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The federal statutory and administrative rules essentially establish basic minimum requirements for the states to implement and broad discretion to the states in certain areas, mirroring the federalism approach often found in federal-state mandate.  In the absence of specific regulations or resource requirements for long-term care assist programs. These federal sources of authority provide the operational framework for the states to design and implement their own individual state agencies to administer the Medicaid program.

The states, in turn, each have enabling acts which create the state portion of the partnership. The state agency designated to run the program is also tasked with implementing regulations for the op- eration of the agency and eligibility for program assistance. These rules must meet the minimum federal requirements. These rules are typically the most consulted by the Medicaid Planner because they directly impact the patient’s eligibility and the procedures in place to establish eligibility.

The rules governing Medicaid are constantly changing and evolving. Because the state rules implementing the Medicaid program must meet certain minimum federal standards, changes in federal laws precipitate changes in the state rules. Because each state is left to implement the program in its own way, with broad discretion on issues that go beyond the scope of the minimum federal requirements, there exists a lack of uniformity in the operation of Medicaid agencies from state to state as well as the specific eligibility requirements.