Financing Medicaid

Federalism and the Growth of America's Health Care Safety Net
Shanna Rose

Medicaid has grown to be the largest intergovernmental grant program in the United States, thanks in part to the efforts of state governors


Conventional wisdom holds that programs for the poor are vulnerable to instability and retrenchment. Medicaid, however, has grown into the nation’s largest intergovernmental grant program, accounting for nearly half of all federal funding to state and local governments. Medicaid’s generous open-ended federal matching grants have given governors a powerful incentive to mobilize on behalf of its maintenance and expansion, using methods ranging from lobbying and negotiation to creative financing mechanisms and waivers to maximize federal financial assistance. Perceiving federal retrenchment efforts as a threat to states’ finances, governors, through the powerful National Governors’ Association, have repeatedly worked together in bipartisan fashion to defend the program against cutbacks.

Financing Medicaid engagingly intertwines theory, historical narrative, and case studies, drawing on sources including archival materials from the National Governors’ Association and gubernatorial and presidential libraries, Centers for Medicare and Medicaid Services data, the Congressional Record, and interviews.

“Rose offers a penetrating, detailed analysis of one of the most remarkable and surprising developments in U.S. health policy over the past half century: the transformation of Medicaid from a modest program for welfare families into the nation’s largest entitlement after Social Security.”
—Eric Patashnik, Frank Batten School of Leadership and Public Policy, University of Virginia

Shanna Rose is Assistant Professor of Financial Management and Politics at New York University’s Robert F. Wagner Graduate School of Public Service.

Praise / Awards

  • "Financing Medicaid provides a greater understanding of governors as an influential interest group. ... The exploration of this issue renders her book essential to comprehending health care reform as it unfolds over the next several years."
  • "In a well-written and insightful volume, Shanna Rose has joined a growing number of scholars in assessing the remarkable rise of Medicaid in the American health care system... Rose's book brings the politics of Medicaid to life in a way that will appeal to both the general reader and the policy specialist."
    --Political Science Quarterly

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Product Details

  • 6 x 9.
  • 322pp.
  • 5 tables, 13 figures.
Available for sale worldwide

  • Hardcover
  • 2013
  • Available
  • 978-0-472-07197-5

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  • $104.95 U.S.

  • Paper
  • 2013
  • Available
  • 978-0-472-05197-7

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  • $36.95 U.S.

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  • Medicaid, health care, federalism, governors, interest group politics, budget policy, federal grants, entitlement spending, policy feedback, historical institutionalism