How the Federal Government Can Help

What is the ideal amount of federal oversight and control? None. Since Medicaid is a welfare program, it would be logical for states to include Medicaid into their "welfare package." Indeed, leaving Medicaid as the exception to returning welfare to the states undercuts welfare reform.

Those who seek to continue federal control often cite the need for retaining federal quality standards. This argument should be reversed. Quality of care has not been the hallmark of 37 years of Medicaid. It certainly should not be the only criterion for continued federal meddling in the program. The states are capable of administering Medicaid and are more interested in quality than is the remote, Medicare-oriented CMS.

Even short of a no-strings-attached block grant to the states, federal oversight should be significantly reduced. States should not have to go through a lengthy, time-consuming waiver process to enact essential reforms.