The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity | Health Care Reform | JAMA

<!DOCTYPE html> <html id="doc" lang="en" class="page-abstract"> <head id="Head1">  <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <script> var SCM = SCM || {}; if (SCM.AMA && SCM.AMA.DataLayerAsync) { SCM.AMA.DataLayerAsync.push("arrSisAffinity", "", "array"); SCM.AMA.DataLayerAsync.push("SubStatus", "no", "string"); } var googletag = window.googletag || {}; googletag.cmd = googletag.cmd || []; if (typeof Storage !== "undefined") { var targetingParamStr = localStorage.getItem("bcDFPTargetingParams"); if (targetingParamStr) { var targetingParameters = JSON.parse(targetingParamStr); // set page-level targeting parameters jQuery.each(targetingParameters, function (index, param) { googletag.cmd.push(function () { window.googletag.pubads().setTargeting(param.key, param.value); }); }); } } if (!googletag.pubads) { (function () { var gads = document.createElement('script'); var useSSL = 'https:' == document.location.protocol; gads.src = (useSSL ? 'https:' : 'http:') + '//securepubads.g.doubleclick.net/tag/js/gpt.js'; gads.setAttribute("async", ""); gads.setAttribute("defer", ""); var node = document.getElementsByTagName('script')[0]; node.parentNode.insertBefore(gads, node); })(); var App = App || {}; App.Ads = App.Ads || {}; App.Ads.adPath = App.Ads.adPath || '/6479/' + 'ama.jama'; App.Ads.Mappings = App.Ads.Mappings || {}; App.Ads.slots = App.Ads.slots || []; App.Ads.fromGoogle = !('yes' === 'yes'); App.isCollection = App.isCollection || !!document.getElementsByClassName('pg_collection').length; googletag.cmd.push(function () { googletag.pubads() .setTargeting('environment', ['newjama']) .setTargeting('site', ['ama.jama']) .setTargeting('sect', ['abstract']) .setTargeting('sub', ['no']) .setTargeting('device', ['Mozilla%2F4.0%20%28compatible%3B%20MSIE%207.0%3B%20Windows%20NT%206.0%3B%20SLCC1%3B%20.NET%20CLR%202.0.50727%3B%20.NET%20CLR%203.0.04506%3B%20.NET%20CLR%203.5.21022%3B%20.NET%20CLR%201.0.3705%3B%20.NET%20CLR%201.1.4322%29']) .setTargeting('usaphys', ['no']) .setTargeting('memberstat', ['no']) .setTargeting('pracset', ['']) .setTargeting('specialty', ['other']) .setTargeting('occupation', ['']) .setTargeting('useraffinity', ['']) .setTargeting('direct', ['yes']) .setTargeting('bot', ['']) .setTargeting('datacenter', ['no']) .setTargeting('selfMPA', ['']) .setTargeting('selfSpecialty', ['']); if (App.isCollection) { googletag.pubads().setTargeting('collection', ['']); } var testParam = getQueryVariable('test'); if (testParam) { googletag.pubads().setTargeting('test', [testParam]); } function getQueryVariable(variable) { var query = window.location.search.substring(1); var vars = query.split('&'); for (var i = 0; i < vars.length; i++) { var pair = vars[i].split('='); if (decodeURIComponent(pair[0]) == variable) { return decodeURIComponent(pair[1]); } } } googletag.pubads().disableInitialLoad(); googletag.enableServices(); }); } </script> <meta name="viewport" content="width=device-width, initial-scale=1" /><meta name="format-detection" content="telephone=no" /><link rel="shortcut icon" href="//cdn.jamanetwork.com/UI/app/img/favicons/jama/favicon.ico"> <link rel="icon" type="image/png" href="//cdn.jamanetwork.com/UI/app/img/favicons/jama/favicon-192x192.png" sizes="192x192"> <link rel="apple-touch-icon" sizes="180x180" href="//cdn.jamanetwork.com/UI/app/img/favicons/jama/apple-touch-icon-180x180.png"> <meta http-equiv="X-UA-Compatible" content="IE=Edge" /> <link rel="stylesheet" href="//cdn.jamanetwork.com/UI/app/dist/app.min.css?v=638677764476993385"> <link href="//cdn.jsdelivr.net/chartist.js/latest/chartist.min.css" type="text/css" rel="stylesheet" /> <meta property="og:title" content="The US Medicaid Program—Coverage, Financing, Reforms, and Implications for Health Equity" /> <meta property="og:type" content="Article" /> <meta property="og:url" content="https://jamanetwork.com/journals/jama/fullarticle/2796374" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004t1_1663338124.3442.png?Expires=2147483647&Signature=AWH-GDJapcowR2~d0JEEw-0rT5of~~Z02VeLrA5rmg84HLN9apab2rqA4Ie96O1JvocwJS2ufqkNwfbFuTQl0bv7wSYdNu6mB2eHwh6hIiD3o9kQFdnirVnZsoAJpzy-3tlulSJIYF0MgwVXns~geob2YmJmiFx2Vm8GDjCpbOsx-SM~da9Jy8nTNQDq3FSnljDQtNFdZQQr-tEphZxoEFOy4MIYLZoMpHfr8Nui2A4IPCAwlBYuzwbIV9b8ATsmyOJd31V-OvBddXNTzsOBw3nrWdRsbnLIItxOs0KUgZvoSBLIM12nwUVcW8RTN5RsS~cv-hCHj5eKQIgTsF2oyw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004t2_1663338124.3692.png?Expires=2147483647&Signature=i6068BL9zFOhdmfvJcxHyHvwQTxHsqve-LoCNC3IlO5zhfUEQicnXgEsJvkG2u-nqQKyY5Ztz8EIrZSWWi9jXlTFDHddNM09SYyxIaRKM139kBf7WYhMVs6X4wqu-SrNe836ysAxQQWgs1hUBD168RGFll2IabtHHvVcv0NT~TjzBlGIlzhanR79JgVimMAYn7p18OPGIA93pQ53ovqTPrqtkIhTwUorWJ9-jS6wyftC168fcJhESqGonIdU6oLaaqfRFtXPV9Qo2ZBmVTSwkNcAo7G~uOFKiahPLjlgi73zq8VaLGJc8IiW6q5GKhTp2spTMJpH9chtAAXmFSa7HA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004f1_1663338124.40601.png?Expires=2147483647&Signature=AWMKanUebKhQIdEr31VTrNyS2TqTh8ZtiqjiHybwVCjfWLpqL0-Zop1KSpzGCUjZHnSPr7EC7hbgoCB~oZJbOxUAul4fxzF8YfY6aVo8E6vulpWvaQCprVd543LzRWyNFf9p~osMC75NZecUjYUX5eYMCBZLsPiSNQLt2vOnJ6yvbh91lw~BLDkqesnrG9viQilQqv2dPxeOp89ANiG2ZhGTNOu00LLy3IQzXzDTZY02KBTrnepYCwqicryfBIoIgQxJTaEuhRsa~R6uqKpbW6DlEhwZmWsvzuzg8EzwX6oant43o7p-GfnAy~wzOH2jmeAcvaQuI5GA6paNuokNJA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004f2_1663338124.45603.png?Expires=2147483647&Signature=oWCMV4gm5VGEHRPmIHBxJLaD~xT2eI70vCEXiTuTFS7UWPoZEZ2hQJzyYs6pnX914Bn7acPX8IYZMmRppZk~qjkq2o85cSU5UQ6jlOtOHeMLyDnyOEoIpPdv9UWnZe04D6ig5Jz2yTCCaPANtbv4jm0w6RtSrPwPtj2zToenkOR1n04OLFZLmWTxp6qHJfppkCn8oohrwOhcUSWX85EvWLwM~pAs3h4nSJjQjMBe5SIc~UyXZML0A3gUJavO22vMTrDs68Mkh1egz24e5Us0j02G-Vhu4zMeYSDXoiaPLDEKqkZDsEKSoji~bcg5cQsJeAKsqQ4-7i42fBlWiZsGrA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004f3_1663338124.47103.png?Expires=2147483647&Signature=o61gG23X~Sbsd89va-7~TsFXUcFayfoX-ecY3AHmSZljxYfiVXBbP84P7J~HR3qx5KKyP0Hm-zkEY2BaScO39z2Amw4AztFLSwge0f5~Ml~slrtsqsVl6NJ-VHIFoQwW~7Wgy9SRSlghRV76JCD0qf2JiyJ~eUM6ltVaGgTiVx9A8ZVmXZrcD-794-vaMBYeUY426dUu0MzWc1EZmljPP5ynP4okCqewAbNSzjMS~yWsMiilOVpG3PqPDf9lOUhCVUhvUASz9sOKdh8a6MmqAzVqlpl1w9xtnrGdZ6ajLRJ7rrz6NtvlBwc4~FZAYAdudN-MhCq3xULximCilWFwLw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:description" content="This Special Communication describes Medicaid eligibility, enrollment, and spending as well as examines areas of Medicaid policy, Medicaid expansion, racial and ethnic health disparities, and the potential to achieve health equity." /> <meta property="fb:pages" content="87087958340" /> <meta property="fb:pages" content="122228711814384" /> <meta property="fb:pages" content="1648414928738217" /> <meta property="fb:pages" content="117506346528" /> <meta property="fb:pages" content="97538728726" /> <meta property="fb:pages" content="114116793520" /> <meta property="fb:pages" content="100679858757" /> <meta property="fb:pages" content="759822190741773" /> <meta property="fb:pages" content="100265333750" /> <meta property="fb:pages" content="234770525256" /> <meta property="fb:pages" content="98784919862" /> <meta property="fb:pages" content="120829458202" /> <meta property="fb:pages" content="124842870398" /> <meta property="fb:pages" content="110245330325636" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:site" content="@JAMA_current" /> <meta name="twitter:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004t1_1663338124.3442.png?Expires=2147483647&Signature=AWH-GDJapcowR2~d0JEEw-0rT5of~~Z02VeLrA5rmg84HLN9apab2rqA4Ie96O1JvocwJS2ufqkNwfbFuTQl0bv7wSYdNu6mB2eHwh6hIiD3o9kQFdnirVnZsoAJpzy-3tlulSJIYF0MgwVXns~geob2YmJmiFx2Vm8GDjCpbOsx-SM~da9Jy8nTNQDq3FSnljDQtNFdZQQr-tEphZxoEFOy4MIYLZoMpHfr8Nui2A4IPCAwlBYuzwbIV9b8ATsmyOJd31V-OvBddXNTzsOBw3nrWdRsbnLIItxOs0KUgZvoSBLIM12nwUVcW8RTN5RsS~cv-hCHj5eKQIgTsF2oyw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta name="citation_author" content="Julie M. Donohue" /><meta name="citation_author_institution" content="Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania" /><meta name="citation_author" content="Evan S. Cole" /><meta name="citation_author_institution" content="Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania" /><meta name="citation_author" content="Cara V. James" /><meta name="citation_author_institution" content="Grantmakers In Health, Washington, DC" /><meta name="citation_author" content="Marian Jarlenski" /><meta name="citation_author_institution" content="Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania" /><meta name="citation_author" content="Jamila D. Michener" /><meta name="citation_author_institution" content="Department of Government and School of Public Policy, Cornell University, Ithaca, New York" /><meta name="citation_author" content="Eric T. Roberts" /><meta name="citation_author_institution" content="Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania" /><meta name="citation_title" content="The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity" /><meta name="citation_firstpage" content="1085" /><meta name="citation_lastpage" content="1099" /><meta name="citation_doi" content="10.1001/jama.2022.14791" /><meta name="citation_keyword" content="medicaid" /><meta name="citation_keyword" content="health disparity" /><meta name="citation_keyword" content="health equity" /><meta name="citation_keyword" content="medicaid expansion" /><meta name="citation_abstract" content="<h3>Importance</h3><p>Medicaid is the largest health insurance program by enrollment in the US and has an important role in financing care for eligible low-income adults, children, pregnant persons, older adults, people with disabilities, and people from racial and ethnic minority groups. Medicaid has evolved with policy reform and expansion under the Affordable Care Act and is at a crossroads in balancing its role in addressing health disparities and health inequities against fiscal and political pressures to limit spending.</p><h3>Objective</h3><p>To describe Medicaid eligibility, enrollment, and spending and to examine areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity.</p><h3>Evidence Review</h3><p>Analyses of publicly available data reported from 2010 to 2022 on Medicaid enrollment and program expenditures were performed to describe the structure and financing of Medicaid and characteristics of Medicaid enrollees. A search of PubMed for peer-reviewed literature and online reports from nonprofit and government organizations was conducted between August 1, 2021, and February 1, 2022, to review evidence on Medicaid managed care, delivery system reforms, expansion, and health disparities. Peer-reviewed articles and reports published between January 2003 and February 2022 were included.</p><h3>Findings</h3><p>Medicaid covered approximately 80.6 million people (mean per month) in 2022 (24.2% of the US population) and accounted for an estimated $671.2 billion in health spending in 2020, representing 16.3% of US health spending. Medicaid accounted for an estimated 27.2% of total state spending and 7.6% of total federal expenditures in 2021. States enrolled 69.5% of Medicaid beneficiaries in managed care plans in 2019 and adopted 139 delivery system reforms from 2003 to 2019. The 38 states (and Washington, DC) that expanded Medicaid under the Affordable Care Act experienced gains in coverage, increased federal revenues, and improvements in health care access and some health outcomes. Approximately 56.4% of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. Expanding Medicaid, addressing disparities within Medicaid, and having an explicit focus on equity in managed care and delivery system reforms may represent opportunities for Medicaid to advance health equity.</p><h3>Conclusions and Relevance</h3><p>Medicaid insures a substantial portion of the US population, accounts for a significant amount of total health spending and state expenditures, and has evolved with delivery system reforms, increased managed care enrollment, and state expansions. Additional Medicaid policy reforms are needed to reduce health disparities by race and ethnicity and to help achieve equity in access, quality, and outcomes.</p>" /><meta name="citation_journal_title" content="JAMA" /><meta name="citation_journal_abbrev" content="JAMA" /><meta name="citation_volume" content="328" /><meta name="citation_issue" content="11" /><meta name="citation_publication_date" content="2022/09/20" /><meta name="citation_issn" content="0098-7484" /><meta name="citation_publisher" content="American Medical Association" /><meta name="citation_reference" content="US Government Accountability Office. Federal low-income programs: eligibility and benefits differ for selected programs due to complex and varied rules. June 2017. Accessed September 30, 2021. https://www.gao.gov/assets/gao-17-558.pdf " /><meta name="citation_reference" content="Centers for Medicare & Medicaid Services. Monthly Medicaid & CHIP application, eligibility determination, and enrollment reports & data. Accessed July 22, 2022. https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-data/index.html " /><meta name="citation_reference" content="Centers for Medicare & Medicaid Services. National health expenditure data, table 19: national health expenditures by type of expenditure and program: calendar year 2020. Accessed July 22, 2022. https://www.cms.gov/files/zip/nhe-tables.zip " /><meta name="citation_reference" content="Colello HJ,Morton WR. Medicaid eligibility: older adults and individuals with disabilities. December 9, 2019. August 26, 2022. https://crsreports.congress.gov/product/pdf/R/R46111 " /><meta name="citation_reference" content="citation_title=Public insurance and mortality: evidence from Medicaid implementation.; citation_author=Goodman-Bacon A; citation_journal_title=J Polit Econ; citation_year=2018; citation_volume=126; citation_issue=1; citation_pages=216-262; " /><meta name="citation_reference" content="citation_title=Childhood Medicaid coverage and later-life health care utilization.; citation_author=Wherry LR; citation_author=Miller S; citation_author=Kaestner R; citation_author=Meyer BD; citation_journal_title=Rev Econ Stat; citation_year=2018; citation_volume=100; citation_issue=2; citation_pages=287-302; " /><meta name="citation_reference" content="citation_title=Saving teens: using a policy discontinuity to estimate the effects of Medicaid eligibility.; citation_author=Wherry LR; citation_author=Meyer BD; citation_journal_title=J Hum Resour; citation_year=2016; citation_volume=51; citation_issue=3; citation_pages=556-588; " /><meta name="citation_reference" content="citation_title=Association of state Medicaid expansion status with low birth weight and preterm birth.; citation_author=Brown CC; citation_author=Moore JE; citation_author=Felix HC; citation_journal_title=JAMA; citation_year=2019; citation_volume=321; citation_issue=16; citation_pages=1598-1609; " /><meta name="citation_reference" content="citation_author=Michener J; citation_publisher=Cambridge University Press, ; citation_title=Fragmented Democracy: Medicaid, Federalism, and Unequal Politics; citation_year=2018; " /><meta name="citation_reference" content="citation_title=Paying for Medicaid: state budgets and the case for expansion in the time of coronavirus.; citation_author=Gruber J; citation_author=Sommers BD; citation_journal_title=N Engl J Med; citation_year=2020; citation_volume=382; citation_issue=24; citation_pages=2280-2282; " /><meta name="citation_reference" content="citation_title=Politics, pandemic, and racial justice through the lens of Medicaid.; citation_author=Michener JD; citation_journal_title=Am J Public Health; citation_year=2021; citation_volume=111; citation_issue=4; citation_pages=643-646; " /><meta name="citation_reference" content="Centers for Medicare & Medicaid Services. Innovation Center strategic direction. Accessed Feb 2, 2022. https://innovation.cms.gov/strategic-direction " /><meta name="citation_reference" content="citation_title=Implementing ObamaCare: the politics of Medicaid expansion under the Affordable Care Act of 2010.; citation_author=Lanford D; citation_author=Quadagno J; citation_journal_title=Sociol Perspect; citation_year=2016; citation_volume=59; citation_issue=3; citation_pages=619-639; " /><meta name="citation_reference" content="citation_title=Race, politics, and the Affordable Care Act.; citation_author=Michener J; citation_journal_title=J Health Polit Policy Law; citation_year=2020; citation_volume=45; citation_issue=4; citation_pages=547-566; " /><meta name="citation_reference" content="citation_title=A blueprint for comprehensive Medicaid reform.; citation_author=Gee RE; citation_author=Shulkin D; citation_author=Romm I; citation_journal_title=JAMA; citation_year=2021; citation_volume=325; citation_issue=7; citation_pages=619-620; " /><meta name="citation_reference" content="National Association of State Budget Officers. State expenditure report. Accessed July 22, 2022. https://www.nasbo.org/reports-data/state-expenditure-report " /><meta name="citation_reference" content="US Government Publishing Office. Budget FY 2022 : table 15.1: outlays for health programs: 1962-2026. Accessed July 15, 2022. https://www.govinfo.gov/app/details/BUDGET-2022-TAB/BUDGET-2022-TAB-16-1 " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Exhibit 15: Medicaid full-year equivalent enrollment by state and eligibility group, FY 2019 (thousands). Accessed January 15, 2022. https://www.macpac.gov/wp-content/uploads/2015/11/EXHIBIT-15.