For most of its history, Medicaid has operated as a distinct health-financing program for discrete low-income populations. Until recently, most of its beneficiaries were receiving welfare and had little or no tie to the workforce. The providers from whom they obtained care were often different from those serving the employed population. Medicaid beneficiaries were more likely to use hospital outpatient departments and emergency rooms or safety net providers such as community health centers. In recent year, however, there has been a gradual - if still - limited convergence of Medicaid and the private health insurance sector.