More than 2.2 million Pennsylvanians are eligible for Medicaid, the federally mandated, state-managed program that provides health care for people and families who can't afford care otherwise.
It is the highest number on record, representing nearly 18 percent of the population -- more than one in six Pennsylvanians -- and underscoring the worrisome economic climate and continued difficulty many people have finding jobs and employer-provided insurance.
But the swelling Medicaid roster is not just a sign of the economic times. It's also reflective of growing dependence on state-sponsored health care and safety nets, as well as the increasing cost of health care and long-term care -- trends showing few signs of immediate abatement.
As a result, the state's Department of Public Welfare budget, and the need to trim it, have been regular sources of political strife for Gov. Ed Rendell and the state Legislature. The same will remain true for future governors and lawmakers.
"It is something that's going to be hard for the state to sustain," said Fran Chervenak, a senior attorney with the Pittsburgh branch of the Pennsylvania Health Law Project, experts in health care issues related to seniors, low-income consumers and people with disabilities.
"It presents short- and long-term burdens on the state budget. I don't think any of this will turn around quickly," she said.
The state's Medicaid enrollment number has grown by nearly 100,000 since the beginning of 2010 -- and by roughly 803,000, or 56 percent, since 2000. Pennsylvania's overall population has grown about 3 percent over the same 10-year period.
Allegheny County trends below the state and national averages, with roughly 202,000 people -- about 16.6 percent of the county population -- receiving Medicaid benefits.
"The economy is definitely at play right now," said Linda Blanchette, a deputy secretary with the state Department of Public Welfare. "Another trend is among the elderly. We're seeing more elderly individuals enroll in Medicaid," many in need of long-term care, including home health care, hospice services, personal care homes and private nurses.
A report issued by the Rockefeller Institute of Government's Health Policy Research Center last month said Pennsylvania was one of the more generous when it comes to doling out long-term care benefits. Pennsylvania, on average, pays out $138 per nursing home patient per day, the eighth-highest dollar amount in the study.
Like many safety net programs funded by tax revenue, the programs are most needed when tax revenues are tanking.
"Medicaid's financing structure is not sufficiently responsive to changing economic conditions, making it difficult for states to budget effectively," another Rockefeller Institute study said. "During economic slowdowns, unemployment rates tend to increase, causing individuals to lose access to employer-sponsored health coverage."
States are trying to be more proactive in steering seniors away from more expensive institutional care and into home-care settings, Ms. Chervenak said. The new Federal Long Term Care Insurance Program is meant to eventually help people pay for some of their own care, easing the burden on the state -- and getting some of them off Medicaid.
This year, Medical Assistance and related programs consumed 21 percent of the state budget. The growth in the program is unsustainable in the long term without significant cost cuts, tax increases or a wild card factor -- such as the recently passed federal health care reform law.
"I think that the federal health care reform will help more people to get health insurance," said Ms. Blanchette. "So it could maybe bend the growth curve in Medicaid."
Medicaid funding is also subject to the whims of Congress, largely funded by federal "matching" money. This summer, Medicaid reductions were threatened here and elsewhere as Congress debated a federal aid package, which eventually directed $668 million toward Pennsylvania's Medicaid programs, averting mass layoffs and benefit cuts.
In this state, Medicaid is the catch-all term for Medical Assistance, the group of programs that pay for the care of the poor, medically needy children, disabled adults and, in some cases, the elderly (who are generally enrolled in Medicare, the federal health insurance program, but can also use Medicaid to offset Medicare costs, if they meet income limits).
Pennsylvania's growing enrollment numbers mirror what is happening across the country -- more than 50 million Americans are now on Medicaid, up by at least 7 million people since the recession began in December 2007, according to USA Today.
One estimate predicts Medicaid enrollment is going to increase by 15.9 million by 2019, bringing federal spending on the program to $443.5 billion; that figure doesn't include what the states spend.
Other anti-poverty programs, such as "food stamp" assistance and welfare assistance, have also grown dramatically in the past two years.
Bill Toland: email@example.com or 412-263-2625.