Abstract
<p>This article argues that Pennsylvania should be required to evaluate and publicly disclose the potential racial effects of Medicaid policy decisions before they are implemented. Focusing on the relationship between race, access to health care, and Medicaid financing, the article examines how policy choices that appear facially neutral can produce significantly different outcomes for racial and ethnic groups. Through a historical analysis of Pennsylvania’s long-term care policies, the article contrasts the effects of the state’s 1982 nursing home capital reimbursement moratorium, which contributed to a decline in Medicaid nursing home resources in heavily minority Philadelphia while resources expanded in predominantly white suburban counties, with the later expansion of the Pennsylvania Department of Aging Waiver program, which disproportionately served minority populations by supporting community-based alternatives to institutional care. The article also reviews other Medicaid eligibility and coverage policies that have directed resources toward populations with markedly different racial compositions. It contends that existing legal remedies are insufficient to identify or correct disparate racial impacts because successful challenges typically require proof of discriminatory intent and federal enforcement mechanisms have been ineffective. Drawing on models used for fiscal notes and racial impact statements in criminal justice legislation, the article proposes that Pennsylvania require racial impact statements for Medicaid regulations and major policy initiatives, including contractual arrangements administered through Medicaid managed care programs. Such disclosures would promote transparency, improve policymaking, and allow public scrutiny of policies that may affect minority communities differently from non-minority populations, thereby advancing efforts to reduce disparities in health care access and outcomes.[This abstract was written by Microsoft Copilot, a generative artificial intelligence.]</p>