"The State of Michigan needs to be more savy with the Medicaid budget"
Like, eliminate the damned thing and refund it to the taxpayer.
You freeloaders, you gluttonous gobblers of stolen wealth, who perpetually suckle at the swollen teats of big government [cue up the Maggie Simpson pacifier-sucking audio loop], heed this: it is *morally repugnant* to use the police power of government to confiscate the property of others to pay for Grampa's Viagra and colostomy bags. Provision of such resources is the job of Grampa, family, church, and charity. Not the cold barrels of state guns pressed to strangers' heads.
What you have created thus far is an intergenerational pyramid scheme that has doomed millions of otherwise self-sufficient individuals to unbreakable dependency on the "public" dole (aka confiscated private propery that's fenced to buy votes). This socialist crack-dealing must stop. Besides, the crack will shortly run out, one way or another.