There aren’t many other political footballs like the social safety net. It’s easy to default to “welfare queens” and abusers of the system when we think of Medicaid recipients, but let’s look instead at a hypothetical example of a deserving recipient of assistance.
Daniel, 42, sustained a spinal cord injury in a car accident several years ago. He enjoys watching baseball and loves to help his nephew with his homework. He uses a wheelchair and needs assistance with some daily activities. He handles what he can himself, but he needs help covering his medical care and daily support needs.
He has regular doctor’s appointments, requires multiple prescriptions, and counts on services that help him live at home. His sister helps him with his appointments and paperwork, but she also has her own job and a household to take care of. His concern is practical: Can he get the care he needs from the providers he relies on?
And that’s an issue that the federal government faces. How does it make sure that people like Daniel get the dependable care they need while making sure that the program spends the taxpayers’ money efficiently?
If we look at the polling, we can see that Americans have the same concerns. A noteworthy 83% support preserving Medicaid for American citizens while ensuring that illegal aliens are ineligible and don’t take advantage of the system. Likewise, 83% are in favor of shoring up Medicaid support for rural hospitals while beefing up eligibility requirements.
Medicaid is a joint program between the states and the federal government. Congress sets up the federal statutory framework, and the Centers for Medicare & Medicaid Services (CMS) oversees federal compliance. State governments operate their programs and determine eligibility, while the federal government provides matching funds to the states.
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This discussion of how Washington and the states can administer Medicaid more efficiently goes beyond the cut Medicaid versus expand Medicaid argument. It’s a bigger-picture question: Who should the safety net support, and how do we root out misuse, fraud, and waste?
CMS is already working to ensure that the people who receive assistance are the ones who need it the most. Guidance that took effect this month works to limit who can claim federal matching funds for Medicaid and other programs.
“CMS is preparing states for an upcoming change that will limit the ability to claim federal matching funds for Medicaid and the Children’s Health Insurance Program (CHIP) for individuals who are not U.S. citizens or U.S. nationals, or who fall into specific noncitizen categories identified in statute,” reads an April 8 press release from CMS. “New guidance issued today will ensure states understand their responsibility in implementing this statutory change beginning October 1, 2026.”
“The Trump Administration has a public mandate, a statutory obligation, and a moral duty to safeguard our federal healthcare programs,” said CMS Administrator Dr. Mehmet Oz. “Today, we’re honoring all three by providing clear guidelines to help states follow the law and safeguard taxpayer dollars.”
The One Big Beautiful Bill, which Congress passed in 2025, sought to preserve Medicaid for those who need it most. Ashley Hayek, president of America First Works, wrote in the run-up to the bill’s passage, “The American people demanded bold action. This bill delivers.”
States have a responsibility as well. America First Policy Institute has an extensive plan that helps fight fraud and bolster accountability for Medicaid and other safety-net systems. It’s worth a read.
Once again, repairing the holes in the safety net is an affordability issue. We have the responsibility to elect leaders at the federal and state level who will combat waste and fraud in Medicaid and other systems this midterm year. People who really need the safety net — like Daniel — depend on us to make the wise decision.