States are given considerable discretion in designing their Medicaid programs and, as a result, Medicaid is made up of 51 different programs. Using data from the 1997 National Survey of America's Families, the authors examine variation in health care access and use by adults in 13 states and then compare those differences with national estimates of access and use. The authors find significant differences in access and use among the 13 study states. This variation persisted after differences in state Medicaid caseload characteristics, including demographic, socioeconomic, and health status, were controlled for. State variation in beneficiaries' access and use also persisted after differences in health care market characteristics, such as supply of health care providers, level of employer-sponsored coverage, and level of HMO penetration, and characteristics of the state Medicaid programs were controlled for.


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pp. 208-228
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