Down​siz​ing​Gov​ern​ment​.org has released a new study on Medicaid. The piece discusses basic problems with the program, examines the rapid rise in spending, and proposes reforms to reduce costs and improve quality.


Medicaid is a joint federal‐​state program that funds medical services and long‐​term care for people with moderate incomes. It is one of the largest and fastest‐​growing items in the federal budget, at almost $400 billion a year.


State governments administer Medicaid, but most of the funding comes from the federal government. The current funding structure encourages expansion and provides little incentive to control costs. At the same time, the top‐​down regulatory structure of Medicaid distorts health care markets. The 2010 Affordable Care Act increased Medicaid spending and did not fix the program’s structural flaws.


Policymakers should reverse course and restructure Medicaid to reduce costs. The program should be turned into a block grant, with the federal government providing a fixed amount of aid to each state. That was the successful approach taken for welfare reform in 1996. Fixed grants would encourage states to restrain spending, combat fraud and abuse, and pursue cost‐​effective health care solutions.


Federal deficits are rising, and health care spending is a major reason why. Reforming Medicaid with a block grant structure would allow federal policymakers to control spending while encouraging health care innovation in the states.


The Down​siz​ing​Gov​ern​ment​.org study is here.


Michael Cannon’s study here is also a good introduction to this costly program.