All 50 states, the District of Columbia, and Congress are all having the same nightmare. It is called Medicaid. Now there is a chance to turn bad dreams into great, big happy ones. Texas is in a unique position to lead.Though most people think Medicaid is a federal program for the poor, it was originally created as medical assistance for those unable to support themselves, listed in the original law as the physically disabled, mentally incompetent, pregnant women and those with chronic kidney disease.Medicaid is the largest single cost item in the Texas state budget. Yet, spending decisions in Texas are made 1,523 miles away in Washington, D.C. Furthermore, the original Medicaid law said the programs would be under state, not federal, administration.