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From the Nov 3, 2008 edition OPINION Medicaid modernization can start in the Ocean State Guest Column: William Felkner Reform often comes first from the local level, rather than being handed down from above. President William J. Clinton recognized this when he signed the Personal Responsibilities and Work Opportunities Reconciliation Act of 1996, which shifted control of welfare away from Washington bureaucrats and returned it to local control. The success of welfare reform since that time has been historic. More » This item is available in full to subscribers. Please log in to continue. To purchase a copy of this article for $2.00, click here.