-Medicaid-Full-Year-Equivalent-Enrollment-by-State-and-Eligibility-Group-FY-2019-thousands.pdf " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. MACStats: Medicaid and CHIP data book. December 2015. Accessed October 14, 2021. https://www.macpac.gov/wp-content/uploads/2020/07/MACStats-Medicaid-and-CHIP-Data-Book-December-2015.pdf " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. MACStats: Medicaid and CHIP data book. December 2021. Accessed July 22, 2022. https://www.macpac.gov/wp-content/uploads/2021/12/MACStats-Medicaid-and-CHIP-Data-Book-December-2021.pdf " /><meta name="citation_reference" content="US Census Bureau. Census Bureau releases analytical report on COVID-19 impact on the 2020 American Community Survey. October 27, 2021. Accessed July 15, 2022. https://www.census.gov/newsroom/press-releases/2021/covid-19-impact-on-2020-acs.html " /><meta name="citation_reference" content="Kaiser Family Foundation. Medicaid waiver tracker: approved and pending Section 1115 waivers by state. Accessed May 28, 2021. https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/ " /><meta name="citation_reference" content="Primary Care Collaborative. Primary care innovations and PCMH programs by title. Accessed May 28, 2021. https://www.pcpcc.org/initiatives/list " /><meta name="citation_reference" content="Center for Health Care Strategies Inc. Medicaid accountable care organization programs: state profiles. Accessed February 15, 2022. https://www.chcs.org/resource/medicaid-accountable-care-organization-programs-state-profiles/ " /><meta name="citation_reference" content="Change Healthcare. Value-based care in America: state-by-state. Accessed February 15, 2022. https://www.pcpcc.org/resource/value-based-care-america-state-state " /><meta name="citation_reference" content="National Academy for State Health Policy. State delivery system and payment reform map. Accessed May 28, 2021. https://www.nashp.org/state-delivery-system-payment-reform-map/#toggle-id-1 " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Delivery System Reform Incentive Payment programs. April 2020. Accessed February 15, 2022. https://www.macpac.gov/publication/delivery-system-reform-incentive-payment-programs/ " /><meta name="citation_reference" content="Centers for Medicare & Medicaid Services. Medicaid.gov. Accessed February 2, 2022. http://www.medicaid.gov " /><meta name="citation_reference" content="citation_author=Perez EO; citation_publisher=University of Chicago Press, ; citation_title=Diversity’s Child: People of Color and the Politics of Identity; citation_year=2021; " /><meta name="citation_reference" content="Congressional Research Service. Medicaid: an overview. Updated February 22, 2021. Accessed February 15, 2022. https://crsreports.congress.gov/product/pdf/R/R43357 " /><meta name="citation_reference" content="citation_title=Executive federalism and Medicaid demonstration waivers: implications for policy and democratic process.; citation_author=Thompson FJ; citation_author=Burke C; citation_journal_title=J Health Polit Policy Law; citation_year=2007; citation_volume=32; citation_issue=6; citation_pages=971-1004; " /><meta name="citation_reference" content="citation_title=Medicaid expansions from 1997 to 2009 increased coverage and improved access and mental health outcomes for low-income parents.; citation_author=McMorrow S; citation_author=Kenney GM; citation_author=Long SK; citation_author=Goin DE; citation_journal_title=Health Serv Res; citation_year=2016; citation_volume=51; citation_issue=4; citation_pages=1347-1367; " /><meta name="citation_reference" content="citation_title=Shaping health policy for low-income populations: an assessment of public comments in a new Medicaid waiver process.; citation_author=Jarlenski M; citation_author=Rocco P; citation_author=Tipirneni R; citation_author=Kennedy AJ; citation_author=Gunturi N; citation_author=Donohue J; citation_journal_title=J Health Polit Policy Law; citation_year=2017; citation_volume=42; citation_issue=6; citation_pages=1039-1064; " /><meta name="citation_reference" content="Centers for Medicare & Medicaid Services. Federal fiscal year (FFY) 2019 statistical enrollment data system (SEDS) reporting. November 10, 2020. Accessed February 15, 2022. https://www.medicaid.gov/chip/downloads/fy-2019-childrens-enrollment-report.pdf " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Exhibit 14: Medicaid enrollment by state, eligibility group, and dually eligible status, FY 2019 (thousands). Accessed January 15, 2022. https://www.macpac.gov/wp-content/uploads/2015/01/EXHIBIT-14.-Medicaid-Enrollment-by-State-Eligibility-Group-and-Dually-Eligible-Status-FY-2019-thousands.pdf " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Exhibit 19: Medicaid benefit spending per full-year equivalent (FYE) enrollee by eligibility group and service category, FY 2019. Accessed September 15, 2021. https://www.macpac.gov/wp-content/uploads/2015/01/EXHIBIT-19.-Medicaid-Benefit-Spending-Per-Full-Year-Equivalent-FYE-Enrollee-by-Eligibility-Group-and-Service-Category-FY-2019.pdf " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Nursing facilities. Accessed September 15, 2021. https://www.macpac.gov/subtopic/nursing-facilities/ " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Medicaid 101 financing. Accessed September 15, 2021. https://www.macpac.gov/medicaid-101/financing/ " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Exhibit 1: Medicaid and CHIP enrollment as a percentage of the US population. Accessed September 15, 2021. https://www.macpac.gov/publication/medicaid-and-chip-enrollment-as-a-percentage-of-the-u-s-population/ " /><meta name="citation_reference" content="Clemans-Cope L,Holahan J,Garfield R. Medicaid spending growth compared to other payers: a look at the evidence. Kaiser Family Foundation. April 13, 2016. Accessed January 15, 2022. https://www.kff.org/report-section/medicaid-spending-growth-compared-to-other-payers-issue-brief/ " /><meta name="citation_reference" content="Kaiser Family Foundation. Medicaid-to-Medicare fee index. Accessed July 15, 2022. https://www.kff.org/medicaid/state-indicator/medicaid-to-medicare-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D " /><meta name="citation_reference" content="Williams E,Rudowitz R. The impact of the COVID-19 recession on Medicaid coverage and spending. Kaiser Family Foundation. March 1, 2022. Accessed July 15, 2022. https://www.kff.org/medicaid/issue-brief/the-impact-of-the-covid-19-recession-on-medicaid-coverage-and-spending/#footnote-548447-3 " /><meta name="citation_reference" content="Williams E,Rudowitz R,Corallo B. Fiscal and enrollment implications of Medicaid continuous coverage requirement during and after the PHE ends. Kaiser Family Foundation. May 10, 2022. Accessed July 15, 2022. https://www.kff.org/medicaid/issue-brief/fiscal-and-enrollment-implications-of-medicaid-continuous-coverage-requirement-during-and-after-the-phe-ends/ " /><meta name="citation_reference" content="citation_title=Medicaid managed care’s effects on costs, access, and quality: an update.; citation_author=Franco Montoya D; citation_author=Chehal PK; citation_author=Adams EK; citation_journal_title=Annu Rev Public Health; citation_year=2020; citation_volume=41; citation_pages=537-549; " /><meta name="citation_reference" content="Sparer M. Medicaid managed care: costs, access, and quality of care. Robert Wood Johnson Foundation. September 2012. Accessed September 15, 2021. https://www.rwjf.org/content/dam/farm/reports/reports/2012/rwjf401106 " /><meta name="citation_reference" content="citation_title=Has Medicaid managed care affected beneficiary access and use?; citation_author=Zuckerman S; citation_author=Brennan N; citation_author=Yemane A; citation_journal_title=Inquiry; citation_year=2002; citation_volume=39; citation_issue=3; citation_pages=221-242; " /><meta name="citation_reference" content="citation_title=A tale of two cities? the heterogeneous impact of Medicaid managed care.; citation_author=Marton J; citation_author=Yelowitz A; citation_author=Talbert JC; citation_journal_title=J Health Econ; citation_year=2014; citation_volume=36; citation_pages=47-68; " /><meta name="citation_reference" content="citation_title=Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?; citation_author=Herring B; citation_author=Adams EK; citation_journal_title=Health Econ; citation_year=2011; citation_volume=20; citation_issue=4; citation_pages=446-460; " /><meta name="citation_reference" content="citation_title=Medicaid managed care: the last bastion of the HMO?; citation_author=Draper DA; citation_author=Hurley RE; citation_author=Short AC; citation_journal_title=Health Aff (Millwood); citation_year=2004; citation_volume=23; citation_issue=2; citation_pages=155-167; " /><meta name="citation_reference" content="Hinton E,Stolyar L. Medicaid authorities and options to address social determinants of health (SDOH). Kaiser Family Foundation. August 5, 2021. Accessed July 15, 2022. https://www.kff.org/medicaid/issue-brief/medicaid-authorities-and-options-to-address-social-determinants-of-health-sdoh/ " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Chapter 3: managed long-term services and supports: status of state adoption and areas of program evolution. Accessed September 15, 2021. https://www.macpac.gov/wp-content/uploads/2018/06/Managed-Long-Term-Services-and-Supports-Status-of-State-Adoption-and-Areas-of-Program-Evolution.pdf " /><meta name="citation_reference" content="Centers for Medicare & Medicaid Services. Long-term services and supports rebalancing toolkit. November 2020. Accessed February 15, 2022. https://www.medicaid.gov/medicaid/long-term-services-supports/downloads/ltss-rebalancing-toolkit.pdf " /><meta name="citation_reference" content="Medicare Payment Advisory Commission;Medicaid and CHIP Payment and Access Commission. Beneficiaries dually eligible for Medicare and Medicaid. Accessed February 5, 2022. https://www.macpac.gov/wp-content/uploads/2022/02/Beneficiaries-Dually-Eligible-for-Medicare-and-Medicaid-February-2022.pdf " /><meta name="citation_reference" content="Centers for Medicare & Medicaid Services. Medicare-Medicaid Coordination Office: FY 2019 report to Congress. 2019. Accessed February 15, 2022. https://www.cms.gov/files/document/mmco-report-congress.pdf " /><meta name="citation_reference" content="citation_title=Medicaid managed care and health care for children.; citation_author=Baker LC; citation_author=Afendulis C; citation_journal_title=Health Serv Res; citation_year=2005; citation_volume=40; citation_issue=5, pt 1; citation_pages=1466-1488; " /><meta name="citation_reference" content="citation_title=Association of state access standards with accessibility to specialists for Medicaid managed care enrollees.; citation_author=Ndumele CD; citation_author=Cohen MS; citation_author=Cleary PD; citation_journal_title=JAMA Intern Med; citation_year=2017; citation_volume=177; citation_issue=10; citation_pages=1445-1451; " /><meta name="citation_reference" content="Kaiser Family Foundation. Medicaid delivery system and payment reform: a guide to key terms and concepts. June 2015. Accessed June 1, 2015. https://files.kff.org/attachment/issue-brief-medicaid-delivery-system-and-payment-reform-a-guide-to-key-terms-and-concepts " /><meta name="citation_reference" content="Centers for Medicare & Medicaid Services. Health Care Innovation Awards. Accessed October 14, 2021. https://innovation.cms.gov/innovation-models/health-care-innovation-awards " /><meta name="citation_reference" content="citation_title=Oregon’s Medicaid coordinated care organizations.; citation_author=McConnell KJ; citation_journal_title=JAMA; citation_year=2016; citation_volume=315; citation_issue=9; citation_pages=869-870; " /><meta name="citation_reference" content="citation_title=Oregon’s emphasis on equity shows signs of early success for Black and American Indian Medicaid enrollees.; citation_author=McConnell KJ; citation_author=Charlesworth CJ; citation_author=Meath THA; citation_author=George RM; citation_author=Kim H; citation_journal_title=Health Aff (Millwood); citation_year=2018; citation_volume=37; citation_issue=3; citation_pages=386-393; " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Delivery system reform incentive payment programs. April 2020. Accessed July 15, 2022. https://www.macpac.gov/wp-content/uploads/2018/03/Delivery-System-Reform-Incentive-Payment-Programs.pdf " /><meta name="citation_reference" content="Mohamoud S,Idala D,Perez R,Malomo-Paris K. Health home program evaluation: CY 2013 to CY 2018. Hilltop Institute, University of Maryland Baltimore County. March 18, 2021. Accessed July 15, 2022. https://www.hilltopinstitute.org/wp-content/uploads/publications/HealthHomeProgramEvaluationCY2013ToCY2018-March2021.pdf " /><meta name="citation_reference" content="citation_title=Early performance in Medicaid accountable care organizations: a comparison of Oregon and Colorado.; citation_author=McConnell KJ; citation_author=Renfro S; citation_author=Chan BK; citation_journal_title=JAMA Intern Med; citation_year=2017; citation_volume=177; citation_issue=4; citation_pages=538-545; " /><meta name="citation_reference" content="citation_title=Medicaid health home reducing costs and reliance on emergency department: evidence from Iowa.; citation_author=Shane DM; citation_author=Nguyen-Hoang P; citation_author=Bentler SE; citation_author=Damiano PC; citation_author=Momany ET; citation_journal_title=Med Care; citation_year=2016; citation_volume=54; citation_issue=8; citation_pages=752-757; " /><meta name="citation_reference" content="citation_title=Effects of Maryland’s Affordable Care Act Medicaid Health Home Waiver on quality of cardiovascular care among people with serious mental illness.; citation_author=McGinty EE; citation_author=Stone EM; citation_author=Kennedy-Hendricks A; citation_journal_title=J Gen Intern Med; citation_year=2020; citation_volume=35; citation_issue=11; citation_pages=3148-3158; " /><meta name="citation_reference" content="citation_title=An innovative model to coordinate healthcare and social services for people with serious mental illness: a mixed-methods case study of Maryland’s Medicaid health home program.; citation_author=McGinty EE; citation_author=Kennedy-Hendricks A; citation_author=Linden S; citation_author=Choksy S; citation_author=Stone E; citation_author=Daumit GL; citation_journal_title=Gen Hosp Psychiatry; citation_year=2018; citation_volume=51; citation_pages=54-62; " /><meta name="citation_reference" content="Guth M,Ammula M. Building on the evidence base: studies on the effects of Medicaid expansion, February 2020 to March 2021. Kaiser Family Foundation. May 6, 2021. Accessed September 15, 2021. https://www.kff.org/medicaid/report/building-on-the-evidence-base-studies-on-the-effects-of-medicaid-expansion-february-2020-to-march-2021/ " /><meta name="citation_reference" content="Kaiser Family Foundation. Status of state Medicaid expansion decisions: interactive map. July 21, 2022. Accessed May 15, 2021. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ " /><meta name="citation_reference" content="citation_title=The impact of the ACA Medicaid expansions on health insurance coverage through 2015 and coverage disparities by age, race/ethnicity, and gender.; citation_author=Wehby GL; citation_author=Lyu W; citation_journal_title=Health Serv Res; citation_year=2018; citation_volume=53; citation_issue=2; citation_pages=1248-1271; " /><meta name="citation_reference" content="citation_title=The effect of the Affordable Care Act Medicaid expansion on disparities in access to care and health status.; citation_author=Lee H; citation_author=Porell FW; citation_journal_title=Med Care Res Rev; citation_year=2020; citation_volume=77; citation_issue=5; citation_pages=461-473; " /><meta name="citation_reference" content="Baumgartner JC,Collins SR,Radley DC,Hayes SL. How the Affordable Care Act has narrowed racial and ethnic disparities in access to health care. The Commonwealth Fund. January 16, 2020. Accessed August 15, 2021. https://www.commonwealthfund.org/sites/default/files/2020-01/Baumgartner_ACA_racial_ethnic_disparities_db.pdf " /><meta name="citation_reference" content="citation_title=COVID-19-related insurance coverage changes and disparities in access to care among low-income US adults in 4 southern states.; citation_author=Figueroa JF; citation_author=Khorrami P; citation_author=Bhanja A; citation_author=Orav EJ; citation_author=Epstein AM; citation_author=Sommers BD; citation_journal_title=JAMA Health Forum; citation_year=2021; citation_volume=2; citation_issue=8; " /><meta name="citation_reference" content="citation_title=The effects of Medicaid on access to care and adherence to recommended preventive services.; citation_author=Hill SC; citation_author=Abdus S; citation_journal_title=Health Serv Res; citation_year=2021; citation_volume=56; citation_issue=1; citation_pages=84-94; " /><meta name="citation_reference" content="citation_title=The impact of health insurance on preventive care and health behaviors: evidence from the first two years of the ACA Medicaid expansions.; citation_author=Simon K; citation_author=Soni A; citation_author=Cawley J; citation_journal_title=J Policy Anal Manage; citation_year=2017; citation_volume=36; citation_issue=2; citation_pages=390-417; " /><meta name="citation_reference" content="citation_title=Increased cancer screening for low-income adults under the Affordable Care Act Medicaid expansion.; citation_author=Hendryx M; citation_author=Luo J; citation_journal_title=Med Care; citation_year=2018; citation_volume=56; citation_issue=11; citation_pages=944-949; " /><meta name="citation_reference" content="citation_title=Effect of Medicaid expansions of 2014 on overall and early-stage cancer diagnoses.; citation_author=Soni A; citation_author=Simon K; citation_author=Cawley J; citation_author=Sabik L; citation_journal_title=Am J Public Health; citation_year=2018; citation_volume=108; citation_issue=2; citation_pages=216-218; " /><meta name="citation_reference" content="citation_title=Medicaid and mortality: new evidence from linked survey and administrative data.; citation_author=Miller S; citation_author=Johnson N; citation_author=Wherry LR; citation_journal_title=Quarterly Journal of Economics; citation_year=2021; citation_volume=136; citation_issue=3; citation_pages=1783-1829; " /><meta name="citation_reference" content="citation_title=The effects of the ACA Medicaid expansion on nationwide home evictions and eviction-court initiations: United States, 2000-2016.; citation_author=Zewde N; citation_author=Eliason E; citation_author=Allen H; citation_author=Gross T; citation_journal_title=Am J Public Health; citation_year=2019; citation_volume=109; citation_issue=10; citation_pages=1379-1383; " /><meta name="citation_reference" content="citation_title=Can Medicaid expansion prevent housing evictions?; citation_author=Allen HL; citation_author=Eliason E; citation_author=Zewde N; citation_author=Gross T; citation_journal_title=Health Aff (Millwood); citation_year=2019; citation_volume=38; citation_issue=9; citation_pages=1451-1457; " /><meta name="citation_reference" content="citation_title=Medicaid expansion and medical debt: evidence from Louisiana, 2014-2019.; citation_author=Callison K; citation_author=Walker B; citation_journal_title=Am J Public Health; citation_year=2021; citation_volume=111; citation_issue=8; citation_pages=1523-1529; " /><meta name="citation_reference" content="Miller S,Hu L,Kaestner R,Mazumder B,Wong A. The ACA Medicaid expansion in Michigan and financial health. National Bureau of Economic Research Working Paper Series. Revised March 2020. Accessed September 15, 2021. https://www.nber.org/system/files/working_papers/w25053/w25053.pdf " /><meta name="citation_reference" content="citation_title=Antipoverty impact of Medicaid growing with state expansions over time.; citation_author=Zewde N; citation_author=Wimer C; citation_journal_title=Health Aff (Millwood); citation_year=2019; citation_volume=38; citation_issue=1; citation_pages=132-138; " /><meta name="citation_reference" content="citation_title=The effect of the Medicaid expansion on dropout rates.; citation_author=Yeung R; citation_journal_title=J