Originally enacted in 1965, Medicaid is a joint federal-state program under which the federal government sets broad parameters for the delivery of health care and family planning, while individual states control program administration. Recognizing the evolution of Medicaid over the past decade from a program based upon traditional fee-for-service payments to one dominated by managed care, Congress, as part of the 1997 Balanced Budget Act, freed states from having to obtain federal waivers before insisting that Medicaid enrollees obtain their care through managed care systems. That freedom was granted, however, on the condition that states meet uniform minimum national standards for Medicaid managed care. In September 1998, the Department of Health and Human Services' Health Care Financing Administration (HCFA) published proposed federal regulations to implement the uniform standards. Public input on the rule was solicited throughout the fall, and the agency is now making final policy decisions. The proposed regulations are discussed as they relate to freedom of choice and direct access to family planning services, cost sharing, informing enrollees of their rights as Medicaid recipients, and the provision which allows entire Medicaid managed care plans to refuse to provide, reimburse for, or provide coverage of a counseling or referral service based upon religious or moral grounds.