A major policy shift is underway for Medicaid, potentially reversing years of efforts to expand access and simplify enrollment. This episode dives into the proposed changes that could create a new maze for millions of Americans. Why is Congress freezing rules designed to make enrollment easier while introducing new community engagement—or work—requirements? We investigate the squeeze on state budgets through tighter controls on provider taxes and ask whether a modest expansion in home care services can offset the potential loss of coverage for others. Is this a necessary move for fiscal control, or will it create more barriers to care for the nation's most vulnerable?