medicaid programs over the last five decades and most especially the last five years. In addition, the brief covers what states stand to lose in terms of progress and innovation in their Medicaid programs and healthcare delivery systems, if federal support for Medicaid is reduced.