John Oliver has done a superb job of how abysmal Medicaid programs have become in this country. With the establishment of managed care in the late 1990s payment was no longer fee for service but rather MCO (Managed Care Organizations) were given a flat rate for every patient. This resulted in patients being denied for services irregardless of their needs. This continues today and it is getting worse - cuts are made every year. In particular cuts and restrictions continue to be imposed on seniors needing home health aide services.