Sure... laugh some more... it's the truth
Some states have restructured their budgets in ways that let them expand coverage to people who should not qualify, while still drawing down federal Medicaid matching funds.
Provider tax recycling: States like California tax hospitals and insurers, then recycle the money back through Medicaid payments. That inflated spending triggers more federal matching funds, which are then used to expand coverage
Artificial cost shifting: By reclassifying certain services or administrative costs, states can claim them under Medicaid and pull in a federal match, even when the services go to populations that should be excluded
Waivers and loopholes: Some states apply for waivers or build state programs that mirror Medicaid, but still manage to intertwine them with the federal match system
State-funded Medicaid lookalikes: In places like California, Oregon, Washington, Illinois, New York, and New Jersey, these programs provide full health coverage to illegal immigrants. On paper, they are “state programs,” but in practice, they often rely on the same infrastructure and funding flows as Medicaid