Sch Health; citation_year=2020; citation_volume=90; citation_issue=10; citation_pages=745-753; " /><meta name="citation_reference" content="citation_title=The effect of health insurance on crime: evidence from the Affordable Care Act Medicaid expansion.; citation_author=He Q; citation_author=Barkowski S; citation_journal_title=Health Econ; citation_year=2020; citation_volume=29; citation_issue=3; citation_pages=261-277; " /><meta name="citation_reference" content="Vogler J. Access to health care and criminal behavior: short-run evidence from the ACA Medicaid expansions. SSRN. November 14, 2017. Accessed September 15, 2021. https://ssrn.com/abstract=3042267 doi: 10.2139/ssrn.3042267 " /><meta name="citation_reference" content="citation_title=Medicaid Expansion’s spillover to the criminal justice system: evidence from six urban counties.; citation_author=Fry CE; citation_author=McGuire TG; citation_author=Frank RG; citation_journal_title=RSF; citation_year=2020; citation_volume=6; citation_issue=2; citation_pages=244-263; " /><meta name="citation_reference" content="citation_title=Understanding the relationship between Medicaid expansions and hospital closures.; citation_author=Lindrooth RC; citation_author=Perraillon MC; citation_author=Hardy RY; citation_author=Tung GJ; citation_journal_title=Health Aff (Millwood); citation_year=2018; citation_volume=37; citation_issue=1; citation_pages=111-120; " /><meta name="citation_reference" content="Hamel L,Kearny A,Kirzinger A,Lopes L,Brodie M. KFF health tracking poll: May 2020. Kaiser Family Foundation. May 27, 2020. Accessed July 15, 2022. https://www.kff.org/coronavirus-covid-19/report/kff-health-tracking-poll-may-2020/ " /><meta name="citation_reference" content="citation_title=The racial divide in state Medicaid expansions.; citation_author=Grogan CM; citation_author=Park SE; citation_journal_title=J Health Polit Policy Law; citation_year=2017; citation_volume=42; citation_issue=3; citation_pages=539-572; " /><meta name="citation_reference" content="citation_author=Omi M; citation_author=Winant H; citation_publisher=Routledge, ; citation_title=Racial Formation in the United States; citation_year=2014; " /><meta name="citation_reference" content="citation_title=Medicaid expansion and the political fate of the governors who support it.; citation_author=Fording RC; citation_author=Patton DJ; citation_journal_title=Policy Stud J; citation_year=2019; citation_volume=47; citation_issue=2; citation_pages=274-299; " /><meta name="citation_reference" content="citation_title=Lingering legacies: public attitudes about Medicaid beneficiaries and work requirements.; citation_author=Haeder SF; citation_author=Sylvester SM; citation_author=Callaghan T; citation_journal_title=J Health Polit Policy Law; citation_year=2021; citation_volume=46; citation_issue=2; citation_pages=305-355; " /><meta name="citation_reference" content="Kaiser Family Foundation. Data note: 5 charts about public opinion on Medicaid. February 28, 2020. Accessed September 15, 2021. https://www.kff.org/medicaid/poll-finding/data-note-5-charts-about-public-opinion-on-medicaid/ " /><meta name="citation_reference" content="Solomon J. Federal action needed to close Medicaid “coverage gap,” extend coverage to 2.2 million people. Center on Budget and Policy Priorities. May 6, 2021. Accessed September 15, 2021. https://www.cbpp.org/sites/default/files/5-6-21health.pdf " /><meta name="citation_reference" content="Artiga S,Orgera K,Damico A. Changes in health coverage by race and ethnicity since implementation of the ACA, 2013-2017. Kaiser Family Foundation. February 2019. Accessed September 15, 2021. https://files.kff.org/attachment/Issue-Brief-Health-Coverage-by-Race-and-Ethnicity-Changes-Under-the-ACA " /><meta name="citation_reference" content="Musumeci MB. Medicaid provisions in the American Rescue Plan Act. Kaiser Family Foundation. March 18, 2021. Accessed July 15, 2022. https://www.kff.org/medicaid/issue-brief/medicaid-provisions-in-the-american-rescue-plan-act/ " /><meta name="citation_reference" content="citation_title=Among low-income adults enrolled in Medicaid, churning decreased after the Affordable Care Act.; citation_author=Goldman AL; citation_author=Sommers BD; citation_journal_title=Health Aff (Millwood); citation_year=2020; citation_volume=39; citation_issue=1; citation_pages=85-93; " /><meta name="citation_reference" content="citation_author=Solomon J; citation_publisher=Center on Budget and Policy Priorities, ; citation_title=Continuous Coverage Protections in Families First Act Prevent Coverage Gaps by Reducing “Churn.”; citation_year=2020; " /><meta name="citation_reference" content="citation_title=Eliminating gaps in Medicaid coverage during reentry after incarceration.; citation_author=Albertson EM; citation_author=Scannell C; citation_author=Ashtari N; citation_author=Barnert E; citation_journal_title=Am J Public Health; citation_year=2020; citation_volume=110; citation_issue=3; citation_pages=317-321; " /><meta name="citation_reference" content="citation_title=Postpartum Medicaid extension to address racial inequity in maternal mortality.; citation_author=Kumar NR; citation_author=Borders A; citation_author=Simon MA; citation_journal_title=Am J Public Health; citation_year=2021; citation_volume=111; citation_issue=2; citation_pages=202-204; " /><meta name="citation_reference" content="Thielke A,Curtis P,King V. Addressing COVID-19 health disparities: opportunities for Medicaid programs. Milbank Memorial Fund. June 28, 2021. Accessed September 15, 2021. https://www.milbank.org/publications/addressing-covid-19-health-disparities-opportunities-for-medicaid-programs/ " /><meta name="citation_reference" content="Medicaid and CHIP Payment and Access Commission. Racial and ethnic disparities in Medicaid: an annotated bibliography. April 2021. Accessed September 15, 2021. https://www.macpac.gov/wp-content/uploads/2021/04/Racial-and-Ethnic-Disparities-in-Medicaid-An-Annotated-Bibliography.pdf " /><meta name="citation_reference" content="citation_title=State policies and enrollees’ experiences in Medicaid: evidence From a new national survey.; citation_author=Barnett ML; citation_author=Clark KL; citation_author=Sommers BD; citation_journal_title=Health Aff (Millwood); citation_year=2018; citation_volume=37; citation_issue=10; citation_pages=1647-1655; " /><meta name="citation_reference" content="citation_title=Racial and ethnic disparities in patient experience of care among nonelderly Medicaid managed care enrollees.; citation_author=Nguyen KH; citation_author=Wilson IB; citation_author=Wallack AR; citation_author=Trivedi AN; citation_journal_title=Health Aff (Millwood); citation_year=2022; citation_volume=41; citation_issue=2; citation_pages=256-264; " /><meta name="citation_reference" content="citation_title=Racial and ethnic disparities in treatment and treatment type for depression in a national sample of Medicaid recipients.; citation_author=McGregor B; citation_author=Li C; citation_author=Baltrus P; citation_journal_title=Psychiatr Serv; citation_year=2020; citation_volume=71; citation_issue=7; citation_pages=663-669; " /><meta name="citation_reference" content="citation_title=Use of medications for treatment of opioid use disorder among US Medicaid enrollees in 11 states, 2014-2018.; citation_author=Medicaid Outcomes Distributed Research Network (MODRN); citation_author=Donohue JM; citation_author=Jarlenski MP; citation_author=Kim JY; citation_journal_title=JAMA; citation_year=2021; citation_volume=326; citation_issue=2; citation_pages=154-164; " /><meta name="citation_reference" content="citation_title=Prenatal and postpartum care disparities in a large Medicaid program.; citation_author=Parekh N; citation_author=Jarlenski M; citation_author=Kelley D; citation_journal_title=Matern Child Health J; citation_year=2018; citation_volume=22; citation_issue=3; citation_pages=429-437; " /><meta name="citation_reference" content="citation_title=Medicaid expansion and racial and ethnic disparities in access to health care: applying the National Academy of Medicine definition of health care disparities.; citation_author=Lee H; citation_author=Hodgkin D; citation_author=Johnson MP; citation_author=Porell FW; citation_journal_title=Inquiry; citation_year=2021; citation_volume=58; citation_issue=Jan-Dec; " /><meta name="citation_reference" content="Centers for Medicare & Medicaid Services. Beneficiary information: race and ethnicity. Accessed October 7, 2021. https://www.medicaid.gov/dq-atlas/landing/topics/single/map?topic=g3m16 " /><meta name="citation_reference" content="State Health & Value Strategies. Collection of race, ethnicity, language (REL) data in Medicaid applications: a 50-state review of the current landscape. May 21, 2021. Accessed July 15, 2022. https://www.shvs.org/resource/collection-of-race-ethnicity-language-rel-data-in-medicaid-applications-a-50-state-review-of-the-current-landscape/ " /><meta name="citation_reference" content="Smithey A,Patel S;Center for Health Care Strategies. Building a culture of health equity from within: spotlight on Virginia Medicaid. June 14, 2021. Accessed September 20, 2021. https://www.chcs.org/building-a-culture-of-health-equity-from-within-spotlight-on-virginia-medicaid/ " /><meta name="citation_reference" content="Office of Minority Health, Centers for Medical & Medicaid Services. Paving the way to equity: a progress report. Accessed September 20, 2021. https://www.cms.gov/files/document/paving-way-equity-cms-omh-progress-report.pdf " /><meta name="citation_reference" content="citation_title=Effect of Medicaid managed care on racial disparities in health care access.; citation_author=Cook BL; citation_journal_title=Health Serv Res; citation_year=2007; citation_volume=42; citation_issue=1, pt 1; citation_pages=124-145; " /><meta name="citation_reference" content="citation_title=Does Medicaid managed care help equalize racial and ethnic disparities in utilization?; citation_author=Marton J; citation_author=Yelowitz A; citation_author=Shores M; citation_author=Talbert JC; citation_journal_title=Health Serv Res; citation_year=2016; citation_volume=51; citation_issue=3; citation_pages=872-891; " /><meta name="citation_reference" content="citation_title=The impact of Medicaid managed care on hospitalizations for ambulatory care sensitive conditions.; citation_author=Bindman AB; citation_author=Chattopadhyay A; citation_author=Osmond DH; citation_author=Huen W; citation_author=Bacchetti P; citation_journal_title=Health Serv Res; citation_year=2005; citation_volume=40; citation_issue=1; citation_pages=19-38; " /><meta name="citation_reference" content="citation_title=Does managed care hurt health? evidence from Medicaid mothers.; citation_author=Aizer A; citation_author=Currie J; citation_author=Moretti E; citation_journal_title=Rev Econ Stat; citation_year=2007; citation_volume=89; citation_issue=3; citation_pages=385-399; " /><meta name="citation_reference" content="citation_title=Does managed care widen infant health disparities? evidence from Texas Medicaid.; citation_author=Kuziemko I; citation_author=Meckel K; citation_author=Rossin-Slater M; citation_journal_title=Am Econ J Econ Policy; citation_year=2018; citation_volume=10; citation_issue=3; citation_pages=255-293; " /><meta name="citation_reference" content="citation_title=Association of Medicaid-focused or commercial Medicaid managed care care plan type with outpatient and acute care.; citation_author=Swaminathan S; citation_author=Ndumele CD; citation_author=Gordon SH; citation_author=Lee Y; citation_author=Trivedi AN; citation_journal_title=JAMA Intern Med; citation_year=2020; citation_volume=180; citation_issue=12; citation_pages=1672-1679; " /><meta name="citation_reference" content="Wallace J. What does a provider network do? evidence from random assignment in Medicaid managed care. SSRN. May 7, 2019. Accessed August 15, 2021. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3544928 " /><meta name="citation_reference" content="Bailit Health. Medicaid managed care contract language: health disparities and health equity. August 2021. Accessed September 20, 2021. https://www.shvs.org/wp-content/uploads/2021/02/SHVS-MCO-Contract-Language-Health-Equity-and-Disparities_August-2021.pdf " /><meta name="citation_reference" content="Taylor E,Dyer MB,Bailit M. Promoting health equity in Medicaid managed care: a guide for states. Bailit Health. September 9, 2021. Accessed July 15, 2022. https://www.shvs.org/resource/promoting-health-equity-in-medicaid-managed-care-a-guide-for-states/ " /><meta name="citation_reference" content="US Department of Health and Human Services Office of Minority Health. Think Cultural Health. Updated October 2, 2018. Accessed September 30, 2021. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53 " /><meta name="citation_reference" content="Pennsylvania Department of Human Services. Pennsylvania receives grant funding to promote racial equity in pregnancy and child health. September 9, 2021. Accessed July 15, 2022. https://www.media.pa.gov/Pages/DHS_details.aspx?newsid=746 " /><meta name="citation_reference" content="Brooks-LaSure C,Fowler E,Seshamani M,Tsai D. Innovation at the centers for Medicare and Medicaid Services: a vision for the next 10 years. Health Affairs. August 12, 2021. Accessed August 28, 2021. https://www.healthaffairs.org/do/10.1377/hblog20210812.211558/full/ " /><meta name="citation_reference" content="citation_title=Incentivizing excellent care to at-risk groups with a health equity summary score.; citation_author=Agniel D; citation_author=Martino SC; citation_author=Burkhart Q; citation_journal_title=J Gen Intern Med; citation_year=2021; citation_volume=36; citation_issue=7; citation_pages=1847-1857; " /><meta name="citation_reference" content="Holgash K,Heberlein M. Physician acceptance of new Medicaid patients: Medicaid and CHIP Payment and Access Commission. January 24, 2019. Accessed July 25, 2022. https://www.macpac.gov/wp-content/uploads/2019/01/Physician-Acceptance-of-New-Medicaid-Patients.pdf " /><meta name="citation_reference" content="citation_title=Residential segregation and the availability of primary care physicians.; citation_author=Gaskin DJ; citation_author=Dinwiddie GY; citation_author=Chan KS; citation_author=McCleary RR; citation_journal_title=Health Serv Res; citation_year=2012; citation_volume=47; citation_issue=6; citation_pages=2353-2376; " /><meta name="citation_reference" content="citation_title=Pathology of racism: a call to desegregate teaching hospitals.; citation_author=Vinekar K; citation_journal_title=N Engl J Med; citation_year=2021; citation_volume=385; citation_issue=13; " /><meta name="citation_reference" content="citation_title=Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial.; citation_author=Kangovi S; citation_author=Mitra N; citation_author=Norton L; citation_journal_title=JAMA Intern Med; citation_year=2018; citation_volume=178; citation_issue=12; citation_pages=1635-1643; " /><meta name="citation_reference" content="citation_title=Physician workforce disparities and patient care: a narrative review.; citation_author=Silver JK; citation_author=Bean AC; citation_author=Slocum C; citation_journal_title=Health Equity; citation_year=2019; citation_volume=3; citation_issue=1; citation_pages=360-377; " /><meta name="citation_reference" content="citation_title=Race and ethnicity, medical insurance, and within-hospital severe maternal morbidity disparities.; citation_author=Howell EA; citation_author=Egorova NN; citation_author=Janevic T; citation_journal_title=Obstet Gynecol; citation_year=2020; citation_volume=135; citation_issue=2; citation_pages=285-293; " /><meta name="citation_reference" content="citation_title=A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.; citation_author=Maina IW; citation_author=Belton TD; citation_author=Ginzberg S; citation_author=Singh A; citation_author=Johnson TJ; citation_journal_title=Soc Sci Med; citation_year=2018; citation_volume=199; citation_pages=219-229; " /><meta name="citation_pdf_url" content="https://jamanetwork.com/journals/jama/articlepdf/2796374/jama_donohue_2022_sc_220004_1663338124.20613.pdf" /> <meta name="citation_xml_url" content="https://datafeed.jamanetwork.com/journals/jama/xml/2796374" /> <title>The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity | Health Care Reform | JAMA | JAMA Network</title> <meta name="description" content="This Special Communication describes Medicaid eligibility, enrollment, and spending as well as examines areas of Medicaid policy, Medicaid expansion,"> <link rel="canonical" href="https://jamanetwork.com/journals/jama/fullarticle/2796374" /> <script src="//cdn.jamanetwork.com/UI/app/dist/head.min.js?v=638677764511843155"></script> <script src="https://r451.jamanetwork.com/script.js" defer></script> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_HeaderScript"> <meta class="SCM-SharedWidgets-AsyncHeaderAdLoader" data-url="/AMA/AdTag/AMA_AdTag_HeaderScript" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":0,"adSection":"abstract","adPosition":"","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"> </div> </head> <body data-sitename="jama" class="pg_abstract " data-thm="jama"> <script> var App = App || {}; App.suppressAds = App.suppressAds || !!document.getElementsByClassName('suppress-ads').length; App.suppressGtm = App.suppressGtm || !!document.getElementsByClassName('suppress-gtm').length; </script> <div id="ad-interstitial" class="ad-interstitial"> <script defer> googletag.cmd.push(function() { if (App.suppressAds) { return; } // Define a web interstitial ad slot. let interstitialSlot = googletag.defineOutOfPageSlot( App.Ads.adPath + '/abstract', googletag.enums.OutOfPageFormat.INTERSTITIAL, ); if (interstitialSlot) { App.Ads.slots[13] = interstitialSlot; // Enable optional interstitial triggers and register the slot. interstitialSlot .setTargeting('pos', ['interstitial']) .addService(googletag.pubads()) .setConfig({ interstitial: { triggers: { navBar: true, unhideWindow: true, }, }, }); googletag.display(interstitialSlot); googletag.pubads().refresh([interstitialSlot], { changeCorrelator: false }); googletag.enableServices(); } }); </script> </div> <a class="accessible js-skip-to-navigation" href="#skip-to-navigation">[Skip to Navigation]</a> <noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-WNKSNP" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-WNKSNP');</script> <span class="hide tagmanagervalue" data-attribute="productName" data-value="JAMA" data-type="string"></span> <form method="post" action="./2796374" id="webform" class="m0"> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="sxSobJnlUkK6JYdqTgPnGsXX5ysV3s1cfhHvoIUN/6A0+ny6jfvv44Pp4r3vU8b2SgPI+C2h1ElgX+b4T8z5sk0eRUU=" /> </div> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="2FAFABAE" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="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" /> </div> <input