The Medicaid 'Fraud' Witch Hunt Begins
Plus: Autism panel canceled as families wait for solutions; Idaho struggles to fund disabled children's care; Lawmakers revive attempt to boost Supplemental Security Income above poverty rates
Congressman Brett Guthrie, the Republican leader of the committee that governs Medicaid, said this week that fraud shouldn’t be a partisan issue.
I would agree with that. Fraud is bad. Wasting taxpayer money is bad. Abuse is bad.
As a recent letter from Guthrie’s committee, the U.S. House Energy and Commerce Committee, put it, “Every dollar stolen from the Medicaid program by fraudsters is taken from children, pregnant women, the elderly, and people with disabilities.”
The E&C committee (as it’s called on Capitol Hill) sent letters like that to 10 states this week, including my own, putting their Medicaid programs under a microscope.
As I read the nine-page letter, my heart sank.
The congressional letter asks Oregon to provide extensive information about fraud risks in its Medicaid-funded programs, with particular attention to Home and Community-Based Services, Consumer-Employed Providers and Applied Behavior Analysis programs. They consider these “high risk.” Those are the very programs that allow disabled children and adults to live at home rather than institutions.
Those of us with these services understand intimately that we already live inside a system built around proving eligibility over and over again. In many American disability households, managing Medicaid compliance is an unpaid part-time job.
We document caregiver hours.
We submit medication records.
We undergo eligibility assessments.
We justify equipment (again and again).
We coordinate with doctors, specialists and therapists.
We track and report changes.
We respond to audits and paperwork requests.
We appeal decisions with even more extensive documentation.
Meanwhile, we are still waking up at 2 a.m. to reposition a child with cerebral palsy, managing seizures, coordinating therapies, and trying to hold together a household built around complex medical needs.
Disabled people BY DEFINITION have less time and energy in their day. And yet our society and our public assistance programs ask them to spend time and energy proving their need and their worth over and over and over again.
All this for conditions that any doctor could tell you are lifelong.
In a thousand ways, on a thousand different days, we are forced to answer the question: Do you deserve it? Do you deserve it? Do you deserve it?
When policymakers start talking about “program integrity,” many disability families know that means they will soon have to jump through even more hoops. And we do. Because we are NOT criminals, even though they often treat us that way just for needing help.
The people committing millions of dollars in Medicaid fraud are not families caring for disabled children in their living rooms. Fraud rings are sophisticated operations involving billing schemes, shell companies, or organized networks exploiting loopholes. And our existing fraud detection systems work. We find them. We prosecute them. We put a stop to it.
Fraud prevention is important, but we must do it in a way that remembers who the system is ultimately supposed to serve.
Perhaps this time will be different. Perhaps they really will only catch the bad guys and leave the rest of us alone.
But even in my short time in Special Needs World, I’ve seen how disabled people — and those who care for them — somehow get fewer and fewer dollars and more and more work to do. Meanwhile, scores of new well-paid jobs are created for auditors and bureaucrats to push paper back and forth.
That’s the waste the E&C committee should be trying to prevent.
Medical Motherhood’s news round up
Snippets of news and opinion from outlets around the world. Click the links for the full story.
• From Disability Scoop: “Federal Autism Panel Cancels Meeting Without Explanation”
For the first time in over a year, a key panel tasked with helping to direct nearly $2 billion in federal autism funds was supposed to meet, but now the gathering has been abruptly called off and it’s unclear why.
The U.S. Department of Health and Human Services said that a meeting of the Interagency Autism Coordinating Committee, or IACC, that had been planned for March 19 would be canceled. The agency did not respond to questions about why.
[…]The delay comes as the panel, which traditionally drew little attention, is now facing intense scrutiny. In January, Secretary of Health and Human Services Robert F. Kennedy Jr. announced a new slate of 21 members, including several known for promoting the discredited idea that autism is linked to vaccines or advocating for treatments that lack evidence.
[…]Alarmed by the shift, the Autism Science Foundation and the Coalition of Autism Scientists — a group of more than 300 researchers in the field — said last week that they would establish a competing panel dubbed the Independent Autism Coordinating Committee, or I-ACC.
