From what I understand, Medicaid costs are supposed to be split 50/50 between the state and Federal Government. Over the years the states have been shifting more cost towards the federal government through various accounting schemes. The bill re-shifts the 50% costs back to the states and at the same time incentivizes them to make lower their error rates, and New York state has a very high error rate. And it is requiring able-bodied people on Medicaid to work, go to school or volunteer 20 hours a week to remain eligible for Medicaid.