When it comes to health care, the Biden administration has a clear goal: to strip away state flexibility and consolidate greater federal control — so much so that it’s willing to nullify settled agreements that the government has had with many states.

Upon taking office, the president issued an Executive Order directing the Department of Health and Human Services to review existing Medicaid policies to determine which should be suspended, revised, or rescinded. It also sent letters to states notifying them that any previous agreements related to the process of reviewing waivers no longer applied, thus fast-tracking the process for the federal government to rescind state agreements.

Last month, the Biden administration took action to strip state policymakers of their ability to help able-bodied, low-income individuals either work, volunteer, or prepare to work in exchange for getting taxpayer funded health care benefits through Medicaid. It sent letters to states with approved or pending work requirement agreements notifying them that the work requirement provisions of those agreements were no longer supported by the administration and under further review.

The principle of integrating work as a condition of receiving welfare benefits has been part of the welfare infrastructure for decades. Yet, despite a steady decline in poverty since the principle was adopted as part of overhauling the welfare system in the 1990s, reversing this principle appears to be part of a larger effort to remove work as condition of receiving welfare benefits across the board.

In Medicaid, the impact also undermines the principle of state flexibility.

Medicaid is a need-based government welfare program that provides health care services to certain low-income individuals. The federal-state partnership of Medicaid gives states the latitude to design their Medicaid program in ways to address the unique needs in their states and prevents the program from morphing into another federally controlled program.

What’s really needed is not a federal, one-size-fits-all model, but a more flexible Medicaid model that allows states to adapt their Medicaid programs to the diverse and changing needs of their citizens. This will also require addressing more fundamental challenges facing the program, including preserving eligibility for those in need, allowing benefits to match the needs of beneficiaries more precisely, and restructuring the financing to target resources and dollars more effectively.

We already know top-down, federal micro-management isn’t healthy. It’s time for a second opinion.

Nina Owcharenko Schaefer is a senior research fellow in health policy at The Heritage Foundation.