Prof. Adler: Is giving states flexibility to sign up more clients for Medicaid a great idea when the federal government splits the tab? Medicaid is growing very quickly. When times are good and states have available revenues, state officials can deliver a dollar of benefits to voters for 50 cents of taxes (because the feds are making up the difference). When times are bad, Medicaid is hard to cut all the way back: Every dollar of benefit cuts yields only 50 cents of savings for the state budget. Under the circumstances, isn’t freeing the states to expand the program a mistake?