Fellow wonk Ezra Klein looks at the vast differences in state Medicaid programs and proposes a plan for simplification: set eligibility at 250% of the federal poverty line “with states able to use state money to expand categories or add services”. Well, that’s basically how it works now. Minnesota has devoted billions of dollars to expanding Medicaid eligibility and providing a multitude of services that are considered “optional” under Medicaid law. To make things even more confusing, states can seek waivers from the federal government to provide an expanded set of Medicaid services to a defined population, like people with developmental disabilities or people who have complex medical conditions. On the one hand, this flexibility gives states the freedom to tailor Medicaid to the needs of their populations. On the other, it creates an environment where one state can offer many more services than the state next door. Klein’s solution wouldn’t change that situation.
Here’s what I would do if I was ruler of everything. Require every state to offer a common menu of Medicaid services that are funded using existing federal matching rates. If a state wants to provide additional services, the feds should provide an enhanced matching rate for those extras. Yes, it will cost more at the federal level, but the alternative is an unpredictable cycle of service expansions and draconian cuts; a wasteful process that devours billions of administrative dollars at the state level.
And we can fund all this by nationalizing Citibank and Bank of America. Viva la revolucion.
“The world is a mess and I just… need to rule it”
Name that Movie!