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Two government budget practices that can have significant implications for lower levels of government are block grants and unfunded mandates.

Higher levels of government should provide adequate resources when mandating functions to lower levels of government.

Services should be implemented and operated by the level of government that can most appropriately and efficiently deliver them.

Federal and state governments have tried to change budget rules to control government spending. Budget rules have also been used to impose fiscal discipline.

Efforts to reform entitlement spending should recognize the following factors:

Federal and state governments must comply with the transparency requirements established by the Affordable Care Act (ACA).

The federal government should not allow states to impose or enforce greater than nominal Medicaid premium- and cost-sharing on Medicaid beneficiaries.

Federal and state governments must ensure that waivers cover all mandatory Medicaid services in the same amount, duration, and scope for all eligible benef

Federal and state governments should ensure that expansion populations have adequate access to the same or comparable provider networks as those available