A new KFF brief examines the changing federal approach to state Medicaid program integrity, including the review of state Medicaid Fraud Control Units (MFCUs) and denial of the Hawaii MFCU’s recertification. CMS has also asked all states to revalidate “high-risk” Medicaid providers and has taken financial actions in two states—pausing $350 million in federal Medicaid funds for Minnesota and $1.3 billion in Medicaid funds for California (the largest deferral in agency history). CMS also sent inquiries about program integrity to California, Florida, Maine, and New York.
The Trump administration has made fraud, waste, and abuse in Medicaid and other federal programs a major focus of its health policy agenda. As the administration’s efforts evolve, many open questions remain about the future of Medicaid program integrity, including which states might become a focus of administration effort, whether Congress will change Medicaid program integrity requirements, and what it means for access to care for Medicaid enrollees.