Popular Medicaid programs do battle with state budget pressures: perspectives from twelve states

Many are concerned that growth of state Medicaid and State Children's Health Insurance Program (SCHIP) spending, along with limited political clout among beneficiaries, make these programs extremely vulnerable in periods of serious state budget constraints. But observations based on Community Tracking Study site visits show that states have thus far largely avoided major cuts that would seriously harm beneficiaries' access, primarily because programs have more support among coalitions of public officials, health care providers, and local advocates than commonly assumed. However, the limits to this surprising level of support are exemplified by decisions in many states to shelve some planned future expansions indefinitely.