Elsewhere, officials are striving to make it harder for people to get Medicaid at all.

Last week, Arkansas became the first state to require some Medicaid recipients to work in order to keep their health insurance. Three other states have secured federal permission to do the same, and several others have similar requests pending with the Centers for Medicare and Medicaid Services.

Proponents of work requirements say that the goal is not to punish the poor, but to lift them out of poverty by nudging them into the work force. But decades of experience with similar social experiments tell us that it will not play out that way. The welfare-to-work strategies of the 1980s and 1990s succeeded at getting people off government rosters — but without alleviating their poverty.

The current Medicaid proposals are likely to have the same effect: The Urban Institute has found that in Arkansas (to take one example) nearly 80 percent of Medicaid enrollees who would be subject to the new work requirements face limitations that include significant health problems, a seriously ill family member, no vehicle or a lack of education. These barriers would make it difficult to impossible for many of them to meet the new rule’s monthly reporting requirements, even if they managed to secure the required 80 hours of work each month.

If only such scrutiny were applied to Medicaid insurers. But even as more Medicaid beneficiaries — including those with complex medical conditions — are shuttled into cost-saving managed care programs, very little is being done to guard against abuses like the ones that left little D’ashon with permanent brain damage. The Centers for Medicare and Medicaid Services began a “scorecard” program on Monday to track the performance of Medicaid providers, but participation is voluntary and participants will face no penalties for poor performance.

“Conservatives love to claim that public program fraud is driven by the people utilizing the programs,” says Frederick Isasi, executive director of Families USA, a health care advocacy group. “But it’s actually corporations, providers and carriers that perpetrate most of it.”