No. of Recommendations: 10

There are a lot of people out there who think that, just because Medicaid is jointly run by the states and the feds, that states have broad latitude in how they administer the program. As Harold Pollack happily puts it in The New Republic, “In practice, states already enjoy great flexibility, with the Obama administration sending many signals that it is wiling to grant more.”

The logic of Harold’s argument is clear: if states “already enjoy great flexibility,” there’s no need to give them more flexibility in the form of block grants. Doing so would only give state governments “more incentive to make deeper cuts.” So I thought I would share with you an example of how ludicrously inflexible Medicaid really is: an example from Illinois, President Obama’s home state.

Illinois has one of the most expansive Medicaid programs in the country, with annual state and federal spending of $15 billion. That compares to a state budget of $33 billion. In the Land of Lincoln, you can qualify for Medicaid if your income is under 200 percent of the federal poverty level—$44,700 for a family of four. Children qualify at 300 percent of FPL. One out of every five Illinoisans is on Medicaid, including one-third of all Illinois kids.

But in order to prove that you’re eligible for Medicaid in Illinois, all you have to do is provide a single pay stub. If that pay stub happens to be artificially low, suggesting a lower income than you actually have, it still counts as “proof” of Medicaid eligibility. As to proving Illinois residency? The nice people of Illinois merely ask that you write down your address. As a result, people earning more than the Medicaid threshold, and people who don’t even live in Illinois, are collecting Illinois Medicaid funds.

So in January, the State of Illinois, under a Democratic House, a Democratic Senate, and a Democratic Governor, passed a landmark Medicaid reform bill aimed at fixing this and other problems with the program. The new law required the state’s Medicaid recipients to provide a month’s worth of pay stubs, instead of just one, in order to provide evidence of residency and income. Not a big deal, you might think.

You’d be wrong.

The federal government denied the Illinois plans because states are not allowed to put in place procedures that are more restrictive than they were on March 23, 2010, the day Democratic President Barack Obama signed the sweeping federal Affordable Care Act.
We're friggin' doomed. If they aren't attempting to go all Cloward and Piven on our sorry asses then i'd like to know what they're doing then, because that's the only explanation that makes sense.
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