id="hdnSiteID" type="hidden" value="3" /> <input id="hdnDomain" type="hidden" value=".jamanetwork.com" /> <section class="master-header"> <script type='text/javascript'> var App = App || {}; App.LoginUserInfo = { isInstLoggedIn: [0], currentSessionId: 'zofpc45mqfpqmeotignop5e2' }; </script> <input name="ctl00$ctl00$BodyContent$Header$hfGlobalSearchSiteURL" type="hidden" id="hfGlobalSearchSiteURL" value="https://jamanetwork.com/" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsPaidUser" type="hidden" id="hfAppIsPaidUser" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsMember" type="hidden" id="hfAppIsMember" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppSubscribedTo" type="hidden" id="hfAppSubscribedTo" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsIndividual" type="hidden" id="hfAppIsIndividual" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppHasAccess" type="hidden" id="hfAppHasAccess" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsReferredFromGoogle" type="hidden" id="hfAppIsReferredFromGoogle" value="False" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrAutoSuggestMinimumCharactersLength" type="hidden" id="hfSolrAutoSuggestMinimumCharactersLength" value="2" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalName" type="hidden" id="hfSolrJournalName" value="JAMA" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalID" type="hidden" id="hfSolrJournalID" value="J67" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsLucy" type="hidden" id="hfAppIsLucy" value="false" /> <div class="header-wrap"> <header class="header"> <div class="widget-GdprCookieBanner widget-instance-GdprCookieBanner"> <div class="gdpr-cookie-wrapper js-gdpr-banner"> <div class="gdpr-cookie-body"> Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our <a href="https://jamanetwork.com/pages/privacy-policy#cookies">Cookie Policy</a> <span class="pipe">|</span> <a href="javascript:;" class="js-gdpr-cookie-acceptLink at-acceptgdpr">Continue</a> </div> <input id="hdnDomain" type="hidden" value=".jamanetwork.com" /> <input id="hdnDomainGdpr" type="hidden" value=".jamanetwork.com" /> <input id="hdnClientIdGdpr" type="hidden" value="3" /> </div> </div> <div class="network-bar"> <a class="jama-network" href="/" title="JAMA Network Home"> <img alt="JAMA Network Home" class="title-image" width="443" height="52" src="//cdn.jamanetwork.com/UI/app/svg/Jama_Network_Logo.svg"> </a> </div> <a class="nav-toggler" href="#nav"> <div class="nav-toggler-indicator"> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> </div> <div class="nav-toggler-site"> <span id="BodyContent_Header_siteFullNamenav" class="nav-toggler-microsite"><span class='network'>JAMA</span></span> </div> </a> <nav id="nav" class="nav hide" > <div class="nav-journal-level sb-nav-journal-level"> <a href="https://jamanetwork.com/journals/jama" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_0" class="home">Home</a><a href="https://jamanetwork.com/journals/jama/newonline" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_1" class="new-online">New Online</a><a href="https://jamanetwork.com/journals/jama/currentissue" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_2" class="current-issue">Current Issue</a><a href="https://jamanetwork.com/journals/jama/pages/for-authors" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_3" class="for-authors">For Authors</a> </div> <div class="nav-journals"> <div class="widget-SelfServeContent widget-instance-HamburgerPublicationMenu"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="HamburgerPublicationMenu" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .nav-journals {margin-bottom: 1em;} .nav-heading {color: #B9B9B9;border-bottom: 0;border-top: 1px solid #242424;font-size: 1.15em;font-weight: 400;margin: 0;padding: .7em .75em .25em;text-transform: uppercase;} a.no-bullet:before {content:none !important;} .nav-heading {font-size: 1.15em;margin-bottom:0;padding-left: 38px;} /* .nav-journals a.theme-jama {background-color: #242424;border-bottom: 1px solid #fff;border-top: 1px solid #fff;color: #fff;font-size: 1.15em;margin-bottom: 8px;padding: 11px 0 9px 37px;} .nav-journals a.theme-jama::before {background: unset;content: "\e91b";display: none;font-family: ama_icons !important;font-size: 1.25em;line-height: 1;} .nav-journals a.theme-jama-network-open {border-bottom:0;} */ .nav .widget-instance-HamburgerPublicationMenu a {padding-left: 36px;} .fake-ribbon {border-left: 8px solid #BE1E32;} .fake-ribbon a:before {content:none;} .nav .widget-instance-HamburgerPublicationMenu .fake-ribbon a {padding-left:30px;} .nav-journals a.theme-plus:before {background:#d71635;} .nav-journals a.theme-jama-network-open {border-bottom:0;} </style> <h2 class="nav-heading">JAMA+</h2> <a href="/channels/ai" class="theme-plus">AI</a> <h2 class="nav-heading">Journals</h2> <a href="/journals/jama" class="theme-jama">JAMA</a> <a href="/journals/jamanetworkopen" class="theme-jama-network-open">JAMA Network Open</a> <a href="/journals/jamacardiology" class="theme-jama-cardiology">JAMA Cardiology</a> <a href="/journals/jamadermatology" class="theme-jama-dermatology">JAMA Dermatology</a> <a href="/journals/jama-health-forum" class="theme-jama-health-forum">JAMA Health Forum</a> <a href="/journals/jamainternalmedicine" class="theme-jama-internal-medicine">JAMA Internal Medicine</a> <a href="/journals/jamaneurology" class="theme-jama-neurology">JAMA Neurology</a> <a href="/journals/jamaoncology" class="theme-jama-oncology">JAMA Oncology</a> <a href="/journals/jamaophthalmology" class="theme-jama-ophthalmology">JAMA Ophthalmology </a> <a href="/journals/jamaotolaryngology" class="theme-jama-otolaryngology-head-neck-surgery">JAMA Otolaryngology–Head & Neck Surgery</a> <a href="/journals/jamapediatrics" class="theme-jama-pediatrics">JAMA Pediatrics</a> <a href="/journals/jamapsychiatry" class="theme-jama-psychiatry">JAMA Psychiatry</a> <a href="/journals/jamasurgery" class="theme-jama-surgery">JAMA Surgery</a> <a href="/journals/archneurpsyc" class="theme-archives-of-neurology-psychiatry-1919-1959-">Archives of Neurology & Psychiatry (1919-1959)</a> <h2 class="nav-heading">Podcasts</h2> <a href="/journals/jama/pages/jama-clinical-reviews">Clinical Reviews</a> <a href="/journals/jama/pages/jama-editors-summary">Editors' Summary</a> <a href="/journals/jama/pages/jama-medical-news">Medical News</a> <a href="/journals/jama/pages/jama-author-interviews">Author Interviews</a> <a href="/pages/audio" class="no-bullet">More</a> </div> </div> </div> <div class="nav-network-other"> <a href="https://edhub.ama-assn.org/jn-learning" id="BodyContent_Header_rptOtherResources_aItemResourceList_0" class="is-b link-jn-learning-cme" target="_blank">JN Learning / CME</a><a href="https://store.jamanetwork.com/index.aspx?productcode=64" id="BodyContent_Header_rptOtherResources_aItemResourceList_1" class="is-b link-subscribe" target="_blank">Subscribe</a><a href="https://careers.jamanetwork.com/" id="BodyContent_Header_rptOtherResources_aItemResourceList_2" class="is-b link-jobs" target="_blank">Jobs</a><a href="https://jamanetwork.com/pages/resources-for-librarians" id="BodyContent_Header_rptOtherResources_aItemResourceList_3" class="is-b link-institutions-librarians">Institutions / Librarians</a><a href="https://jamanetwork.com/pages/reprints-and-permissions" id="BodyContent_Header_rptOtherResources_aItemResourceList_4" class="is-b link-reprints-permissions" rel="nofollow">Reprints & Permissions</a> </div> <div class="white text-xxs"> <div class="p05 ml4 mr3 mb1 mt10 flex hamburger-menu-legal"> <a href="/pages/conditions-of-use" class="p0" rel="nofollow">Terms of Use</a> <span class="pl1 pr1">| </span> <a href="/pages/privacy-policy" class="p0" rel="nofollow">Privacy Policy</a> <span class="pl1 pr1">| </span> <a href="/pages/accessibility-statement" class="p0" rel="nofollow">Accessibility Statement</a> </div> <div class="ta-c"> <span class="pb1">2024 American Medical Association. All Rights Reserved</span> </div> </div> </nav> <a class="toolbar-search-trigger is-b" data-mobile-tog-target=".site-search"></a> <div id="site-search" role="search" class="site-search"> <div class="site-search-bar"> <div role="search"> <select name="ctl00$ctl00$BodyContent$Header$ddlForSearch" id="BodyContent_Header_ddlForSearch" Name="dropDownList" class="cs-select cs-skin-border" title="Search Site Selector" role="options" aria-labelledby="searchLabel"> <option value="J*">Search All</option> <option value="3">JAMA</option> <option value="214">JAMA Network Open</option> <option value="192">JAMA Cardiology</option> <option value="12">JAMA Dermatology</option> <option value="261">JAMA Forum Archive</option> <option value="193">JAMA Health Forum</option> <option value="15">JAMA Internal Medicine</option> <option value="16">JAMA Neurology</option> <option value="159">JAMA Oncology</option> <option value="17">JAMA Ophthalmology</option> <option value="18">JAMA Otolaryngology–Head & Neck Surgery</option> <option value="19">JAMA Pediatrics</option> <option value="14">JAMA Psychiatry</option> <option value="20">JAMA Surgery</option> <option value="23">Archives of Neurology & Psychiatry</option> </select> </div> <div class="search-input-container"> <input type="search" name="textbox" autocomplete="off" role="textbox" id="search-term" aria-labelledby="searchLabel" class="search-term at-microsite-search-term" placeholder="Enter Search Term" maxlength="255" title="Enter Search Term"> <ul id="umbrellaSiteAutoCompleteResults" class="term-list hidden"></ul> <label style="display:none" for="umbrellaSiteSearchInputHint" id="searchLabel">Input Search Term</label> <input class="searchTerm search-input" name="textbox" role="textbox" type="text" id="umbrellaSiteSearchInputHint" aria-labelledby="searchLabel" title="Input Search Term" autocomplete="off"> </div>  <a name="button" role="button" class="search-button is-b js-search-button" alt="search button" href="/searchresults"></a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_auth" class="auth"> <a class="auth--trigger is-b is-a" href="javascript:;"> <span id="BodyContent_Header_GlobalSignIn_spnUserFullName" class="user-full-name">Sign In</span> </a> <div class="auth--dropdown js-signIn-dropdown"> <div class="auth--option auth--ind"> <div id="BodyContent_Header_GlobalSignIn_divUserFullName" class="auth--ind-user"></div> <div id="BodyContent_Header_GlobalSignIn_divIndSignIn" class="auth--ind-auth"> <div class="auth--title">Individual Sign In</div> <a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2796374" id="BodyContent_Header_GlobalSignIn_oauthSignInLink" rel="nofollow" class="auth--ind-sign-in">Sign in</a><a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2796374" id="BodyContent_Header_GlobalSignIn_oauthSignUpLink" rel="nofollow" class="auth--ind-create">Create an Account</a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_divInstSignIn" class="auth--option auth--inst"> <div class="auth--inst-auth"> <div class="auth--title">Access through your institution</div> <a href="/signinshibboleth?returnUrl=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2796374" id="BodyContent_Header_GlobalSignIn_institutionSignIn" rel="nofollow" class="auth--shib">Sign In</a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_divPurchaseOptions" class="auth--option auth--purchase"> <div class="auth--title">Purchase Options:</div> <a id="BodyContent_Header_GlobalSignIn_lnkBuyArticle" class="auth--buy" href="https://jamanetwork.com/oauthsignin?return_url=https://store.jamanetwork.com/CustomerType.aspx?articleId=2796374">Buy this article</a> <div class="widget-DeepDyve widget-instance-AMAv2_DeepDyve"> <a rel="nofollow" data-doi="10.1001/jama.2022.14791" data-fieldname="journal_doi" data-issneissn="0098-7484" data-affiliate="JAMA" class="deepDiveLink auth--shib deep-dive-wrap js-deepdyve-link" href="https://www.deepdyve.com/doc-view?docId=10.1001/jama.2022.14791&fieldName=journal_doi&affiliateId=JAMA" target="_blank">Rent this article</a> </div> <a id="BodyContent_Header_GlobalSignIn_lnkSubscribeJournal" class="auth--subscribe" rel="nofollow" href="https://store.jamanetwork.com/index.aspx?productcode=64">Subscribe to the JAMA journal</a> </div> </div> </div> </header> </div> <div class="editors-choice-header"> </div> <div id="BodyContent_Header_divAds" class="header-ad-wrap sb-background-primary-dark"> <div class="leader-ad desktop-only"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_LeaderboardAd"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_LeaderboardAd" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":1,"adSection":"abstract","adPosition":"atf","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> </div>  </section> <section class="master-main"> <span class="hide tagmanagervalue" data-attribute="template" data-value="abstract" data-type="string"></span> <script type="application/ld+json"> { "@context": "https://schema.org/", "@type": "Article", "headline": "The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity", "author": "Julie M. Donohue, PhD", "url": "https://jamanetwork.com/journals/jama/fullarticle/2796374", "datePublished": "2022-09-20", "description": "This Special Communication describes Medicaid eligibility, enrollment, and spending as well as examines areas of Medicaid policy, Medicaid expansion, racial and ethnic health disparities, and the potential to achieve health equity.", "publisher": { "@type": "Organization", "name": "JAMA Network", "logo": { "@type": "ImageObject", "url": "//cdn.jamanetwork.com/UI/app/img/favicons/jama/favicon.ico" } }, "image": [ "https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004t1_1663338124.3442.png?Expires=2147483647&Signature=AWH-GDJapcowR2~d0JEEw-0rT5of~~Z02VeLrA5rmg84HLN9apab2rqA4Ie96O1JvocwJS2ufqkNwfbFuTQl0bv7wSYdNu6mB2eHwh6hIiD3o9kQFdnirVnZsoAJpzy-3tlulSJIYF0MgwVXns~geob2YmJmiFx2Vm8GDjCpbOsx-SM~da9Jy8nTNQDq3FSnljDQtNFdZQQr-tEphZxoEFOy4MIYLZoMpHfr8Nui2A4IPCAwlBYuzwbIV9b8ATsmyOJd31V-OvBddXNTzsOBw3nrWdRsbnLIItxOs0KUgZvoSBLIM12nwUVcW8RTN5RsS~cv-hCHj5eKQIgTsF2oyw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004t2_1663338124.3692.png?Expires=2147483647&Signature=i6068BL9zFOhdmfvJcxHyHvwQTxHsqve-LoCNC3IlO5zhfUEQicnXgEsJvkG2u-nqQKyY5Ztz8EIrZSWWi9jXlTFDHddNM09SYyxIaRKM139kBf7WYhMVs6X4wqu-SrNe836ysAxQQWgs1hUBD168RGFll2IabtHHvVcv0NT~TjzBlGIlzhanR79JgVimMAYn7p18OPGIA93pQ53ovqTPrqtkIhTwUorWJ9-jS6wyftC168fcJhESqGonIdU6oLaaqfRFtXPV9Qo2ZBmVTSwkNcAo7G~uOFKiahPLjlgi73zq8VaLGJc8IiW6q5GKhTp2spTMJpH9chtAAXmFSa7HA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004f1_1663338124.40601.png?Expires=2147483647&Signature=AWMKanUebKhQIdEr31VTrNyS2TqTh8ZtiqjiHybwVCjfWLpqL0-Zop1KSpzGCUjZHnSPr7EC7hbgoCB~oZJbOxUAul4fxzF8YfY6aVo8E6vulpWvaQCprVd543LzRWyNFf9p~osMC75NZecUjYUX5eYMCBZLsPiSNQLt2vOnJ6yvbh91lw~BLDkqesnrG9viQilQqv2dPxeOp89ANiG2ZhGTNOu00LLy3IQzXzDTZY02KBTrnepYCwqicryfBIoIgQxJTaEuhRsa~R6uqKpbW6DlEhwZmWsvzuzg8EzwX6oant43o7p-GfnAy~wzOH2jmeAcvaQuI5GA6paNuokNJA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004f2_1663338124.45603.png?Expires=2147483647&Signature=oWCMV4gm5VGEHRPmIHBxJLaD~xT2eI70vCEXiTuTFS7UWPoZEZ2hQJzyYs6pnX914Bn7acPX8IYZMmRppZk~qjkq2o85cSU5UQ6jlOtOHeMLyDnyOEoIpPdv9UWnZe04D6ig5Jz2yTCCaPANtbv4jm0w6RtSrPwPtj2zToenkOR1n04OLFZLmWTxp6qHJfppkCn8oohrwOhcUSWX85EvWLwM~pAs3h4nSJjQjMBe5SIc~UyXZML0A3gUJavO22vMTrDs68Mkh1egz24e5Us0j02G-Vhu4zMeYSDXoiaPLDEKqkZDsEKSoji~bcg5cQsJeAKsqQ4-7i42fBlWiZsGrA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/jama/938990/jsc220004f3_1663338124.47103.png?Expires=2147483647&Signature=o61gG23X~Sbsd89va-7~TsFXUcFayfoX-ecY3AHmSZljxYfiVXBbP84P7J~HR3qx5KKyP0Hm-zkEY2BaScO39z2Amw4AztFLSwge0f5~Ml~slrtsqsVl6NJ-VHIFoQwW~7Wgy9SRSlghRV76JCD0qf2JiyJ~eUM6ltVaGgTiVx9A8ZVmXZrcD-794-vaMBYeUY426dUu0MzWc1EZmljPP5ynP4okCqewAbNSzjMS~yWsMiilOVpG3PqPDf9lOUhCVUhvUASz9sOKdh8a6MmqAzVqlpl1w9xtnrGdZ6ajLRJ7rrz6NtvlBwc4~FZAYAdudN-MhCq3xULximCilWFwLw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" ], "articleSection": [ "Introduction", "Methods", "Results", "Medicaid Eligibility, Population Characteristics, and Financing", "Eligibility", "Population Characteristics", "Financing", "Medicaid and COVID-19", "Medicaid Managed Care and Delivery System Reforms", "Medicaid Managed Care", "Delivery System Reforms", "ACA Medicaid Expansion", "History and Context", "Evaluations of Medicaid Expansions", "Structural Racism and the Politics of Medicaid Expansion", "Medicaid and Health Equity", "Medicaid Coverage Among Racial and Ethnic Minority Groups", "Expanding and Extending Medicaid Coverage", "Racial and Ethnic Disparities Within Medicaid", "Strategies to Address Racial and Ethnic Inequities Within Medicaid", "Measurement of Racial and Ethnic Disparities", "Managed Care Contract Levers to Advance Equity", "Payment and Delivery System Reforms", "Workforce Policies", "Discussion", "Limitations", "Conclusions", "Article Information", "References" ], "keyWords": "medicaid, health disparity, health equity, medicaid expansion" } </script> <div class="widget-UserContentAccessWrite widget-instance-AMA_UserContentAccessWrite_AbstractView"> <div class="SCM-SharedWidgets-LocalStorage-UserContentAccessWrite" data-values='{"id":"2796374","type":"Article","date":"11/30/2024 11:39:26 PM"}'></div> </div> <a id="skip-to-navigation" href="#" tabindex="-1"></a> <div class="ymal--leader hide-small"> <div id="BodyContent_PageContent_ymalPersonalized" class="ymal--personalized js-ymal-personalized hide"> <div class="widget-WidgetLoader widget-instance-AMA_PersonalizedContent_AbstractView_Leaderboard"> <div class="SCM-SharedWidgets-AsyncWidgetLoader" data-url="/Personalization/PersonalizedContent/AMA_PersonalizedContent_AbstractView_Leaderboard" data-params="{"parameters":{"resourceIdToExclude":2796374,"resourceTypeToExclude":3},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div id="BodyContent_PageContent_ymalCurated" class="ymal--curated js-ymal-curated"> <div class="ymal row"> </div> </div> </div> <div class="content pb0"> <a id="top"></a> <div class="article-content"> <div class="social-share hide" data-share-journal="JAMA_current" data-share-title="The US Medicaid Program—Coverage, Financing, Reforms, and Implications for Health Equity"> <a class="st-custom-button addthis_button_twitter is-b toolbar-twitter toolbar-share" data-network="twitter" data-title="" data-url="" data-email-subject="" rel="nofollow" href="javascript:;"> <span class="share-text">X</span> </a> <a class="st-custom-button addthis_button_facebook is-b toolbar-facebook toolbar-share" data-network="facebook" data-title="" data-url="" data-email-subject="" rel="nofollow" href="javascript:;"> <span class="share-text">Facebook</span> </a> <div class="toolbar-share-more"> <a class="st-custom-button addthis_button_linkedin is-b toolbar-linkedin