Mehmet Oz, the Centers for Medicare & Medicaid Services administrator, is ordering all states to step up their efforts to .
His April 21, 2026, announcement expanded on the Trump administration’s related , such as withholding Medicaid funds from and threatening to do that for , .
The Trump administration says there’s a big problem with fraud tied to government-funded care delivered in a person’s home or in the community, officially known as , along with nonmedical transportation, behavioral health and new or high billing providers.
The agency Oz leads is now asking states to immediately they claim are “high risk.” That is, states are supposed to require providers to prove that they remain eligible to participate in Medicaid and bill the program. The providers primarily offer at-home care, transportation, behavioral health and other services.
Related , sponsored by Republicans, .
We are who of the Medicaid home and community-based services program. One of us () previously served in the role of administrator and assistant secretary for aging of the .
We strongly believe that it is sensible and necessary for the government to take steps to prevent, root out and punish Medicaid fraud. But we are mindful that the government’s anti-fraud strategies and tactics could unnecessarily disrupt the very services that people depend on day to day.
We aren’t alone. Many , and are alarmed by this White House policy.
What’s at stake
All told, Medicaid provides health insurance coverage for , including .
More than benefit from government-funded home care, which is aimed at keeping low-income people with disabilities and frail older people living in their own homes and communities. Medicaid , covering nearly two-thirds of all such spending in 2023.
When home care works well, people become less likely to have to move into nursing homes or other assisted living facilities. If a home care aide doesn’t show up, the consequences are immediate and can be dire.
An older adult may be unable to get out of bed. A person with disabilities may miss meals or medications. A family caregiver may have to take time off without notifying their employer in advance and lose wages.
That’s why the federal government’s actions – particularly those targeting services provided in a person’s home or community – could endanger millions of people.
Supreme Court ruling
Home and community-based services include help with bathing, dressing, eating, medication management and mobility – services that allow people to remain in their homes rather than moving into nursing facilities. A shift toward home-based care has been underway for decades, driven by both costs and civil rights protections.
One reason for the shift was the 6-3 ruling in 1999 by the Supreme Court in the case. The majority affirmed the right of people with disabilities to live in their own homes and communities when possible.
Today, covers the cost of services provided in a person’s home or local community, rather than in an institution. These services cost less and . Research and program data consistently show that fraud in these programs is .
This is especially true due to safeguards like , which ensures providers are actually providing services in the home.
Another safeguard in place is that most states contract with and approve, which act as payroll, payment and compliance managers, to make sure that there are verifiable records, payment controls and audit trails in place for the Medicaid program.
Not all ‘improper payments’ are fraudulent
A central problem in the Trump administration’s strategy to root out alleged Medicaid fraud is a basic mischaracterization of many things as fraud that aren’t fraudulent.
Federal agencies are tracking “improper payments” and incorrectly equating them with fraud. The Centers for Medicare & Medicaid Services makes clear that or administrative issues – .
The , a nonpartisan government agency that produces in-depth research, notes that while fraud does lead to improper payments, the reverse is not necessarily true. That is, improper payments can have a cause besides fraud, such as administrative errors and eligibility processing mistakes.
Blurring the distinction between improper payments and fraud can make it seem like providers are illegally taking advantage of the system. And when that happens, policymakers may turn to blunt solutions that do little to punish actual fraudsters, such as , rather than fixing administrative problems.
Exaggerating the scope of Medicaid fraud
In our view, proposals to overhaul Medicaid’s enforcement methods . Yet much of the argument for structural reform relies on anecdotal examples, isolated cases and select audit findings without broader context.
One of the more egregious cases perpetrated by providers was a home care agency in Pennsylvania that billed fraudulent claims between 2020-2023 . Another was the Minnesota provider penalized in 2025 after billing for services .
But those infractions do not justify characterizing an entire category of services that helps tens of millions of Americans remain in their homes as rife with fraud and in need of dramatic changes.
By contrast, as we explained in in March 2026, federal – including the Centers for Medicare & Medicaid Services, the Government Accountability Office and the Health and Human Services’ inspector general – produce systematic, data-driven analyses.
These sources consistently caution against equating improper payments with fraud and emphasize targeted approaches to program integrity.
The government designated some 6% of the annual payments by Medicaid as improper payments between 2022-2025, which were worth about . Yet, more than 3 in 4 improper payments resulted from insufficient documentation, which usually doesn’t indicate fraud or abuse.
What’s more, Medicaid fraud is regularly subject to enforcement actions. In 2025, Medicaid fraud control units reported 1,185 convictions for fraud nationwide, and combined .
Emphasis on high-profile cases
Again, a few widely publicized fraud cases in do not prove that fraud is a chronic problem for Medicaid billing in home care programs.
In an agency as big as Medicaid, which , some level of fraud will occur. The key question is whether fraud is widespread, systemic or goes unpunished.
suggests Medicaid fraud is none of those things.
For example, large-scale home care programs serving hundreds of thousands of people of confirmed fraud cases. Enforcement data from , which investigate and prosecute Medicaid fraud, show that when fraud occurs, it is investigated and prosecuted.
In other words, the presence of enforcement activity is evidence that oversight systems are working – not that they’re failing.
A better approach
We believe that many strategies that are better than those that the Trump administration is embracing are readily available. Some examples include improved data analytics, stronger referral systems within managed care plans, enhanced provider screening and documentation standards, and for Medicaid Fraud Control Units.
These approaches target fraud directly without jeopardizing access to the essential Medicaid services that help tens of millions of older adults and disabled people remain where they want to be: in their own homes instead of in more expensive nursing homes.
Given that the U.S. spends about , we don’t question the wisdom of engaging in its oversight.
But we are concerned that the policy response to alleged fraud could harm the very people that the Trump administration says its efforts are meant to protect.
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