Depending on who is doing the talking these days, New York State is either a national model of how to curb Medicaid spending, or the nation’s prime example of Medicaid abuse.

Now billions of dollars in state revenue may ride on which image prevails, as presidential politics puts a new spotlight on the joint federal and state spending program for care of the disabled, the elderly and the poor.

No state spends more Medicaid money than New York — $54 billion a year. But Gov. Andrew M. Cuomo, a Democrat, persuaded health care providers and major health worker unions to live within a strict Medicaid spending limit last year, and to accept an ambitious Medicaid redesign that promises better health outcomes at a lower cost.

The governor takes credit for $2 billion in federal savings already, and projects that $15.1 billion more will be saved over five years. He is asking federal authorities for a waiver that would give $10 billion of the federal savings back to New York to help pay for the overhaul, to “permanently restructure our health system and continue to make New York a national model.”