toolbar-share" data-network="linkedin" data-title="" data-url="" data-email-subject="" rel="nofollow" href="javascript:;"> <span class="share-text">LinkedIn</span> </a> </div> <a class="toolbar-share-more-link is-a" rel="nofollow" data-tog-target=".social-share .toolbar-share-more"><span class="icon icon-carrot_down social-arrow"></span>More</a> </div> <div class="widget-ArticleLinks widget-instance-AMA_ErrataArticleLinks_Abstract"> </div> <div class="widget-ArticleLinks widget-instance-AMA_ArticleLinks_ToErrata_Abstract"> </div> <div class="widget-ArticleNavLinks widget-instance-AMA_ArticleNavLinks_Abstract"> <a class="toc-link btn" href="https://jamanetwork.com/journals/jama/issue/328/11">This Issue</a> </div> <div id="BodyContent_PageContent_divArticleLevelMetrics" class="article-metrics-wrapper"> <div class="widget-ArticleLevelMetrics widget-instance-AMA_ArticleMetrics"> <div class="artmet-condensed-wrap clearfix"> <div class="artmet-condensed-stats clearfix"> <div class="artmet-item artmet-views"> <span class="artmet-text sb-sc">Views</span> <span class="artmet-number sb-sc">9,715</span> </div> <div class="artmet-item artmet-citations"> <a class="artmet-citations-link" href="https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=silverchair&SrcAuth=WosAPI&KeyUT=WOS:000862909200022&DestLinkType=FullRecord&DestApp=WOS_CPL" target="_blank"> <span class="artmet-text">Citations</span> <span class="artmet-number">51</span> </a> </div> <div class="artmet-item artmet-altmetric"> <div class="widget-AltmetricLink widget-instance-AMAv2_ArticleLevelMetrics_AltmetricLinkSummary">  <div id="altmetricEmbedId" class='altmetric-embed' data-link-target="_blank" data-badge-type="text" data-hide-no-mentions="false" data-doi="10.1001/jama.2022.14791" ></div> </div> </div> </div> <div class="artmet-modal-trigger-wrap"> <a rel="nofollow" class="artmet-modal-trigger" data-article-id="2796374"><i class="icon-metrics"></i><span>View Metrics</span></a> </div> </div> </div> </div> <ul class="toolbar-trigger"> <li class="toolbar-pdf-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-pdf is-b" data-trigger=".abstract-toolbar .toolbar-pdf"><span class="toolbar-pdf-text"><span class="toolbar-link-text-extra">Download </span><span class="toolbar-link-text">PDF</span></span></a> </li> <li class="toolbar-full-text-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-full-text is-b" data-url="" data-article-id="2796374" data-trigger=".abstract-toolbar .toolbar-full-text">Full Text</a> </li> <li class="toolbar-cme-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-cme is-b jama-active-cme-button" data-trigger=".abstract-toolbar .toolbar-cme" rel="nofollow">CME & MOC</a> </li> <li class="toolbar-share-wrap toolbar-tool-wrap"> <div class="toolbar-tool toolbar-share is-b"> <a class="toolbar-share-more-link">Share</a> <div class="toolbar-share-more"> <a class="toolbar-share toolbar-twitter is-b" rel="nofollow" data-trigger=".social-share .toolbar-twitter"><span class="share-text">X</span></a> <a class="toolbar-share toolbar-facebook is-b" rel="nofollow" data-trigger=".social-share .toolbar-facebook"><span class="share-text">Facebook</span></a> <a class="toolbar-share toolbar-email is-b" rel="nofollow" data-trigger=".social-share .toolbar-email"><span class="share-text">Email</span></a> <a class="toolbar-share toolbar-linkedin is-b" rel="nofollow" data-trigger=".social-share .toolbar-linkedin"><span class="share-text">LinkedIn</span></a> </div> </div> </li> <li class="toolbar-citation-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-citation is-b stats-citation" rel="nofollow" data-trigger=".abstract-toolbar .toolbar-citation"><span class="toolbar-link-text">Cite</span> <span class="toolbar-link-text-extra">This</span></a> </li> <li class="toolbar-permissions-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-permissions is-b" rel="nofollow" data-trigger=".abstract-toolbar .toolbar-permissions"><span class="toolbar-link-text">Permissions</span></a> </li> </ul> <div class="widget-ArticleTopInfo widget-instance-AMA_ArticleTop_Info_Widget"> <span class="hide tagmanagervalue" data-attribute="articleId" data-value="2796374" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="arrArticleAuthor" data-value="Julie%20M.%C2%A0Donohue%2C%C2%A0PhD,Evan%20S.%C2%A0Cole%2C%C2%A0PhD,Cara%20V.%C2%A0James%2C%C2%A0PhD,Marian%C2%A0Jarlenski%2C%C2%A0PhD%2C%20MPH,Jamila%20D.%C2%A0Michener%2C%C2%A0PhD,Eric%20T.%C2%A0Roberts%2C%C2%A0PhD" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="articleDOI" data-value="10.1001/jama.2022.14791" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articleTitle" data-value="The US Medicaid Program<span class="subtitle"><span class="colon-for-citation-subtitle">: </span>Coverage, Financing, Reforms, and Implications for Health Equity</span>" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="type" data-value="Special Communication" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueVolume" data-value="328" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueNo" data-value="11" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="publishDate" data-value="September 20, 2022" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="topics" data-value="Health Care Reform, Health Care Economics, Insurance, Payment, Health Policy, Health Inequities, Equity, Diversity, and Inclusion, Health Disparities" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="topicCode" data-value="5680, 42114, 44020, 46328, 46387, 5679" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="category" data-value="Review" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="journalClub" data-value="No" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentStatus" data-value="Locked" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articlePubState" data-value="Final" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentMedium" data-value="Article" data-type="string"></span> <div class="meta-article-type-wrap"> <div class="meta-article-type thm-col">Special Communication </div> </div> <div class="meta-date"><span class="ppub"><span class="month">September </span><span class="day">20, </span><span class="year">2022</span></span></div> <div class="meta-article-title-wrap"> <h1 class="meta-article-title ">The US Medicaid Program<span class="subtitle"><span class="colon-for-citation-subtitle">: </span>Coverage, Financing, Reforms, and Implications for Health Equity</span></h1> </div> <div class="meta-authors"> <span class="meta-authors--limited"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Julie+M.+Donohue&q=Julie+M.+Donohue" rel=nofollow target="_blank">Julie M. Donohue, PhD<sup>1</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Evan+S.+Cole&q=Evan+S.+Cole" rel=nofollow target="_blank">Evan S. Cole, PhD<sup>1</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Cara+V.+James&q=Cara+V.+James" rel=nofollow target="_blank">Cara V. James, PhD<sup>2</sup></a></span>; <a class="meta-authors--etal td-u stats-meta-authors--etal">et al</a></span> <span class="meta-authors--remaining"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Marian+Jarlenski&q=Marian+Jarlenski" rel=nofollow target="_blank">Marian Jarlenski, PhD, MPH<sup>1</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jamila+D.+Michener&q=Jamila+D.+Michener" rel=nofollow target="_blank">Jamila D. Michener, PhD<sup>3</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Eric+T.+Roberts&q=Eric+T.+Roberts" rel=nofollow target="_blank">Eric T. Roberts, PhD<sup>1</sup></a></span></span> </div> <div class="meta-author"> <a class="meta-author-title is-b stats-meta-author-toggle" data-tog-target=".meta-author-content">Author Affiliations</a> <a class="meta-articleinfo-jumplink section-jump-link scroll-to stats-scroll-to-articleinfo" data-tab-toggle=".tab-nav-full-text" href="#248610314">Article Information</a> <div class="meta-author-content"> <ul class="meta-author-affiliations"> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>1</sup>Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>2</sup>Grantmakers In Health, Washington, DC</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>3</sup>Department of Government and School of Public Policy, Cornell University, Ithaca, New York</div> </li> </ul> </div> </div> <div class="meta-citation-wrap"> <span class="meta-citation-journal-name">JAMA. </span><span class="meta-citation"> 2022;328(11):1085-1099. doi:10.1001/jama.2022.14791</span> </div> </div> <div class="widget-EditorsChoice widget-instance-AMA_EditorsChoice_Links"> </div> <div class="widget-LinkedContentToolbar widget-instance-AMA_LinkedContentToolbar"> <div class="linked-content-toolbar"> <div class="hidden js-search-open-multimedia-by-default" showContentByDefault="False"></div> <div class="linked-content-controls"> <a class="linked-content-trigger td-n stats-graphical-abstract" href="#graphical-abstract-tab"> <i class="icon-visual-abstract"><span class="sr-t">visual abstract icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Visual <div>Abstract</div></div> </a> <a class="linked-content-trigger td-n stats-editorial-comment" href="#editorial-comment-tab"> <i class="icon-document"><span class="sr-t">editorial comment icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Editorial <div>Comment</div></div> </a> <a class="linked-content-trigger td-n stats-related-articles" href="#related-articles-tab"> <i class="icon-related"><span class="sr-t">related articles icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Related <div>Articles</div></div> </a> <a class="linked-content-trigger td-n stats-author-interviews" href="#author-interviews-tab"> <i class="icon-author_interview"><span class="sr-t">author interview icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Interviews</div> </a> <a class="linked-content-trigger td-n stats-more-multimedia" href="#more-multimedia-tab"> <i class="icon-multimedia"><span class="sr-t">multimedia icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Multimedia</div> </a> <a class="linked-content-trigger td-n stats-listen-to-this-article" href="#listen-to-this-article-tab"> <i class="icon-audio"><span class="sr-t">audio icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Listen to <div>this article</div></div> </a> </div> <div class="linked-content-tabs"> <div id="graphical-abstract-tab" class="linked-content-tab graphical-abstract-tab"> <div class="widget-SectionDisplay widget-instance-AMA_GraphicalAbstract_Tab"> </div> </div> <div id="editorial-comment-tab" class="linked-content-tab editorial-comment-tab"> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_EditorialComments"> <ul class="article-abstract-links related-abstract-content"> <li class="article-link related-abstract-article"> <a class="related-article-title" href="https://jamanetwork.com/journals/jama/fullarticle/2796396"> <div class="related-article-type">Editorial</div> <div class="related-article-title sb-tc">Medicaid as a Driver of Health Equity</div> </a> <div class="related-article-authors">Alice Hm Chen, MD, MPH; Mark A. Ghaly, MD, MPH</div> <div class="related-article-journal-name">JAMA</div> </li> </ul> </div> </div> <div id="related-articles-tab" class="linked-content-tab related-article-tab"> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedArticle"> <ul class="article-abstract-links related-abstract-content"> <li class="article-link related-abstract-article"> <a class="related-article-title" href="https://jamanetwork.com/journals/jama/fullarticle/2749799"> <div class="related-article-type">Viewpoint</div> <div class="related-article-title sb-tc">Assessing Health Outcomes Attributable to Medicaid Expansion At 5 Years</div> </a> <div class="related-article-authors">Heidi Allen, PhD, MSW; Benjamin D. Sommers, MD, PhD</div> <div class="related-article-journal-name">JAMA</div> </li> <li class="article-link related-abstract-article"> <a class="related-article-title" href="https://jamanetwork.com/journals/jama/fullarticle/2776340"> <div class="related-article-type">Viewpoint</div> <div class="related-article-title sb-tc">A Blueprint for Comprehensive Medicaid Reform</div> </a> <div class="related-article-authors">Rebekah E. Gee, MD, MPH; David Shulkin, MD; Iyah Romm, BS</div> <div class="related-article-journal-name">JAMA</div> </li> <li class="article-link related-abstract-article"> <a class="related-article-title" href="https://jamanetwork.com/journals/jama/fullarticle/2792275"> <div class="related-article-type">Viewpoint</div> <div class="related-article-title sb-tc">Value-Based Care in the Center for Medicare and Medicaid Innovation</div> </a> <div class="related-article-authors">John E. McDonough, DrPH, MPA; Eli Y. Adashi, MD, MS</div> <div class="related-article-journal-name">JAMA</div> </li> <li class="article-link related-abstract-article"> <a class="related-article-title" href="https://jamanetwork.com/journals/jama/fullarticle/2798835"> <div class="related-article-type">Viewpoint</div> <div class="related-article-title sb-tc">Medicaid’s Moment for Protecting and Promoting Women’s Health</div> </a> <div class="related-article-authors">Mohammad Hussain Dar, MD; Charissa Fotinos, MD, MS; Christopher R. Cogle, MD</div> <div class="related-article-journal-name">JAMA</div> </li> </ul> </div> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedEditorsChoices"> </div> </div> <div id="author-interviews-tab" class="linked-content-tab linked-author-interviews-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_AuthorInterviews"> </div> </div> <div id="listen-to-this-article-tab" class="linked-content-tab linked-listen-to-this-article-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_ListenToThisArticle"> </div> </div> <div id="more-multimedia-tab" class="linked-content-tab more-multimedia-tab"> </div> </div> </div> </div> <a class="full-text-link is-b" data-url="" data-article-id="2796374"> <div class="full-text-link--text"><span class="full-text-link--text-top">Full </span>Text</div> </a> <div class="abstract-content"> <div class="widget-ArticleFulltext widget-instance-AMA_Article_Abstract_Widget"> <div class="article-full-text" data-userHasAccess="False"> <a class="article-section-id-anchor" id="248610220"></a> <span class="heading-text thm-col h3 cb section-type-keyPoints decorated-hed sb-sc ">Key Points</span><p><strong>Question</strong> <span>Who does Medicaid insure, how is the program financed and delivered, how have policies evolved, and how could reforms address racial and ethnic health equity?</span></p><p><strong>Findings</strong> <span>In 2022, Medicaid insured approximately 80.6 million individuals (56.4% from racial and ethnic minority groups in 2019). In 2020, estimated Medicaid spending was $671.2 billion (16.3% of total US health spending). The proportion of beneficiaries enrolled in Medicaid managed care was 69.5% in 2019, 45 states have pursued 139 Medicaid delivery system reforms from 2003 to 2019, and 38 states and Washington, DC, have expanded Medicaid under the Affordable Care Act. Racial and ethnic health disparities are common within Medicaid, and evidence on the association of Medicaid policies and reforms with achieving racial health equity remains limited.</span></p><p><strong>Meaning</strong> <span>Medicaid is an important source of insurance and accounts for substantial health care spending. Medicaid reforms have expanded coverage and provide further opportunities to reduce disparities and address health inequities.</span></p> <a class="article-section-id-anchor" id="248610221"></a> <div class="h3 cb section-type-abstract decorated-hed "> <div class="heading-text thm-col sb-sc"> Abstract </div> </div> <p><strong>Importance</strong> <span>Medicaid is the largest health insurance program by enrollment in the US and has an important role in financing care for eligible low-income adults, children, pregnant persons, older adults, people with disabilities, and people from racial and ethnic minority groups. Medicaid has evolved with policy reform and expansion under the Affordable Care Act and is at a crossroads in balancing its role in addressing health disparities and health inequities against fiscal and political pressures to limit spending.</span></p><p><strong>Objective</strong> <span>To describe Medicaid eligibility, enrollment, and spending and to examine areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity.</span></p><p><strong>Evidence Review</strong> <span>Analyses of publicly available data reported from 2010 to 2022 on Medicaid enrollment and program expenditures were performed to describe the structure and financing of Medicaid and characteristics of Medicaid enrollees. A search of PubMed for peer-reviewed literature and online reports from nonprofit and government organizations was conducted between August 1, 2021, and February 1, 2022, to review evidence on Medicaid managed care, delivery system reforms, expansion, and health disparities. Peer-reviewed articles and reports published between January 2003 and February 2022 were included.</span></p><p><strong>Findings</strong> <span>Medicaid covered approximately 80.6 million people (mean per month) in 2022 (24.2% of the US population) and accounted for an estimated $671.2 billion in health spending in 2020, representing 16.3% of US health spending. Medicaid accounted for an estimated 27.2% of total state spending and 7.6% of total federal expenditures in 2021. States enrolled 69.5% of Medicaid beneficiaries in managed care plans in 2019 and adopted 139 delivery system reforms from 2003 to 2019. The 38 states (and Washington, DC) that expanded Medicaid under the Affordable Care Act experienced gains in coverage, increased federal revenues, and improvements in health care access and some health outcomes. Approximately 56.4% of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. Expanding Medicaid, addressing disparities within Medicaid, and having an explicit focus on equity in managed care and delivery system reforms may represent opportunities for Medicaid to advance health equity.</span></p><p><strong>Conclusions and Relevance</strong> <span>Medicaid insures a substantial portion of the US population, accounts for a significant amount of total health spending and state expenditures, and has evolved with delivery system reforms, increased managed care enrollment, and state expansions. Additional Medicaid policy reforms are needed to reduce health disparities by race and ethnicity and to help achieve equity in access, quality, and outcomes.