Republicans in Congress are rightly looking to Medicaid’s out-of-control spending growth for possible savings to help preserve the 2017 tax cuts in what President Donald Trump hopes will be “one big, beautiful” reconciliation bill. 

If done right, those savings could also help save Medicaid as we know it. That means saving Medicaid for its intended recipients and saving Medicaid from being squandered on payments that are either implicitly or explicitly prohibited by law.