In its design (as opposed to its objective) Stephen Moore doesn’t much like Medicaid:

You’d be hard-pressed to find a more poorly designed program in the federal budget than Medicaid, the health insurance program for low-income Americans. The costs are shared between the states and the feds, which means that the more money a state wastes under Medicaid, the bigger the check Washington writes to the state. No wonder the program costs keep spiraling out of control.

Obamacare added nearly 20 million people to the Medicaid rolls, and the left considers that a policy victory. Federal and state budgets are swelling.

Oh, to return to the days when taking people off of welfare — not putting them on the dole — was the goal.

In an unusual experience, for a conservative, Moore cites Rhode Island as an example of a different way, referring back to a block-grant program implemented in the waning days of the President Bush and Governor Carcieri days.  Gary Alexander, who ran Health and Human Services in RI back then comments in Moore’s essay:

Alexander has become the Pied Piper for Medicaid waivers. “This is such a terrific solution because in Rhode Island we reduced costs and provided better care. When the state had an incentive to save money rather than spend it, this changed everything.” He added, “State waivers are the way out of the Medicaid crisis.”

Of course, elected officials in Rhode Island moved quickly to give away the budget slack in the Medicaid expansion and other constituent buy-offs, so clearly we have to work on step 2 of the “saving money” process (i.e., not immediately spending it on something else).  But it’d be nice to be recognized more often for innovative, smart policies.