MCKNIGHT: States go above and beyond to prevent Medicaid home care fraud, KFF survey finds
Based on a 2026 KFF survey of state Medicaid home care programs, nearly all responding states exceed federal electronic visit verification (EVV) requirements and use a multifaceted approach to prevent fraud, waste, and abuse. Most states analyze claims by provider and enrollee, update care plans annually or more frequently, require in-person assessments, and verify claims against authorizations prior to payment, with a vast majority implementing all eight key program integrity strategies. Furthermore, states are increasingly adopting artificial intelligence tools—such as predictive algorithms and aggregated grievance monitoring—to enhance data oversight and program integrity, particularly across waiver programs for older adults, individuals with physical disabilities, and those with intellectual and developmental disabilities.
