Medicaid expansion creates new dilemmas for state programs.

At the same time advocates for the poor are rejoicing over Medicaid program expansions passed as part of the FY 1991 federal budget, state Medicaid directors are wondering how to accommodate all the potential new recipients. Ironically, because of budget pressures at the state level, the new federal mandates could force some current program recipients off the rolls in order to allow new ones on. "Expanding obstetrical and prenatal care is something we want to do because it's sound social policy--but the mandates have been compressed into time frames that are too short for state budgets," says one state Medicaid director.