Medicaid faces growing pains as possible overhaul looms

Facing the need to balance their budgets next year, states are examining a variety of changes to their Medicaid programs even as Republicans weigh a major spending overhaul to the healthcare program for the poor.

The changes underscore the difficulties of structuring the Medicaid program, which has little consensus across states or residents over who should qualify for it and what constitutes an appropriate level of spending. Obamacare aimed to make Medicaid more uniform by requiring states to expand it to more low-income people, but the Supreme Court ruled that portion of the bill would be optional. The District of Columbia and 31 states expanded Medicaid, leaving uneven strides in coverage from state to state.