The Centers for Medicare & Medicaid Services has been instructed by President Donald Trump to adjust its rules to allow the States to adjust their own rules to require work for Medicaid payments.
This is a very good start. There are two remaining steps, though. The funds transferred to the States in support of Medicaid need to be converted to block grants with no strings attached. Each State knows its own medical support needs far better than does the Federal government.
The last step is to begin reducing, over a short number of years, the size of those block grants until no funds at all are being sent to the States. This will get the Feds out of the States’ business, remove an extortion tool from the Feds’ kit which the Feds use to push the States into doing (or not doing) things the Feds demand be done or not done, and it will greatly reduce Federal spending. In 2016, the Federal government sent almost $350 billion to the States in Medicaid transfers.