The number of individuals on Medicaid, the joint state-federal health care program for low-income families and individuals, is projected to increase by about 14 million as a result of expanded eligibility under the Affordable Care Act (ACA). Since the inception of the Medicaid program, each state has covered roughly one-quarter to half of the cost of its own Medicaid enrollees. Under the ACA, the federal government will bear 100 percent of the cost of expansion through 2016, working down to 90% by 2020 and thereafter. But in reality, a loophole known as the Medicaid provider tax, which allows states to artificially inflate Medicaid costs, will let states milk the federal government for up to 106 percent of the cost of new enrollees. This tax gimmick should be repealed.