As America ages, states face a tough question: how do we fund long-term care and protect the truly vulnerable without crowding out everything else? In this episode of American Potential, host David From talks with Brian Blase, President of the Paragon Health Institute, about why Medicaid’s design is straining state budgets—and what to do about it. Blase explains how open-ended federal matching, expansion to able-bodied adults, and “legalized money-laundering” schemes (like provider taxes) have warped incentives—paying up to seven times more federal dollars for able-bodied adults than for seniors and people with disabilities.

Blase lays out a reform roadmap: ideally block-grant Medicaid, but in the near term level the federal match across eligibility groups, curb provider-tax loopholes, tighten eligibility reviews, and require community engagement for able-bodied adults—so states can prioritize long-term care and home- and community-based services for aging Americans. If you want a clear, practical plan to keep Medicaid sustainable while strengthening the safety net, this conversation is your briefing.