[…]Jackie Kancir, executive director of the National Council on Severe Autism, said many members of her group advocated for greater attention to the needs of those with profound autism when the Autism CARES Act was renewed in 2024. More recently, they submitted public comments to the IACC and were eager to see how the remade committee would address their concerns.
“Families — already holding the weight of safety nets that have systematically collapsed upon their shoulders — sacrificed and exerted great energy into advocating for improvements to the Autism CARES Act of 2024. Fifteen months later, they are still waiting for the first public meeting of IACC to hear how — or if — their efforts had a meaningful impact,” Kancir said. “The committee charged to direct nearly $2 billion in autism research funding must be expected to show up also, without delay.”
• From KMVT 11 (Idaho): “Budget cuts, disabled children’s care bill among key issues in eighth legislative week”
The Idaho Legislature is entering the final stretch of its session with a sine die target of March 27, as the Joint Finance Appropriations Committee works to set budgets amid a funding shortfall.
House Minority Leader Rep. Ilana Rubel, D-District 18, said lawmakers are overlooking available solutions to the budget problem, including revisiting the school choice tax credit passed last session.
“There’s such an obvious solution sitting right there and for really arbitrary reasons we’re being told you can’t use that obvious solution,” Rubel said. “It’s like you’re dying of thirst there’s a big cup of water sitting right there and they’re saying no you can’t drink that cup of water you’ve gotta go try to distil something out of the muddy swamp if you want to get a drink.”
[…]The budget constraints are also affecting legislation. Rubel pointed to families of severely disabled children as among those impacted.
“The state’s too broke we don’t have any money too many tax cuts you know voucher program for private school tuition that there’s no money left in the bank for these families of disabled kids which is really disturbing,” Rubel said.
Rubel has been working on House Bill 807, which would reinstate some caregiver compensation for families of severely disabled children.[…]
• From CNBC: “Lawmakers to introduce bill strengthening federal anti-poverty program: It’s ‘a critical lifeline,’ Warren says”
A bipartisan group of Washington, D.C., lawmakers plans to reintroduce a bill on Thursday that would update a federal anti-poverty program that millions of Americans rely on to provide for their basic needs.
Supplemental Security Income is a federal program that provides monthly benefits to adults and children who are blind, disabled or age 65 and older who have limited income and financial resources. Approximately 7.4 million Americans receive SSI benefits.
The forthcoming bill, called the Supplemental Security Income Restoration Act, would expand and strengthen SSI benefits at a time when everyday costs are increasing, bill sponsor Sen. Elizabeth Warren, D-Mass., said in a statement.
[…]In 2026, the maximum monthly SSI payments are $994 for individual beneficiaries and $1,491 for eligible married couples, according to the Social Security Administration. That amounts to almost $12,000 per year for individuals and $18,000 per year for couples, according to the agency.
Many individuals who are on the program have severe mental, physical and cognitive disabilities that limit their ability to work, said Stephen Nuñez, director of stratification economics at the Roosevelt Institute.
[…]SSI recipients are currently limited to $20 per month in non-employment income, such as Social Security benefits or a pension — an amount that hasn’t been adjusted since 1974. If income is higher, the Social Security Administration may reduce benefits or restrict eligibility.
That threshold would be updated to $158 per month under the new bill, according to the text CNBC reviewed.
Another provision proposes adjusting another threshold, the earned income exclusion, that currently makes it so an SSI recipient’s first $65 in earnings does not count as income — which was meant as a work incentive when it was set at that level in 1972.
The new bill would update that level to $512 per month.
It also calls for updating resource limits for beneficiaries — currently set at $2,000 per individual and $3,000 per eligible couple — that apply to certain assets like cash, bank accounts and investments. Those thresholds would be raised to $10,000 per individual and $20,000 per eligible couple, which the proposal says would better enable beneficiaries to save for emergencies.
All the new thresholds would be indexed to inflation and adjusted annually.
[…]Two former Social Security Administration executives — Andrew Biggs, senior fellow at the American Enterprise Institute, a conservative think tank, and Jason Fichtner, executive director of the LIMRA Retirement Income Institute, a research initiative within insurance trade association LIMRA — called SSI reform “far more cost-effective than fighting poverty through Social Security,” in a February op-ed published in The Hill.[…]
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Thank you for reminding us where the source of Medicaid fraud is and where the burden of audit SHOULD be.