Governor Andrew Cuomo is betting the house on Medicaid managed care ringing up estimated savings of $34 billion, to be split between New York and the federal government over the next five years.

That’s his springboard to submitting a waiver request to the Center for Medicaid and Medicare Services (CMS) in the next few months, asking the federal government to give back to New York $10 billion of its $17 billion share of the savings the Cuomo administration expects to result from curtailing growth and improving patient outcomes.  Who could disagree with those goals in principle?

But money is tight and it’s a huge fiscal ask of a federal government reeling under a staggering annual deficit, a growing national debt and a polarized discussion over the growth of entitlement programs including Medicaid.  No matter how laudable the goals, will the Obama administration give back such a princely amount in this environment to a single state?

Stay tuned, as the Governor’s future goals for Medicaid depend on a yes.