More than 12 million people live in Pennsylvania, and 3 million of them — nearly one-quarter of the state’s population — depend on Medicaid. That’s why it’s so concerning that the Centers for Medicaid and Medicare Services (CMS) recently issued new guidelines that will add an extra burden to Pennsylvania’s already overburdened public health system.

Under existing laws and regulations, the federal government must match money Pennsylvania puts into its Medicaid program. The new guidance from the federal government seemingly tries to lessen that federal spending by limiting Pennsylvania’s options for generating the state dollars that qualify for match.

We need to reform Medicaid and make it more sustainable, but top-down guidance that undercuts federalism and Pennsylvania’s discretionary ability to use Medicaid funds is not the answer. A diverse congressional coalition, which included now-Vice President Kamala Harris and Pennsylvania U.S. Sen. Bob Casey, made this clear in 2020 when the Trump administration first proposed the idea in the proposed Medicaid Fiscal Accountability Regulation (MFAR). That was enough to convince CMS to suspend the rule then.

Why, then, is the Biden administration turning back the clock to implement this failed idea today? Why is his Medicaid team creating MFAR 2.0, in spite of the strong opposition of both the vice president and Casey?

Enrollment in Medicaid surged after the Affordable Care Act’s passage, leaving more people dependent on Medicaid as their main source of health care. Enrollment skyrocketed again once the pandemic-era relief measures that added more people to the Medicaid rolls went into effect. Why would the federal government pull the rug out from under the most vulnerable among us right now?

The federal government is struggling to adequately combat the rampant fraud and abuse that has famously plagued Medicaid for decades. According to a 2022 report from the Department of Health and Human Resources, “Medicaid Fraud Control Units (MFCUs) recovered more than $1.1 billion in criminal and civil recoveries, amounting to $3.08 for every dollar spent.” Per the report, 2022 was “the fourth year in a row that recoveries topped $1 billion.”

Rather than dictate how Pennsylvania can fund its Medicaid program, the federal government should focus on cracking down on the rampant waste, fraud and abuse that’s currently within the system and introduce new ways to make health care more affordable, like addressing antitrust issues and cracking down on the price-gouging induced by some drug companies. Both of these solutions would help in unburdening the Medicaid system. MFAR 2.0 utilizes neither of these approaches.

Should the new CMS guidance remain in effect, dependency on the Medicaid system, which has dramatically expanded in recent years, would remain the same. The cost of Medicaid would not go down; there would simply be fewer funds to meet the existing massive needs.

Both the state and federal government should work to achieve Medicaid and entitlement reform, but it should be meaningful reform that improves the quality of life for the people of Pennsylvania. The citizens of the commonwealth deserve better.

Jason Altmire was a member of Congress from Pennsylvania from 2007-13. He is an adjunct professor of health care management at the Texas Tech University Health Sciences Center. Follow him on Twitter @jasonaltmire.

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