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Gov. Bev Perdue opposed the Ryan budget even before it was released. One specific area mentioned in the News & Observer was the idea of a block grant for Medicaid. This is something we have recommended more than once. A block grant would give states flexibility to tailor the Medicaid program as necessary without seeking federal permission. Former Rhode Island Health and Human Services Secretary Gary Alexander said his state's block grant is “the sole reason why Rhode Island possessed a state budget surplus in SFY2010.” Clearly, if the Ryan plan's purpose is to “give states the flexibility to tailor their Medicaid programs to the needs of their unique populations,” the formula would take into account North Carolina's growing and aging population. It is odd, however, that Gov. Perdue opposes the block grant idea, but supports ObamaCare which makes Medicaid unaffordable this year and removes all flexibility from the state to change the program in a way to make it fiscally viable while protecting the health of Medicaid recipients.