Population 6 million

Tennessee becomes first state to ask permission for Medicaid block grants

Medium state allowing itself to rescale as needed. 

But 6 million seems enough t support a state based Medicaid system? The problem is state basing on the House programs.  The House need to execute a single 'rescale' adjustment for everything on a two year deal. That allows the sstates to apportion liquidity across multiple programs on a per state basis. Senators pay attention, they save their own dollars. So a senator can price the trade between national efficiency and state efficiency. They use their rescale money where it can effectively help the state to adjust, thus making their own balance every two years under the negotiations.