Dr. Clif CleavelandPrior to 1965, poor people in America faced grim prospects when they became ill or injured. Cities might offer care in a charity wing of a general hospital. If a medical school utilized that facility for training students and residents, care might rise to a surprisingly high level.
But in smaller communities and rural areas poor, sick persons were left to the variable mercies of a local physician or hospital with limited facilities. I saw too many examples of frightful suffering in that time.
A process of change began on July 31, 1965, when, in the presence of former President Harry Truman in Independence, Mo., President Lyndon Johnson signed legislation that created Medicaid as an amendment to the Social Security Act. The program became operational on Jan. 1, 1966.
Designed as a system to provide medical care to impoverished and disabled citizens and legal residents, Medicaid offered federal funding to states that, in turn, established eligibility and the range of services to be provided. States could choose not to participate, but all eventually established a plan.
The federal-state split of funding for each plan depended upon the average income within each state. Some states offered a wide range of services to all citizens who fell below the federal poverty level; others provided restricted services to a small fraction of poor residents. Despite monitoring of each state’s performance by the federal government, there were wide variations in quality, access and coverage.