Medicaid is a joint Federal-state health care program that pays for the health care services for primarily low-income people. In 2023, the Federal spending for Medicaid amounted to $616 billion. Medicaid has grown rapidly since its creation in 1965, more than doubling in just the past decade. In the past year alone, CBO has increased its projections of Medicaid spending over the next decade by over $300 billion due to higher-than-expected enrollment and expansions implemented by the Biden Administration.  The Federal government provides a match for state spending that varies by state. To enhance the size of the Federal match, states began taxing Medicaid providers and then returned those collections to the providers in form of higher Medicaid payments, which had the effect of increasing the Federal match. Congress moved to limit these Medicaid “provider taxes” in the 1990s but also included a safe harbor provision that limits provider taxes to 6 percent of the provider’s net patient revenues. By eliminating this safe harbor provision, the program would save a little over $500 billion over 10 years.