</span></p> <div class="movable-ad-target bta"> </div> </div> </div> <div class="widget-ArticleLinks widget-instance-AMA_Abstract_EditorialComments"> <ul class="article-abstract-links related-abstract-content"> <li class="article-link related-abstract-article"> <a class="related-article-abstract-link" href="https://jamanetwork.com/journals/jama/fullarticle/2796396"> <div class="related-article-abstract-type">Editorial</div> <div class="related-article-abstract-title sb-tc">Medicaid as a Driver of Health Equity</div> </a> <div class="related-article-journal-name">JAMA</div> </li> </ul> </div> <a class="full-text-link is-b d-b bd-none ta-c fl-n radius mt1 mb1 m-auto" data-url="" data-article-id="2796374"> <div class="full-text-link--text fw-b"><span class="full-text-link--text-top">Full </span>Text</div> </a> <div class="seamless-access-button--mobile-only"> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_AdvancedSeamlessAccessButton_Mobile"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> </div> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_abstract_bta_dual"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_abstract_bta_dual" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":8,"adSection":"abstract","adPosition":"bta","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div class="widget-RelatedTopics widget-instance-AMA_Related_Topics_Abstract"> <div class="related-topics-block"> <h4 class="related-topics-heading topic-suggestions-heading sb-sc"> Read More About </h4> <div class="related-topics topic-suggestions"> <a href="https://jamanetwork.com/collections/5680/health-care-reform" id="item_Link" class="related-topic topic-suggestion no-wrap sb-anchor-light">Health Care Reform</a> <a href="https://jamanetwork.com/collections/42114/health-care-economics-insurance-payment" id="item_Link_1" class="related-topic topic-suggestion no-wrap sb-anchor-light">Health Care Economics, Insurance, Payment</a> <a href="https://jamanetwork.com/collections/44020/health-policy" id="item_Link_2" class="related-topic topic-suggestion no-wrap sb-anchor-light">Health Policy</a> <a href="https://jamanetwork.com/collections/46328/health-inequities" id="item_Link_3" class="related-topic topic-suggestion no-wrap sb-anchor-light">Health Inequities</a> <a href="https://jamanetwork.com/collections/46387/equity-diversity-and-inclusion" id="item_Link_4" class="related-topic topic-suggestion no-wrap sb-anchor-light">Equity, Diversity, and Inclusion</a> <a href="https://jamanetwork.com/collections/5679/health-disparities" id="item_Link_5" class="related-topic topic-suggestion no-wrap sb-anchor-light">Health Disparities</a> </div> </div> </div> </div> <div class="sidebar"> <div class="branded-bar"></div> <div class="abstract-toolbar"> <a id="pdf-link" href="/journals/jama/articlepdf/2796374/jama_donohue_2022_sc_220004_1663338124.20613.pdf" class="toolbar-tool toolbar-pdf al-link pdfaccess js-pdfaccess" data-article-id="2796374" data-article-url="/journals/jama/articlepdf/2796374/jama_donohue_2022_sc_220004_1663338124.20613.pdf" data-ajax-url="/Content/CheckPdfAccess"><span class="toolbar-pdf-text"><span class="toolbar-link-text-extra">Download </span><span class="toolbar-link-text">PDF</span></span> </a> <a class="toolbar-tool toolbar-full-text is-b" data-url="" data-article-id="2796374"><span class="toolbar-link-text-extra">Full</span> Text</a> <div class="widget-ToolboxGetCitation widget-instance-AMA_Get_Citation_Abstract"> <a class="toolbar-tool toolbar-citation is-b stats-citation" rel="nofollow" data-reveal-id="get-citation" data-reveal> <span class="toolbar-link-text">Cite</span> <span class="toolbar-link-text-extra">This</span> </a> <div id="get-citation" class="reveal-modal get-citation" data-reveal> <h3 class="get-citation-title">Citation</h3> <p class="get-citation-citation">Donohue JM<span class='al-author-delim'>, </span>Cole ES<span class='al-author-delim'>, </span>James CV<span class='al-author-delim'>, </span>Jarlenski M<span class='al-author-delim'>, </span>Michener JD<span class='al-author-delim'>, </span>Roberts ET. The US Medicaid Program<span class="subtitle"><span class="colon-for-citation-subtitle">: </span>Coverage, Financing, Reforms, and Implications for Health Equity</span>. <em>JAMA.</em> 2022;328(11):1085–1099. doi:10.1001/jama.2022.14791</p> <h4 class="get-citation-download-heading">Manage citations:</h4> <div class="get-citation-types"> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2796374&resourceType=3&citationFormat=0">Ris (Zotero)</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2796374&resourceType=3&citationFormat=1">EndNote</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2796374&resourceType=3&citationFormat=2">BibTex</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2796374&resourceType=3&citationFormat=3">Medlars</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2796374&resourceType=3&citationFormat=0">ProCite</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2796374&resourceType=3&citationFormat=3">RefWorks</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2796374&resourceType=3&citationFormat=0">Reference Manager</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2796374&resourceType=3&citationFormat=0">Mendeley</a> </div> <p class="get-citation-copyright">© 2024 </p> <a class="close-reveal-modal icon-close" rel="nofollow"></a> </div> </div> <div class="widget-ToolboxPermissions widget-instance-AMA_Get_Permissions_Abstract"> <a href="http://s100.copyright.com/AppDispatchServlet?publisherName=AMA&publication=0098-7484&title=The+US+Medicaid+Program%3a+Coverage%2c+Financing%2c+Reforms%2c+and+Implications+for+Health+Equity&publicationDate=2022-09-20&volumeNum=328&issueNum=11&author=Donohue%2c+Julie+M.%3b+Cole%2c+Evan+S.&startPage=1085&endPage=1099&contentId=10.1001%2fjama.2022.14791&oa=&orderBeanReset=True" rel="nofollow" id="PermissionsLink" class="toolbar-tool toolbar-permissions is-b" target="_blank"><span class="toolbar-link-text">Permissions</span></a> </div> <li class="toolbar-cme-wrap toolbar-tool-wrap"> <a class="toolbar-tool toolbar-cme is-b jama-active-cme-button" rel="nofollow" href="https://edhub.ama-assn.org/jn-learning/module/2796374">CME & MOC</a> </li> </div> <div class="seamless-access-button--desktop-only"> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_AdvancedSeamlessAccessButton_Desktop"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> </div> <div class="widget-SignUpAffinityAlert widget-instance-AMAv2_AffinityAlertSignUp"> </div> <div class="cme-promo ta-c"> <div class="widget-SelfServeContent widget-instance-AMA_SelfServe_Promote_Cme_To_Inst_SubUsers"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="AMAV2_Rightrail_Other_Promo" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="bc_rr_theme_promo"></div> <div class="bc_right_rail_article_promo"></div> <link rel="stylesheet" href="https://cdn.jamanetwork.com/data/CSSUploads/jamanetwork-selfserve-maintenance.css?versionId=82944"> <style type="text/css"> .jn-rr-feature {border-top: 4px solid #d71635; border-bottom: 4px solid #d71635;} p.globe-icon {font-weight:700;padding:0.35em 0} .icon-url:before {font-size:24px;margin-right:6px;} .icon-url:hover {text-decoration: none;} </style> <div class="jn-rr-feature"> <p class="globe-icon"><a href="/channels/ai" target="_blank"><span class="badge icon-url"></span>JAMA+ AI</a></p> </div>  <div class="bc_maintenance"></div> <iframe id="selfserve-maintenance" src="https://sites.jamanetwork.com/maintenance/index.html" width="100%" frameborder="0"></iframe>  </div> </div> </div> <div class="widget-WidgetLoader widget-instance-AMA_PersonalizedContent_AbstractView_RightRail"> <div class="SCM-SharedWidgets-AsyncWidgetLoader" data-url="/AMA/PersonalizedContent_RightRail/AMA_PersonalizedContent_AbstractView_RightRail" data-params="{"parameters":{"resourceIdToExclude":2796374,"resourceTypeToExclude":3},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_abstract_mid_dual"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_abstract_mid_dual" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":6,"adSection":"abstract","adPosition":"mid","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> <div class="widget-WidgetLoader widget-instance-AMA_JobsAd"> <div class="SCM-SharedWidgets-AsyncJobsAdLoader" data-url="/AMA/JobsAd/AMA_JobsAd" data-params="{"parameters":{"siteId":3},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> <h4 class="thm-col-sec">Others Also Liked</h4> <div id="trendmd-suggestions"></div> </div> </div> <div class="ymal--footer"> <div class="widget-WidgetLoader widget-instance-AMA_PersonalizedContent_AbstractView_Footer"> <div class="SCM-SharedWidgets-AsyncWidgetLoader" data-url="/Personalization/PersonalizedContent/AMA_PersonalizedContent_AbstractView_Footer" data-params="{"parameters":{"resourceIdToExclude":2796374,"resourceTypeToExclude":3},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div class="manage-interest"> <div class="widget-ManageCollectionInterests widget-instance-ManageCollectionInterests_Magazine"> <div class="manage-interests-modal reveal-modal small modal" data-reveal> <div class="manage-interests--header"> <div class="widget-SelfServeContent widget-instance-AMA_ManageInterests_Header"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="AllSitesManageInterestsHeader" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style> h4 { font-size: 20px !important; } </style> <h4>Select Your Interests</h4> <p>Customize your JAMA Network experience by selecting one or more topics from the list below.</p> </div> </div> </div><div class="manage-interests--categories"> <ul class="category-list"> <li><span class="category-list-item " data-categoryid="46425">Academic Medicine</span></li> <li><span class="category-list-item " data-categoryid="5489">Acid Base, Electrolytes, Fluids</span></li> <li><span class="category-list-item " data-categoryid="5504">Allergy and Clinical Immunology</span></li> <li><span class="category-list-item " data-categoryid="46447">American Indian or Alaska Natives</span></li> <li><span class="category-list-item " data-categoryid="5510">Anesthesiology</span></li> <li><span class="category-list-item " data-categoryid="42143">Anticoagulation</span></li> <li><span class="category-list-item " data-categoryid="6261">Art and Images in Psychiatry</span></li> <li><span class="category-list-item " data-categoryid="42097">Assisted Reproduction</span></li> <li><span class="category-list-item " data-categoryid="42099">Bleeding and Transfusion</span></li> <li><span class="category-list-item " data-categoryid="5548">Cardiology</span></li> <li><span class="category-list-item " data-categoryid="44036">Caring for the Critically Ill Patient</span></li> <li><span class="category-list-item " data-categoryid="6255">Challenges in Clinical Electrocardiography</span></li> <li><span class="category-list-item " data-categoryid="46435">Climate and Health</span></li> <li><span class="category-list-item " data-categoryid="46448">Climate Change</span></li> <li><span class="category-list-item " data-categoryid="44038">Clinical Challenge</span></li> <li><span class="category-list-item " data-categoryid="44039">Clinical Implications of Basic Neuroscience</span></li> <li><span class="category-list-item " data-categoryid="5614">Clinical Pharmacy and Pharmacology</span></li> <li><span class="category-list-item " data-categoryid="46499">Coaching</span></li> <li><span class="category-list-item " data-categoryid="5575">Complementary and Alternative Medicine</span></li> <li><span class="category-list-item " data-categoryid="44040">Consensus Statements</span></li> <li><span class="category-list-item " data-categoryid="46099">Coronavirus (COVID-19)</span></li> <li><span class="category-list-item " data-categoryid="5584">Critical Care Medicine</span></li> <li><span class="category-list-item " data-categoryid="46325">Cultural Competency</span></li> <li><span class="category-list-item " data-categoryid="44019">Dental Medicine</span></li> <li><span class="category-list-item " data-categoryid="5598">Dermatology</span></li> <li><span class="category-list-item " data-categoryid="44011">Diabetes and Endocrinology</span></li> <li><span class="category-list-item " data-categoryid="46320">Diagnostic Test Interpretation</span></li> <li><span class="category-list-item " data-categoryid="46498">Digital Health</span></li> <li><span class="category-list-item " data-categoryid="42054">Drug Development</span></li> <li><span class="category-list-item " data-categoryid="5621">Emergency Medicine</span></li> <li><span class="category-list-item " data-categoryid="5819">End of Life, Hospice, Palliative Care</span></li> <li><span class="category-list-item " data-categoryid="42107">Environmental Health</span></li> <li><span class="category-list-item " data-categoryid="46387">Equity, Diversity, and Inclusion</span></li> <li><span class="category-list-item " data-categoryid="42108">Ethics</span></li> <li><span class="category-list-item " data-categoryid="5644">Facial Plastic Surgery</span></li> <li><span class="category-list-item " data-categoryid="44012">Gastroenterology and Hepatology</span></li> <li><span class="category-list-item " data-categoryid="5664">Genetics and Genomics</span></li> <li><span class="category-list-item " data-categoryid="44041">Genomics and Precision Health</span></li> <li><span class="category-list-item " data-categoryid="5668">Geriatrics</span></li> <li><span class="category-list-item " data-categoryid="5670">Global Health</span></li> <li><span class="category-list-item " data-categoryid="46427">Guide to Statistics and Methods</span></li> <li><span class="category-list-item " data-categoryid="5672">Guidelines</span></li> <li><span class="category-list-item " data-categoryid="5674">Hair Disorders</span></li> <li><span class="category-list-item " data-categoryid="42113">Health Care Delivery Models</span></li> <li><span class="category-list-item " data-categoryid="42114">Health Care Economics, Insurance, Payment</span></li> <li><span class="category-list-item " data-categoryid="42116">Health Care Quality</span></li> <li><span class="category-list-item " data-categoryid="5680">Health Care Reform</span></li> <li><span class="category-list-item " data-categoryid="5830">Health Care Safety</span></li> <li><span class="category-list-item " data-categoryid="5682">Health Care Workforce</span></li> <li><span class="category-list-item " data-categoryid="5679">Health Disparities</span></li> <li><span class="category-list-item " data-categoryid="46328">Health Inequities</span></li> <li><span class="category-list-item " data-categoryid="44020">Health Policy</span></li> <li><span class="category-list-item " data-categoryid="46451">Health Systems Science</span></li> <li><span class="category-list-item " data-categoryid="5688">Hematology</span></li> <li><span class="category-list-item " data-categoryid="5692">History of Medicine</span></li> <li><span class="category-list-item " data-categoryid="5514">Humanities</span></li> <li><span class="category-list-item " data-categoryid="5697">Hypertension</span></li> <li><span class="category-list-item " data-categoryid="44043">Images in Neurology</span></li> <li><span class="category-list-item " data-categoryid="45887">Implementation Science</span></li> <li><span class="category-list-item " data-categoryid="5702">Infectious Diseases</span></li> <li><span class="category-list-item " data-categoryid="44044">Innovations in Health Care Delivery</span></li> <li><span class="category-list-item " data-categoryid="46477">JAMA Forum</span></li> <li><span class="category-list-item " data-categoryid="44070">JAMA Infographic</span></li> <li><span class="category-list-item " data-categoryid="5716">Law and Medicine</span></li> <li><span class="category-list-item " data-categoryid="45308">Leading Change</span></li> <li><span class="category-list-item " data-categoryid="44045">Less is More</span></li> <li><span class="category-list-item " data-categoryid="46327">LGBTQIA Medicine</span></li> <li><span class="category-list-item " data-categoryid="5720">Lifestyle Behaviors</span></li> <li><span class="category-list-item " data-categoryid="45311">Medical Coding</span></li> <li><span class="category-list-item " data-categoryid="5738">Medical Devices and Equipment</span></li> <li><span class="category-list-item " data-categoryid="44023">Medical Education</span></li> <li><span class="category-list-item " data-categoryid="5739">Medical Education and Training</span></li> <li><span class="category-list-item " data-categoryid="5713">Medical Journals and Publishing</span></li> <li><span class="category-list-item " data-categoryid="5746">Melanoma</span></li> <li><span class="category-list-item " data-categoryid="5766">Narrative Medicine</span></li> <li><span class="category-list-item " data-categoryid="5769">Nephrology</span></li> <li><span class="category-list-item " data-categoryid="5777">Neurology</span></li> <li><span class="category-list-item " data-categoryid="44052">Neuroscience and Psychiatry</span></li> <li><span class="category-list-item " data-categoryid="44053">Notable Notes</span></li> <li><span class="category-list-item " data-categoryid="5787">Nursing</span></li> <li><span class="category-list-item " data-categoryid="5788">Nutrition</span></li> <li><span class="category-list-item " data-categoryid="44027">Nutrition, Obesity, Exercise</span></li> <li><span class="category-list-item " data-categoryid="5791">Obesity</span></li> <li><span class="category-list-item " data-categoryid="44013">Obstetrics and Gynecology</span></li> <li><span class="category-list-item " data-categoryid="5796">Occupational Health</span></li> <li><span class="category-list-item " data-categoryid="5801">Oncology</span></li> <li><span class="category-list-item " data-categoryid="5804">Ophthalmology</span></li> <li><span class="category-list-item " data-categoryid="5808">Orthopedics</span></li> <li><span class="category-list-item " data-categoryid="5811">Otolaryngology</span></li> <li><span class="category-list-item " data-categoryid="44028">Pain Medicine</span></li> <li><span class="category-list-item " data-categoryid="46446">Palliative Care</span></li> <li><span class="category-list-item " data-categoryid="44029">Pathology and Laboratory Medicine</span></li> <li><span class="category-list-item " data-categoryid="45306">Patient Care</span></li> <li><span class="category-list-item " data-categoryid="6258">Patient Information</span></li> <li><span class="category-list-item " data-categoryid="5843">Pediatrics</span></li> <li><span class="category-list-item " data-categoryid="44060">Performance Improvement</span></li> <li><span class="category-list-item " data-categoryid="45315">Performance Measures</span></li> <li><span class="category-list-item " data-categoryid="42050">Perioperative Care and Consultation</span></li> <li><span class="category-list-item " data-categoryid="42125">Pharmacoeconomics</span></li> <li><span class="category-list-item " data-categoryid="42126">Pharmacoepidemiology</span></li> <li><span class="category-list-item " data-categoryid="5851">Pharmacogenetics</span></li> <li><span class="category-list-item " data-categoryid="44030">Pharmacy and Clinical Pharmacology</span></li> <li><span class="category-list-item " data-categoryid="5856">Physical Medicine and