The article discusses the alleged theft of $3.5 billion from California's hospice system and suggests that the federal government does not have to accept California’s bookkeeping tricks. The state manipulates Medicaid, a federal program meant to help the poor, through a bureaucratic “shell game” that shifts billions while taxpayers and taxpayers pick up the tab. This scheme has driven ambulance reimbursements into the stratosphere, with the cost of publicly funded ambulances increasing from $339 to $1,168 per trip between 2022 and 2024. The increase means more than $1.200 per ambulance ride that does not go to patient care. The author's brother, who has level 3 autism spectrum disorder, uses Medicaid and In-Home Supportive Services to provide support for his family. The article also suggests that President Trump could direct federal agencies to stop approving inflated reimbursement schemes.