The Medicaid program, signed into law by President Lyndon B. Johnson on July 30, 1965, will reach its 50th anniversary this year, a historic milestone. At the Kaiser Commission on Medicaid and the Uninsured, where we have closely studied and analyzed Medicaid for nearly 25 years, we are recognizing this important occasion by documenting Medicaid's evolution and its role in our health care system today. This report reflects on Medicaid's accomplishments and challenges and considers the issues on the horizon that will influence the course of this major health coverage and financing program moving forward. In the pages that follow, we trace Medicaid's evolution, discussing major legislative changes and other inflection points in the program's history, both for the record and for perspective on Medicaid's different roles in our health care system and how they developed. In doing so, we also show how Medicaid threads through our health care system today and take the measure of its impact. We begin by discussing Medicaid coverage for the main populations served by the program. We then discuss delivery systems and innovation in Medicaid and Medicaid spending and financing. We conclude by looking forward to consider the main issues that will concern the Medicaid program in the decades ahead and to assess how Medicaid is poised to meet the future needs of our nation.
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