Kaiser Commission reports on Medicaid.

Policymakers have been wringing their hands over skyrocketing Medicaid costs. And they have scrambled to devise ways to tax providers to increase federal matching funds.

These schemes have given federal officials fits, and have led to restrictions in "creative financing." But states have been equally frustrated by new congressional mandates. How much more of a bite is Medicaid going to take, and who will pay? If states can't find the money, they will have to cut programs.

A new report from the Kaiser Commission on the Future of Medicaid, "The Medicaid Cost Explosion: Causes and Consequences," points out that during the '80s, as other federal funds to the states dried up, Medicaid became the "bank" for financing social welfare spending.

Because Medicaid was exempt from budgetary ceilings, Congress could expand it, along with actively encouraging Medicaid financing for community health centers and other things previously supported by grant funds.

Federal grants to states including Medicaid, grew from $91 billion in 1980 to $152 billion in 1991. The Medicaid share grew from 15 percent to 35 percent of the total.

Much blame has been cast on the 1989 congressional mandate to extend Medicaid coverage to all pregnant women and children under age 6 in families with incomes less than 133 percent of the poverty level. Although mothers and dependent children...