Rehabilitation</span></li> <li><span class="category-list-item " data-categoryid="42059">Physical Therapy</span></li> <li><span class="category-list-item " data-categoryid="45313">Physician Leadership</span></li> <li><span class="category-list-item " data-categoryid="44061">Poetry</span></li> <li><span class="category-list-item " data-categoryid="45316">Population Health</span></li> <li><span class="category-list-item " data-categoryid="46445">Primary Care</span></li> <li><span class="category-list-item " data-categoryid="45309">Professional Well-being</span></li> <li><span class="category-list-item " data-categoryid="44064">Professionalism</span></li> <li><span class="category-list-item " data-categoryid="5871">Psychiatry and Behavioral Health</span></li> <li><span class="category-list-item " data-categoryid="42128">Public Health</span></li> <li><span class="category-list-item " data-categoryid="5877">Pulmonary Medicine</span></li> <li><span class="category-list-item " data-categoryid="42129">Radiology</span></li> <li><span class="category-list-item " data-categoryid="42058">Regulatory Agencies</span></li> <li><span class="category-list-item " data-categoryid="46443">Reproductive Health</span></li> <li><span class="category-list-item " data-categoryid="5916">Research, Methods, Statistics</span></li> <li><span class="category-list-item " data-categoryid="42142">Resuscitation</span></li> <li><span class="category-list-item " data-categoryid="5896">Rheumatology</span></li> <li><span class="category-list-item " data-categoryid="46326">Risk Management</span></li> <li><span class="category-list-item " data-categoryid="38802">Scientific Discovery and the Future of Medicine</span></li> <li><span class="category-list-item " data-categoryid="46495">Sexual Health</span></li> <li><span class="category-list-item " data-categoryid="5833">Shared Decision Making and Communication</span></li> <li><span class="category-list-item " data-categoryid="5912">Sleep Medicine</span></li> <li><span class="category-list-item " data-categoryid="5915">Sports Medicine</span></li> <li><span class="category-list-item " data-categoryid="5533">Stem Cell Transplantation</span></li> <li><span class="category-list-item " data-categoryid="5921">Substance Use and Addiction Medicine</span></li> <li><span class="category-list-item " data-categoryid="5923">Surgery</span></li> <li><span class="category-list-item " data-categoryid="44065">Surgical Innovation</span></li> <li><span class="category-list-item " data-categoryid="44066">Surgical Pearls</span></li> <li><span class="category-list-item " data-categoryid="44067">Teachable Moment</span></li> <li><span class="category-list-item " data-categoryid="44034">The Art of JAMA</span></li> <li><span class="category-list-item " data-categoryid="44037">The Arts and Medicine</span></li> <li><span class="category-list-item " data-categoryid="6257">The Rational Clinical Examination</span></li> <li><span class="category-list-item " data-categoryid="5936">Tobacco and e-Cigarettes</span></li> <li><span class="category-list-item " data-categoryid="5938">Toxicology</span></li> <li><span class="category-list-item " data-categoryid="46433">Translational Medicine</span></li> <li><span class="category-list-item " data-categoryid="42136">Trauma and Injury</span></li> <li><span class="category-list-item " data-categoryid="5942">Treatment Adherence</span></li> <li><span class="category-list-item " data-categoryid="46323">Ultrasonography</span></li> <li><span class="category-list-item " data-categoryid="5947">Urology</span></li> <li><span class="category-list-item " data-categoryid="44069">Users' Guide to the Medical Literature</span></li> <li><span class="category-list-item " data-categoryid="5950">Vaccination</span></li> <li><span class="category-list-item " data-categoryid="5955">Venous Thromboembolism</span></li> <li><span class="category-list-item " data-categoryid="45312">Veterans Health</span></li> <li><span class="category-list-item " data-categoryid="5957">Violence</span></li> <li><span class="category-list-item " data-categoryid="42139">Women's Health</span></li> <li><span class="category-list-item " data-categoryid="45307">Workflow and Process</span></li> <li><span class="category-list-item " data-categoryid="42140">Wound Care, Infection, Healing</span></li> </ul> </div> <div class="manage-interests--save-preferences"> <div class="save-preferences-btn thm-bg "> <span class="save-preferences-btn-text fw-b">Save Preferences</span> </div> </div> <div class="manage-interests--privacy-terms"> <a class="manage-interests--privacy-terms-color" href="/pages/privacy-policy">Privacy Policy</a> | <a class="manage-interests--privacy-terms-color" href="/pages/terms-of-use">Terms of Use</a></div> <a class="close-reveal-modal icon-close"></a> </div> </div> </div> </section> <section id="secFooterControl" class="master-footer"> <script> var App = App || {}; function scmByClass(className) { return document.getElementsByClassName(className); } function scmById(id) { return document.getElementById(id); } function scmquery(selector) { return document.querySelector(selector); } function queryAll(selector) { return document.querySelectorAll(selector); } function isTrueString(string) { if (typeof string === 'string') { return string.toLowerCase() === 'true'; } return undefined; } function updateViewportDimensions() { var w = window, d = document, e = d.documentElement, g = d.getElementsByTagName('body')[0], x = w.innerWidth || e.clientWidth || g.clientWidth, y = w.innerHeight || e.clientHeight || g.clientHeight; return { width: x, height: y }; } var viewport = updateViewportDimensions(); var debounce = function (func, wait, immediate) { var timeout; return function () { var context = this, args = arguments; var later = function () { timeout = null; if (!immediate) func.apply(context, args); }; var callNow = immediate && !timeout; clearTimeout(timeout); timeout = setTimeout(later, wait); if (callNow) func.apply(context, args); }; }; (function (App) { App.mobileUpperBreakpoint = 767; App.mobileAltBreakpoint = 640; App.mobileMinBreakpoint = 547; App.tabletUpperBreakpoint = 1023; function setVariables() { viewport = updateViewportDimensions(); App.isMobile = (viewport.width <= App.mobileUpperBreakpoint); App.isMobileAlt = (viewport.width <= App.mobileAltBreakpoint); App.isTablet = (viewport.width > App.mobileUpperBreakpoint && viewport.width <= App.tabletUpperBreakpoint); App.isTabletDown = (viewport.width <= App.tabletUpperBreakpoint); App.isDesktop = (viewport.width > App.tabletUpperBreakpoint); App.activeViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large'; } setVariables(); App.cachedViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large'; App.isAnyArticle = !!(scmByClass('widget-ArticleFullView').length || scmByClass('pg_abstract').length || scmByClass('widget-MagazineView').length || scmByClass('widget-ChannelsMagazineView').length); App.isSplitScreen = !!scmByClass('widget-ArticleFullView').length; App.isArticleRedesign = !!scmByClass('widget-ArticleWrapper').length; App.isAbstract = !!scmByClass('pg_abstract').length; App.isMag = !!(scmByClass('widget-MagazineView').length); App.isChannel = !!(scmByClass('channel-site').length); App.isChannelMag = !!(scmByClass('widget-ChannelsMagazineView').length); App.isFreeArticle = !!(scmquery('.widget-ArticleTopInfo .free-access') || scmquery('.widget-ArticleTopInfo .open-access') || scmquery('.widget-ArticleTopInfo .icon-free') || scmquery('.widget-ChannelsMagazineView .free-access')); App.isTollFreeAccess = false; App.isIssue = !!scmByClass('pg_issue').length || !!scmByClass('pg_newonline').length || !!scmByClass('pg_currentissue').length || !!scmByClass('pg_pastissues').length; App.isNewOnline = !!scmByClass('pg_newonline').length; App.isCurrentIssue = !!scmByClass('pg_currentissue').length; App.isPastIssues = !!scmByClass('pg_pastissues').length; App.isJournal = !!scmByClass('pg_journal').length; App.isNetworkHome = !!scmByClass('pg_index').length; App.isSearch = !!scmByClass('pg_searchresults').length; App.isAdvancedSearch = !!scmByClass('pg_advancedsearch').length; App.isPlayer= !!scmByClass('pg_multimediaplayer').length; App.isSelfServe = !!scmByClass('pg_sspage').length; App.isCmsPage = !!scmByClass('pg_cmspage').length; App.isMyAccount = !!scmByClass('pg_myaccount').length; App.supportsFlexbox = !!scmByClass('flexbox').length; App.isCollection = !!scmByClass('pg_collection').length; App.isPaidUser = isTrueString(scmById('hfAppIsPaidUser').getAttribute('value')); App.isMember = isTrueString(scmById('hfAppIsMember').getAttribute('value')); App.isIndividual = isTrueString(scmById('hfAppIsIndividual').getAttribute('value')); App.hasAccess = isTrueString(scmById('hfAppHasAccess').getAttribute('value')); App.isReferredFromGoogle = isTrueString(scmById('hfAppIsReferredFromGoogle').getAttribute('value')); var subscribedTo = scmById('hfAppSubscribedTo').getAttribute('value'); App.userSubscribedTo = subscribedTo ? subscribedTo.split(',') : undefined; App.isLucy = isTrueString(scmById('hfAppIsLucy').getAttribute('value')); App.currentJournalCount = 27; App.isChannelPage = !!(scmByClass('channels-page')); App.updateAppVariables = debounce(function () { setVariables(); }, 50, false); })(App); </script> <div class="footer-ad-wrapper"> <div id="BodyContent_Footer_divAds" class="footer-ad desktop-only"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_AnchorboardAd_btf"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_AnchorboardAd_btf" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":11,"adSection":"abstract","adPosition":"btf","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> </div> <div class="ad-riser-wrap desktop-only"> <div class="ad-riser--dismiss t-c">X</div> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_Riser"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_Riser" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":12,"adSection":"abstract","adPosition":"Riser","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div class="footer-wrap"> <footer class="footer" id="footer"> <div id="footer-microsite" class="footer-microsite"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Left" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> @media (min-width: 1024px) {.split-screen .footer-microsite-contents {border-bottom:0 !important;}} .footer-microsite-contents {margin-bottom:1em;width:100%;} .footer-network-other .link-apps:before {width: 23px;} .footer-network-other .link-institutions-librarians:before {width: 23px;} .jn-ss-footer-border-top {border-top:1px solid #555;padding-top:15px;} .jn-ss-footer-border-bottom {border-bottom:1px solid #555;padding-bottom:10px;padding-right:3px;} </style> <div class="footer-heading-wrap"> <h3 id="BodyContent_Footer_h3SiteName" class="footer-heading is-b footer-microsite-heading" data-mobile-tog-target=".footer-microsite-links-wrap">JAMA</h3> </div> <div class="footer-microsite-links-wrap"> <div class="footer-microsite-contents jn-ss-footer-border-bottom"> <h4 id="BodyContent_Footer_ContentHeader" class="footer-subheading">Content</h4> <a href="/journals/jama">Home</a> <a href="/journals/jama/newonline">New Online</a> <a href="/journals/jama/currentissue">Current Issue</a> </div> <div class="footer-microsite-contents jn-ss-footer-border-bottom"> <h4 class="footer-subheading">Podcasts</h4> <a href="/journals/jama/pages/covid-19-interviews#audio">Coronavirus (COVID-19) Q&A</a> <a href="/journals/jama/pages/jama-clinical-reviews">Clinical Reviews</a> <a href="/journals/jama/pages/jama-editors-summary">Editors' Summary</a> <a href="/journals/jama/pages/jama-medical-news">Medical News</a> <a href="/journals/jama/pages/jama-author-interviews">Author Interviews</a> <a href="/journals/jama/pages/jamaevidence-jama-guide-to-statistics-and-methods">JAMAevidence: <em>JAMA Guide to Statistics and Methods</em></a> <a href="/journals/jama/pages/jamaevidence-the-rational-clinical-examination">JAMAevidence: The Rational Clinical Examination</a> <a href="/journals/jama/pages/jamaevidence-users-guides-to-the-medical-literature">JAMAevidence: Users' Guides to the Medical Literature</a> </div> <div class="footer-microsite-services cf"> <h4 id="BodyContent_Footer_ServiceHeader" class="footer-subheading">Journal Information</h4> <a href="/journals/jama/pages/for-authors">For Authors</a> <a href="/journals/jama/pages/jama-editors">JAMA Editors</a> <a href="/journals/jama/editors-and-publishers">Editors & Publishers</a> <a href="/pages/rss">RSS</a> <a href="/journals/jama/pages/contact-us">Contact Us</a> </div> <div class="footer-network-other jn-ss-footer-border-bottom"> <a href="https://edhub.ama-assn.org/jn-learning" class="link-network-other is-b link-learning">JN Learning / CME</a> <a href="https://store.jamanetwork.com" class="link-network-other is-b link-store" target="_blank">Store</a> <a href="/pages/apps" class="link-network-other is-b link-mobile" target="_blank">Apps</a> <a href="https://careers.jamanetwork.com/" class="link-network-other is-b link-jobs" target="_blank">Jobs</a> <a href="/pages/resources-for-librarians" class="link-network-other is-b link-institutions-librarians" target="_blank">Institutions</a> <a href="/pages/reprints-and-permissions" class="link-network-other is-b link-reprints-permissions">Reprints & Permissions</a> </div> <div id="BodyContent_Footer_divSubscribe" class="footer-microsite-subscribe"> <img src="//cdn.jamanetwork.com/UI/app/img/covers/jama.jpg" class="subscribe-image" alt="Journal Cover"> <div class="subscribe-meta"> <h4 class="subscribe-heading footer-subheading">Subscribe</h4> <a href="https://store.jamanetwork.com/productDetails.aspx?productcodeID=64" class="subscribe-submit btn">Go</a> </div> </div> </div> </div> <div id="footer-network" class="footer-network"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Middle" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .footer-network-sites {width: 62.85542%;} .footer-network-info {width: 35.93976%} .jn-ss-subheading-mt {margin-top: 1.5em;} .jn-registered:after {content: "\00AE";font-size: 50%;vertical-align: top;} .jn-trademark:after {content: "\2122";font-size: 50%;vertical-align: top;} .nav-logo-cme-signin-container .nav-logo .site-logo img { min-width:50px;} </style> <div class="footer-heading-wrap"> <h3 class="footer-heading is-b jn-registered" data-mobile-tog-target=".footer-network-links-wrap"><strong>JAMA</strong> Network</h3> </div> <div class="footer-network-links-wrap"> <div class="footer-network-sites"> <div class="internal"> <h4 id="BodyContent_Footer_JournalHeader" class="footer-subheading">Publications</h4> <a href="/journals/jama">JAMA</a> <a href="/journals/jamanetworkopen" target="_blank">JAMA Network Open</a> <a href="/journals/jamacardiology">JAMA Cardiology</a> <a href="/journals/jamadermatology">JAMA Dermatology</a> <a href="/journals/jama-health-forum">JAMA Health Forum</a> <a href="/journals/jamainternalmedicine">JAMA Internal Medicine</a> <a href="/journals/jamaneurology">JAMA Neurology</a> <a href="/journals/jamaoncology">JAMA Oncology</a> <a href="/journals/jamaophthalmology">JAMA Ophthalmology</a> <a href="/journals/jamaotolaryngology">JAMA Otolaryngology–Head & Neck Surgery</a> <a href="/journals/jamapediatrics">JAMA Pediatrics</a> <a href="/journals/jamapsychiatry">JAMA Psychiatry</a> <a href="/journals/jamasurgery">JAMA Surgery</a> <a href="/journals/archneurpsyc">Archives of Neurology & Psychiatry (1919-1959)</a> </div> <div class="external"> <h4 class="footer-subheading">Sites</h4> <div id="BodyContent_Footer_ssFooterSiteMenu"> <div class="selfServe"> <a target="_blank" href="https://sites.jamanetwork.com/art-and-images-in-psychiatry/">Art and Images in Psychiatry</a> <a target="_blank" href="/journals/jama/pages/2023-most-viewed-jama">Best of the JAMA Network</a> <a target="_blank" href="/channels/caring-for-the-critically-ill-patient">Caring for the Critically Ill Patient</a> <a target="_blank" href="/journals/jama/pages/crosswords">Clinical Crosswords from JAMA</a> <a target="_blank" href="/journals/jama/pages/coronavirus-alert">Coronavirus Resource Center</a> <a target="_blank" href="https://ebm.jamanetwork.com/index.html">Evidence-Based Medicine: An Oral History</a> <a target="_blank" href="/pages/fishbein-fellowship">Fishbein Fellowship</a> <a target="_blank" href="/channels/genomics/">Genomics and Precision Health</a> <a target="_blank" href="/pages/health-and-the-2024-us-election">Health and the 2024 US Election</a> <a target="_blank" href="/channels/hypertension">Hypertension</a> <a target="_blank" href="/channels/health-forum/archive">JAMA Forum Archive</a> <a target="_blank" href="https://sites.jamanetwork.com/audio">JAMA Network Audio</a> <a target="_blank" href="/pages/video">JAMA Network Video</a> <a target="_blank" href="/pages/conferences">JAMA Network Conferences </a> <a target="_blank" href="/channels/ai">JAMA+ AI</a> <a target="_blank" href="/pages/jama-summit">JAMA Summit </a> <a target="_blank" href="/journals/jamasurgery/pages/statistics-and-methods">JAMA Surgery Guide to Statistics and Methods</a> <a target="_blank" href="/channels/medical-news">Medical News</a> <a target="_blank" href="/channels/monkeypox">Mpox (Monkeypox)</a> <a target="_blank" href="https://sites.jamanetwork.com/research-ethics/">Research Ethics</a> <a target="_blank" href="/pages/collections">Topics and Collections</a> <a target="_blank" href="/pages/visual-abstracts">Visual Abstracts</a> <a target="_blank" href="/channels/war">War and Health</a> <a target="_blank" href="/channels/womens-health">Women's Health</a> <h4 class="footer-subheading jn-ss-subheading-mt">Featured Articles</h4> <a href="/journals/jama/fullarticle/2781397">CONSERVE 2021 Guidelines for Reporting Trials Modified for the COVID-19 Pandemic</a> <a href="/journals/jama/fullarticle/2808296">Creation and Adoption of Large Language Models in Medicine</a> <a href="/journals/jamaoncology/fullarticle/2787350">Global Burden of Cancer, 2010-2019</a> <a href="/journals/jama/fullarticle/2797443">Global Burden of Long COVID</a> <a href="/journals/jamadermatology/fullarticle/2790344">Global Burden of Melanoma</a> <a href="/journals/jamadermatology/fullarticle/2787350">Global Burden of Skin Diseases, 1990-2017</a> <a href="/journals/jamaneurology/fullarticle/2793874">Global Disparities in Parkinson Disease</a> <a href="/journals/jama/fullarticle/2799547">Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension</a> <a href="/journals/jamapsychiatry/fullarticle/2799486">Mass Violence and the Complex Spectrum of Mental Illness and Mental Functioning</a> <a href="/journals/jamapsychiatry/fullarticle/2793903">Neuropsychiatry Sequelae of COVID-19</a> <a href="/journals/jamaneurology/fullarticle/2810313">A New Framework for Dementia Nomenclature</a> <a href="/journals/jama/fullarticle/2800656">Organization and Performance of US Health Systems</a> <a