New Report Targets Medicaid Fraud While Protecting People with Disabilities

20 May 2026 New Report Targets Medicaid Fraud While Protecting People with Disabilities

"Fraud must be rooted out. People with disabilities should not be uprooted with it."

Washington, D.C. - As the Trump Administration targets widespread fraud in government benefit programs, a new report from the National Center for Public Policy Research's Able Americans initiative proposes six key reforms that would prevent fraud, waste, and abuse while still protecting Medicaid's Home- and Community-Based Services (HCBS) for the millions of vulnerable Americans who depend on the program.

Medicaid's HCBS program was created in 1981 to allow Americans with disabilities to receive care at home instead of an institution. HCBS currently enables 8.4 million Americans with disabilities to live independently, at less than one-third the cost of institutional care.

"For millions of people, HCBS is the difference between living in a facility and living at home. It is the difference between isolation and community," co-authors Leslie Ford, Sara Hart Weir, and Rachel Barkley said. "That is why fraud, waste, and abuse in HCBS must be taken seriously. When Medicaid dollars are diverted, misspent, or poorly overseen, taxpayers are harmed-but so are the individuals with disabilities and families the program exists to serve."

In "Addressing Fraud, Waste, and Abuse in Medicaid's HCBS," Ford, Weir and Barkley propose six key reforms that would combat fraud while protecting and empowering America's most vulnerable citizens:

1. Create and Enforce Transparency: States should be required to publish transparent HCBS dashboards showing waiver waitlists, eligibility criteria, individuals served, provider directories, service rates, and per-person expenditures. Families should know what services are available, and taxpayers should know where funds are going.

2. Increase Federal Oversight: CMS should increase oversight of state waste, especially where eligibility thresholds are broad, spending is far above national norms, or new service categories lack clear standards.

3. Utilize Data for Consistent Fraud Detection: States should use consistent fraud detection systems, including predictive analytics, claims review, electronic visit verification, and independent audits to identify billing spikes, duplicate claims, and high-risk providers.

4. Cut Out the Middle Men: Recipients with severe disabilities, particularly who face waitlists and provider shortages, should be empowered to direct their own care. Individuals and families should be able to access electronic visit verification records, correct inaccurate provider logs, and choose care arrangements that preserve autonomy and dignity.

5. Measure and Report Outcomes: States should report whether people actually receive authorized services, whether waitlists prioritize the highest-need individuals, and whether HCBS improves stability, independence, health, and community participation.

6. Ensure Integrity of Third-Party Providers: Medicaid funds intended for care should not be used for lobbying, forced unionization, excessive administrative profits, or political influence. Provider ownership and related-party arrangements should be transparent.

"Fraud must be rooted out. Families and people with disabilities should not be uprooted with it," write the authors.

"Addressing Fraud, Waste, and Abuse in Medicaid's HCBS" can be perused here and downloaded here.

About

Able Americans is a nonprofit, nonpartisan project of the National Center for Public Policy Research dedicated to advancing innovative, free-market solutions that empower Americans with intellectual, developmental, and physical disabilities. It advocates for policies that remove barriers, expand individual freedom and choice, and deliver better outcomes for people with disabilities and their caregivers. Its mission is rooted in the belief that opportunity and human dignity are part of the American promise for all people, regardless of ability.

The National Center for Public Policy Research, founded in 1982, is a nonpartisan, free-market, independent conservative think tank. Contributions are tax-deductible and may be earmarked for Able Americans.

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