Why Medicaid has drifted from its mission — and how to fix It
The Hill
by Virat Agrawal and Neeraj Sood, opinion contributorsFebruary 21, 2026
AI-Generated Deep Dive Summary
The Trump administration is stepping up oversight of Medicaid to tackle issues like fraud, waste, and abuse, while also addressing what some call "mission creep" where the program has expanded beyond its original scope. This shift comes as policymakers explore ways to ensure Medicaid remains focused on healthcare by increasing transparency and possibly restructuring how funding is allocated—moving away from open-ended financing toward per-capita allotments that limit spending based on the number of beneficiaries.
Medicaid, a joint federal-state program providing health coverage to low-income individuals, has grown significantly since its inception in 1965. The Affordable Care Act (ACA) expansion in 2010 increased enrollment and shifted Medicaid into a key role in healthcare access, particularly in states that expanded Medicaid under the law. However, this growth has also led to concerns about rising costs and how funds are being used, with some states diverting Medicaid dollars to non-healthcare purposes like housing assistance.
Critics argue that while addressing fraud and waste is crucial, the broader issue of mission creep risks undermining Medicaid's core purpose. By shifting to per-capita allotments, policymakers aim to clarify funding priorities and ensure resources align with healthcare needs. This approach could also help states manage budgets more effectively by capping their financial exposure for Medicaid.
The push for transparency and accountability in Medicaid spending is particularly relevant in the political landscape, as debates over healthcare reform and federal-state partnerships continue to evolve. Addressing these challenges will be key to maintaining public trust and ensuring that Medicaid remains a reliable source of healthcare support for vulnerable populations.
Ultimately, fixing Medicaid's mission drift requires balancing federal oversight with state flexibility. By redefining funding structures and clarifying program boundaries, policymakers can strengthen Medicaid's ability to meet its original goals while adapting to modern challenges. This effort not only impacts healthcare delivery but also has significant implications for budget management and intergovernmental collaboration in the years ahead.
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Originally published on The Hill on 2/21/2026