href="/journals/jama-health-forum/fullarticle/2791195">Pharmacy Benefit Managers: History, Business Practices, Economics, and Policy</a> <a href="/journals/jama-health-forum/fullarticle/2791195">Promoting EDI in Genetics Research</a> <a href="/journals/jamacardiology/fullarticle/2781972">PTSD and Cardiovascular Disease</a> <a href="/journals/jama/fullarticle/2810754">Red Blood Cell Transfusion: 2023 AABB International Guidelines</a> <a href="/journals/jamapediatrics/fullarticle/2797600">Reimagining Children’s Rights in the US</a> <a href="/journals/jama/fullarticle/2794049">Spirituality in Serious Illness and Health</a> <a href="/journals/jama/fullarticle/2796374">The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity</a> <h4 class="footer-subheading jn-ss-subheading-mt">USPSTF Recommendation Statements</h4> <a href="/journals/jama/fullarticle/2779985">Screening for Colorectal Cancer</a> <a href="/journals/jama/fullarticle/2779190">Screening for Hypertension</a> <a href="/journals/jama/fullarticle/2777244">Screening for Lung Cancer</a> <a href="/journals/jama/fullarticle/2796244">Screening for Prediabetes and Type 2 Diabetes In Children</a> <a href="/journals/jama/fullarticle/2783414">Screening for Prediabetes and Type 2 Diabetes In Adults</a> <a href="/journals/jama/fullarticle/2795521">Statins for Primary Prevention of Cardiovascular Disease</a> <a href="/journals/jama/fullarticle/2793446">Vitamin and Mineral Supplements for Primary Prevention of of Cardiovascular Disease and Cancer</a> <h4 class="footer-subheading jn-ss-subheading-mt">Blogs</h4> <a target="_blank" href="https://amastyleinsider.com/">AMA Style Insider</a> </div> </div> </div> </div> <div id="footer-network-info" class="footer-network-info"> <div class="information-for-links"> <h4 id="BodyContent_Footer_InfoHeader" class="footer-subheading">Information</h4> <a href="/pages/for-authors">For Authors</a> <a href="/pages/resources-for-librarians">For Institutions & Librarians</a> <a href="/pages/advertisers">For Advertisers</a> <a href="/pages/subscription-agents">For Subscription Agents</a> <a href="https://careers.jamanetwork.com/" target="_blank">For Employers & Job Seekers</a> <a href="https://media.jamanetwork.com" rel="nofollow" target="_blank">For the Media</a> <a href="/pages/equity-diversity-inclusion">Equity, Diversity, Inclusion</a> <a href="/pages/commenting-policy">Online Commenting Policy</a> <a href="/pages/access-at-jama-network">Public Access and Open Access Policy</a> <a href="/pages/offensive-content-statement">Statement on Potentially Offensive Content</a> </div> <div class="services-links"> <h4 id="BodyContent_Footer_JAMANetworkProductsHeader" class="footer-subheading">JAMA Network Products</h4> <a href="http://www.amamanualofstyle.com/" class="footer-service-link" target="_blank">AMA Manual of Style</a> <a href="https://jamaevidence.mhmedical.com/" class="footer-service-link" target="_blank"><span class="jn-registered">JAMAevidence</span></a> <a href="http://www.peerreviewcongress.org/" class="footer-service-link" target="_blank">Peer Review Congress</a> </div> <div class="learning-links"> <h4 id="BodyContent_Footer_LearningHeader" class="footer-subheading">JN Learning</h4> <a href="https://edhub.ama-assn.org/jn-learning">Home</a> <a href="https://edhub.ama-assn.org/jn-learning/state-cme">State CME</a> <a href="https://edhub.ama-assn.org/jn-learning/pages/clinical-challenge-courses">Clinical Challenge CME</a> <a href="https://edhub.ama-assn.org/jn-learning/course/288 ">Atrial Fibrillation Course</a> <a href="https://edhub.ama-assn.org/jn-learning/course/294 ">Women's Health Course</a> <a target="_blank" href="https://edhub.ama-assn.org/pages/auto-credit-reporting">CME / MOC Reporting Preferences</a> <a href="https://edhub.ama-assn.org/jn-learning/pages/about-cme">About CME & MOC</a> </div> </div> </div> </div> <div id="footer-resources-wrap" class="footer-resources-wrap"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Right" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .footer-resources-wrap .footer-subheading {color: grey;display:block !important;font-size: 1.17647em;font-weight: 400;text-transform: uppercase;} </style> <div class="footer-heading-wrap"> <h3 class="footer-heading is-b footer-resources-heading" data-mobile-tog-target=".footer-resources">Help</h3> </div> <div class="footer-resources"> <a href="https://store.jamanetwork.com" class="footer-service-link" target="_blank">Subscriptions & Renewals</a> <a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-alerts" class="footer-service-link" rel="nofollow">Manage Emails</a> <a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-profile" class="footer-service-link" rel="nofollow">Update My Address</a> <a href="https://support.jamanetwork.com/hc/en-us" class="footer-service-link">Support Center</a> <a href="/myaccount " class="footer-service-link">My Account</a> <h4 class="footer-subheading jn-ss-subheading-mt">JAMA Career Center</h4> <a href="https://careers.jamanetwork.com/" class="footer-service-link" target="_blank">Physician Job Listings</a> </div> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Socials" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .widget-instance-AMA_Journal_Home_Socials .iconsocial {display: inline-block !important;width: 34px;height: 34px;min-width: unset !important;margin: 0 2px !important;background-color: #fff;border-radius: 20px;border: 1px solid #191919;vertical-align: middle;} .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);background-position: 7px 7px;background-repeat: no-repeat;background-size: 18px;} .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram:hover, .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram:focus {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png);border-color: #C13584;} .footer-resources-wrap .iconsocial {display: inline-block !important;width: 32px;height: 32px;min-width: unset !important;margin: 0 2px 0 3px !important;background-color: #fff;border-radius: 20px;border: 1px solid #191919;vertical-align: middle;} .footer-resources-wrap .iconsocial.instagram {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);background-position: 6px 6px;background-repeat: no-repeat;background-size: 18px;} .footer-resources-wrap .iconsocial.instagram:hover, .footer-resources-wrap .iconsocial.instagram:focus {background-color: #C13584;border-color: #191919;} #load-instagram-image { background: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png) no-repeat -9999px -9999px; } </style> <div id="BodyContent_Footer_divSocial" class="social-links footer-social-links"> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.facebook.com/JAMAJournal/" class="social-link is-b facebook"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://twitter.com/JAMA_current" class="social-link is-b twitter"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.instagram.com/jamanetwork/?hl=en" class="iconsocial instagram"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.linkedin.com/company/jamanetwork/" class="social-link is-b linked-in"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.youtube.com/jamanetwork" class="social-link is-b you-tube"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.pinterest.com/jamanetwork/" class="social-link is-b pinterest"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="/rss/site_3/67.xml" class="social-link is-b rss"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://jamanetwork.com/journals/jama/pages/jama-editors-summary" class="social-link is-b podcast"></a> <div id="load-instagram-image"> </div> </div> <div id="BodyContent_Footer_divEmailUpdate" class="footer-email-updates"> <div class="widget-EmailListSignUp widget-instance-AMAv2_EmailListSignUp_Footer"> <div class="email-signup"> <div class="email-signup--text sb-pc">Get the latest from JAMA</div> <div class="email-signup--input-wrap is-b"> <input type="text" name="email" class="email-signup--input" placeholder="Email address" title="Email address" /> <a rel="nofollow" href="javascript:;" class="email-signup--submit sb-sc btn">Sign Up</a> </div> <div class="email-signup--link"> <a class="email-signup--privacy" href="/pages/privacy-policy">Privacy Policy</a> | <a class="email-signup--terms" href="/pages/terms-of-use">Terms of Use</a></div> <div class="email-signup--user-message"></div> </div> </div> </div> </div> <div class="footer-bar" itemscope itemtype="https://schema.org/Organization"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Bottom_Bar" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .network-bar .auth--inst {color:#B8B8B8;} .multimedia-caption-container div.video-caption {color: #262626;font-size: 15px;font-weight: 700;line-height: 1.5;} .nav-journals a.theme-jama-health-forum:before {background: #133763;} .jn-bottom-bar {color: #fff; float: left;font-size: 10px;padding: 13px 20px;width: 33.33%;} .jn-bottom-bar p {line-height: 2;} @media (max-width: 900px) {.jn-bottom-bar {float: none;width: 100%;}} .jn-footer-copyright {font-size:12px;line-height:1.5;margin-bottom:10px;} .jn-footer-pipe {margin:0 10px;} .footer-bar-jn-logo img {width: 230px;} @media (max-width: 900px) {.footer-bar-jn-logo img {width: 200px;}} [data-thm=umb] .jobs-ad--text h6 {color: #d71635 !important;} [data-thm=jama] .jobs-ad--text h6 {color: #d71635 !important;} [data-thm=jaman] .jobs-ad--text h6 {color: #ed0973 !important;} [data-thm=cardi] .jobs-ad--text h6 {color: #be1e32 !important;} [data-thm=derm] .jobs-ad--text h6 {color: #006f3b !important;} [data-thm=faci] .jobs-ad--text h6 {color: #ed1c24 !important;} [data-thm=jama-] .jobs-ad--text h6 {color: #fb5252 !important;} [data-thm=intem] .jobs-ad--text h6 {color: #006e96 !important;} [data-thm=neur] .jobs-ad--text h6 {color: #981b1e !important;} [data-thm=oncol] .jobs-ad--text h6 {color: #3b923f !important;} [data-thm=ophth] .jobs-ad--text h6 {color: #66bc29 !important;} [data-thm=otol] .jobs-ad--text h6 {color: #34b6e4 !important;} [data-thm=peds] .jobs-ad--text h6 {color: #0084c0 !important;} [data-thm=psych] .jobs-ad--text h6 {color: #005276 !important;} [data-thm=surg] .jobs-ad--text h6 {color: #f47920 !important;} .blockquote .para {margin: 0 0 1em 1em;} .jn-footer-copyright {display: block;} .inline-block {display: inline-block;} </style> <a class="footer-bar-jn-logo d-b no-mw mb1" href="/" title="JAMA Network Home"><img class="mw-100" src="https://cdn.jamanetwork.com/ImageLibrary/global/jn-signature-reversed-r.svg?versionId=82308" alt="Jama Network Logo"></a> <div class="jn-bottom-bar"> <p> <span class="jn-footer-copyright">© 2024 American Medical Association. <span class="inline-block">All rights reserved,</span> including those for text and data mining, AI training, <span class="inline-block">and similar technologies.</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/terms-use" rel="nofollow" class="p0">Terms of Use</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/privacy-policy" rel="nofollow" class="p0">Privacy Policy</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/accessibility-statement" rel="nofollow" class="p0">Accessibility Statement</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a onclick="OneTrust.ToggleInfoDisplay()" rel="nofollow" class="p0" id="CookieFooter">Cookie Settings</a></span> </p> </div>  <a class="footer-bar-sis no-mw relative nudge-down" href="https://www.silverchair.com" target="_blank"><img class="footer-bar-sis-img mt05 mw-100" width="600" height="70" src="//cdn.jamanetwork.com/UI/app/img/powered.png" alt="Silverchair Logo" /></a> </div> </footer> </div> <div class="ss-ui-only"> <div class="widget-SelfServeContent widget-instance-AMA_SS_UI_Only"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SsUiOnly" /> <input type="hidden" class="SelfServeVersionId" value="0" /> . </div> </div> </div> </section> <div id="revealModal" class="reveal-modal" data-reveal> <div id="revealContent"></div> <a class="close-reveal-modal icon-close"></a> </div> <div class="artmet-modal" id="MetricsModal"> <div class="artmet-modal-contents"> <a class="artmet-close-modal">×</a> </div> </div> <div class="widget-SigninModals widget-instance-AMA_SigninModals"> <div class="js-modal-no-access-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Access your subscriptions</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2796374"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_NoAccess_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_PurchaseOptions_NoAccessAndPaidPDF"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_NoAccessAndPaidPDF" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr> <button class="modal--btn js-btn-subscribe-journal" type="button" role="button"> <div class="text-truncate">Subscribe to journal</div> </button> <div class="modal--btn-desc">Get full journal access for 1 year</div> <button class="modal--btn js-btn-purchase-article" type="button" role="button"> <div class="text-truncate">Buy article</div> </button> <div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br> <em>Sign in or create a free account</em></div>  </div> </div> <div class="widget-DeepDyve widget-instance-AMA_NoAccess_DeepDyve"> <button type="button" role="button" class="modal--btn js-deepdyve-link hiddenRentalLink" data-deepdyveurl="https://www.deepdyve.com/doc-view?docId=10.1001/jama.2022.14791&fieldName=journal_doi&affiliateId=JAMA" data-doi="10.1001/jama.2022.14791" data-fieldname="journal_doi" data-issneissn="0098-7484" data-affiliate="JAMA">Rent article</button> <div class="modal--btn-desc js-deepdyve-desc hiddenRentalLink">Rent this article from DeepDyve</div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-paid-pdf-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Access your subscriptions</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2796374"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_PaidPdf_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_PurchaseOptions_NoAccessAndPaidPDF"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_NoAccessAndPaidPDF" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr> <button class="modal--btn js-btn-subscribe-journal" type="button" role="button"> <div class="text-truncate">Subscribe to journal</div> </button> <div class="modal--btn-desc">Get full journal access for 1 year</div> <button class="modal--btn js-btn-purchase-article" type="button" role="button"> <div class="text-truncate">Buy article</div> </button> <div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br> <em>Sign in or create a free account</em></div>  </div> </div> <div class="widget-DeepDyve widget-instance-AMA_PaidPDF_DeepDyve"> <button type="button" role="button" class="modal--btn js-deepdyve-link hiddenRentalLink" data-deepdyveurl="https://www.deepdyve.com/doc-view?docId=10.1001/jama.2022.14791&fieldName=journal_doi&affiliateId=JAMA" data-doi="10.1001/jama.2022.14791" data-fieldname="journal_doi" data-issneissn="0098-7484" data-affiliate="JAMA">Rent article</button> <div class="modal--btn-desc js-deepdyve-desc hiddenRentalLink">Rent this article from DeepDyve</div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-free-pdf-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Sign in to access free PDF</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2796374"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_FreePdf_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_FreePdf_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-save-search-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Save your search</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2796374"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_SaveSearch_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_SaveSearch"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_SaveSearch" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr /> <button class="modal--btn js-btn-subscribe-now">Subscribe now</button>  </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-follow-collection-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Customize your interests</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2796374"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_FollowCollection_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_FollowCollection"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_FollowCollection" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--sub-title">Create a personal account or sign in to:</div> <ul> <li>Register for email alerts with links to free full-text articles</li> <li>Access PDFs of free articles</li> <li>Manage your interests</li> <li>Save searches and receive search alerts</li> <ul>  </div> </div> <div class="modal--link-wrap"> <a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-user-comment-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Make a comment</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2796374"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_UserComment_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_UserComment"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_UserComment" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--sub-title">Create a personal account or sign in to:</div> <ul> <li>Register for email alerts with links to free full-text articles</li> <li>Access PDFs of free articles</li> <li>Manage your interests</li> <li>Save searches and receive search alerts</li> <ul>  </div> </div> <div class="modal--link-wrap"> <a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="hidden-true js-modal-page-data" data-store-url="https://store.jamanetwork.com" data-store-purchase-url="https://jamanetwork.com/oauthsignin?return_url=https://store.jamanetwork.com" data-store-subscribe-url="https://store.jamanetwork.com/index.aspx?productcode=64"> </div> </div> <script src="//cdn.jamanetwork.com/UI/app/vendor/jquery-2.2.4.min.js?v=638654734634555810"></script> <script>window.jQuery || document.write('<script src="/UI/app/vendor/jquery-2.2.4.min.js">\x3C/script>')</script> <script src="//cdn.jamanetwork.com/UI/app/dist/app.min.js?v=638677764559592887" defer></script> <script src="//cdn.jsdelivr.net/chartist.js/latest/chartist.min.js" type="text/javascript"></script> <script src="//d1bxh8uas1mnw7.cloudfront.net/assets/embed.js" type="text/javascript"></script> <script defer src='//js.trendmd.com/trendmd.min.js' data-trendmdconfig='{"element":"#trendmd-suggestions"}'></script> <script type='text/javascript' src='https://platform-api.sharethis.com/js/sharethis.js#property=643701de45aa460012e1032e&product=sop' async='async'></script> </form> <link rel="stylesheet" href="//cdn.jamanetwork.com/UI/app/scss/modules/_trendMD.css"> <div class="widget-CustomJSScript widget-instance-"> <script src="//cdn.jamanetwork.com/ama/ama.proxylogging.js" async></script> </div> </body> </html>

CINXE.COM

The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity | Health Care Reform | JAMA | JAMA Network