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Medicaid should “NEVER” be an allocation based on any state’s GDP.

Am I suggesting that California is not now or ever was getting a share of Medicaid spending that was NOT larger than it should have been?

No.

What first needs to be adjusted is to go back to the Medicaid spending levels, state by state BEFORE Obamacare forced all states into a Medicaid expansion that made all states benefit levels more equal with what had been just the most liberal states. That should be first set as a base.

Second, the funding method then (before Obamacare) and now commits federal dollars to the states, giving each state 50% of what THAT STATE IS SPENDING PER MEDICAID RECIPIENT. The higher a state’s costs AND THE HIGHER MEDICAID BENEFITS IT PROVIDES, then the higher Medicaid expense per recipient it has and the more federal money per recipient it gets.

Third, that funding method needs to be revised so that what the federal funding amount is, to any state, is never more than 50% of the national median Medicaid expense per Medicaid recipients. States that want to adopt more generous Medicaid programs, and/or who do not work to get their state health care spending costs down as much as national median rates, should not be rewarded with what in fact is subsidies from states with less generous and less costly Medicaid expenses.

Then, lastly, whatever adjustments need to be applied to the pre-Obamacare Medicaid spending, need to bring it forward on with the spending formula I just described, which is to use national median Medicaid spending figures as a ceiling above which states are on their own to fund.

That also matches Medicaid spending to Medicaid spending regardless of a state’s GDP. Why give a larger Medicaid “block grant” to a state based only on a state GDP of 10% of the nation’s GDP, while its Medicaid spending is only 5% of all Medicaid spending. That seems no more fair than NOT penalizing states like California that spend more per recipient than the national median.

Funding for Medicaid should bear some relationship to Medicaid spending, but it should reward lean entitlements to it, not greater, and lower costs, not greater, so it should use a benchmark-ceiling, like a national Medium above which states are on their own.