Medicaid in the 1990s: Trends, Innovations, and the Future of the "PAC-Man" of State Budgets

Rapidly escalating health-care inflation and congressionallymandated expansions have led to large increases in spendingfor Medicaid, the federal-state program of health care for thepoor. These increases came at a time when state budgets werealready under recession-induced stresses. In addition, 1991brought new pressures for Medicaid spending from the courtsand closer federal scrutiny and control over revenues used forthe program's state "match." Yet the Medicaid picture is farfrom bleak. Diversity, innovation, and an emerging stale policyrole also characterize the program in ways that epitomize thestrengths and weaknesses of the American intergovernmental system.     

The Medicare secondary payor provisions: possible rewards and pitfalls

A 1990 report prepared by the Office of Inspector General estimated that as much as $1 billion is lost to the Medicare program annually because (i) secondary payor situations are not detected and (ii) insurance companies often do not pay when they are required to be the primary payors. Office of Inspector General, No. A-09-98-00151, April 1990, Medicare and Medicaid Guide (CCH) [symbol: see text] 39,112, at 25,649. In order to better enforce the MSP provisions, suggestions have been made at the Congressional level to impose sanctions against providers who demonstrate a pattern of inappropriate billing practices such as double billing, repeated failures to screen beneficiaries for other insurance coverage, and the repeated submission to Medicare of bills that should be submitted to another payor. (See the Subcommittee Report on erroneous payments under the MSP program, supra.) Although authority for such sanctions has yet to be adopted, given the fiscal problems currently plaguing the federal government, providers can expect increased enforcement of the MSP provisions as a means of reducing Medicare costs, and should review their screening and billing practices accordingly.     

Family types and communication with parents: A comparison of youth at different identity levels

Recent theory views adolescent behavior as nested in an ongoing system of family relationships. In keeping with this focus, differences in family functioning of high vs. low identity achievement youth were examined and variables to account for differing identity levels were explored. However, the hypothesized relationship (Circumplex Model) between family type and communication was also examined. Subjects were 411 male students, 18–24 years of age, belonging to intact nuclear middle-class homes, who resided with parents in urban areas. Measures used were the Identity Achievement Scale, Family Adaptability and Cohesion Evaluation Scale, and the Parent-Adolescent Communication Scale. Results supported an association between balanced family type and effective communication (p.001). Significant differences in the family types were found (p.001), with high identity subjects belonging to balanced families, experiencing more openness (p.01) and less problems (p.01) in communicating with parents. Openness with father, mother, and problems with father emerged as significant discriminants. There are important implications for counselling and therapy with youth, placing family at the center of the psychosocial milieu influencing their development.Received Ph.D. from H.P. University. Research interests: adolescent psychosocial development, youth, identity, and family influences.Received M.A.; Ph.D. from Boston University; Panjab University. Research interests: family interiors, women studies, life stress, self image (DAP), sexuality, myths, holistic healing, and tribal women.