ABSTRACT
In many states the Comprehensive Health Planning agencies, established in state health departments with area subsidiaries, have provided a focus for publicity and debate. With rising costs, the concept of "medical indigence" has been gathering new meaning, far beyond the concept that led to Kerr-Mills and, later, to Medicaid. The problems of middle-class medicine were, however, also increasingly evident at the state and local level. Some states attempted to emphasize better administration, including utilization review, in an effort to halt rising costs. The more decisive and imaginative direction in the Medical Services Administration in Health, Education and Welfare began to have some effect on those responsible for running state Medicaid programs. The interactions and controversies of all of the various groups—federal agencies, departments in the state governments, health care providers, fiscal agents, the courts—seemed sometimes to overwhelm the actual recipients.
