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Abstract: In 1987, Missouri was ranked fifth worst in state Medicaid programs. This case outlines the factors most critical to Missouri's medicaid reformation: federal mandates that expanded coverage, particularly to poor women and children; a professional and activist Department of Social Services; the influence of national organizations including the Medicaid Director's Association and the National Governor's Association; an activist state provider organization -- the Missouri Hospital Association; and the implementation of an innovative finance mechanism which enabled the state to leverage additional federal funds.
Learning Objective: This case describes the confluence of forces that served to bring Missouri's Medicaid program in line with the nation.