This paper details several factors that affect Medicaid, the federal program that provides health care reimbursement for millions of low-income Americans. The research presents many challenges to sustaining an equitable welfare system that also produces positive health outcomes. Growing levels of poverty have resulted in increased enrollment in the Medicaid program and projections indicate a continuation of this trend. A decrease in the supply of physicians along with an aging population creates new obstacles to health care access. The Patient Protection and Affordable Care Act (PPACA) introduces additional complexities by expanding Medicaid enrollment, increasing regulatory requirements and reducing payments to health care providers through rate cuts and penalties.