Society for Social Work and Research

Medicaid has played an increasingly significant role in financing health and social services in the United States. Over the past two decades, the federal government has provided states with new “options” that have allowed states to cover new populations, including working disabled and parents and children in families with incomes above the traditional income eligibility requirements for Medicaid. At the same time, Medicaid benefits have also expanded. Many states have elected to use flexibility inherent in the Medicaid program to expand the role of Medicaid in funding social services, establishing benefits under Medicaid for such services as community mental health, substance abuse treatment, child care, services for individuals with developmental disabilities, and community-based home care. Indeed, expenditures for Medicaid's rehabilitative services option—the primary vehicle through which states have expanded benefits for social services—increased 77% from 1999-2005.

What is more, Medicaid's role in financing health and social services for low-income individuals will undoubtedly grow with the passage of the Patient Protection and Affordable Care Act (PPACA). The act will abolish categorical restrictions on eligibility that limit enrollment to parents, children, elderly and disabled individuals, thus extending coverage to millions of uninsured. The PPACA will also result in expanded coverage in many states, as the new legislation will require all state Medicaid programs to provide a more comprehensive array of health and social services than previously mandated. While it is unknown exactly how states with implement these changes, it is clear that they will have a dramatic impact of the financing and organization of health and social services for low-income individuals.

Yet, relatively little research has considered how the nonprofit sector has responded to the growing presence of Medicaid. Important questions remain regarding how the program has influenced nonprofit organizations' resource dependencies, relationships with public sector stakeholders, and service provision to vulnerable populations. In response, this symposium will bring together four studies that consider how nonprofits organizations have been influenced by—and agents of—Medicaid expansion. Specifically, papers in the symposium will address the following three questions: (1) What opportunities has Medicaid expansion created for nonprofits? (2) What challenges and risks has Medicaid expansion presented for nonprofits? And (3) How can nonprofit organizations respond to—and influence—Medicaid policies in order to increase the accessibility of services to individuals in need? To examine these questions, studies in the symposium have considered these questions from multiple perspectives—from the national to the local—drawing from diverse quantitative and qualitative approaches, including ethnography, in-depth interviews, and survey research.