This week, The New York Times highlighted a study on Medicaid, the federal–state partnership to provide health care to the poor and disabled, and its failure to offer enrolled children access to care. The researchers used a “secret shopper” technique to see how many specialists in Cook County, Illinois, turned away children with Medicaid compared to private insurance.

The results were jaw-dropping. While specialists turned away 11 percent of privately insured children, 66 percent of children with Medicaid were unable to get an appointment. For those who did, the waiting time was 22 days longer than for other patients.

Shocking as these results may be, they aren’t a surprise—and they aren’t unique to Cook County. One physician’s response: “It’s interesting to think you even need a study to prove that. It’s pretty much common knowledge.” Though Medicaid provides adequate coverage on paper, nationwide, beneficiaries experience low access and poor quality care. The reason is decreasing provider reimbursement, which is a symptom of a large issue: States can’t afford the current Medicaid program, and thanks to the new health care law, it is only going to get worse.

Senator Orrin Hatch (R–UT) recently visited The Heritage Foundation to bring attention to this issue. He pointed to Medicaid’s “mission creep” as one of the largest problems:

Though Medicaid was intended to serve the most vulnerable members of society, it now covers almost one-fourth of the entire population. And that number will grow under Obamacare, which extends the program to upward of 20 million additional individuals.… An ever-expanding Medicaid program is devastating for our nation and our states’ finances, and by spreading itself so thin, fails to provide adequate care for those who need it.

Meanwhile, states’ hands are further tied by so-called maintenance of eligibility restrictions in the stimulus and Obamacare that limit their ability to review or restructure who is eligible for the program. This leaves states with fewer tools to manage the program and forces them to reduce spending by further cutting benefits or reimbursements for providers. This has led to the severe access problems outlined above.

Governors from 29 states recently sent a letter to Senator Hatch outlining the principles to guide Medicaid reform. They write that Congress “should provide states and territories a general healthcare framework where we can make necessary adjustments without constantly seeking permission from the federal government for changes that we already know work.”

The first step is repeal of Obamacare, which exacerbates the Medicaid crisis through a huge expansion in eligibility. Then, Washington should change the federal financing of the program to encourage financially responsible behavior from the states and the federal government. Meanwhile, the role of Medicaid should be reorganized. Under the Heritage plan, Medicaid would assist healthy moms and kids mainstream into private health insurance. For the truly vulnerable poor, disabled, and elderly, states should be given greater authority to develop innovative models that promote patient-centered reforms. To read more about the right direction for Medicaid reform, read Heritage’s plan at