Medicaid: 35 years of service.

On this 35th anniversary of the enactment of Medicaid, it is important to reflect on the program's role in the U.S. health care system. The Medicaid program is the third largest source of health insurance in the United States - after employer-based coverage and Medicare. The significance of Medicaid's role in providing health insurance cannot be overstated. As the largest in the Federal safety net of public assistance programs, Medicaid provides essential medical and medically related services to the most vulnerable populations in society. In 1998, the Medicaid program covered 41.4 million low-income children, their families, elderly people, and individuals with disabilities - approximately 12 percent of the total U.S. population. Since its inception in 1965, Medicaid enrollment and expenditures have grown substantially. In addition, the program has evolved as Federal and State governments balance social, economic, and political factors affecting this and other public assistance programs. This article presents an overview of the Medicaid program and highlights trends in enrollment and expenditures.