April 21, 2026

As the debate over access to and affordability of health care intensifies in advance of the Congressional midterm elections, a coordinated effort is underway between members of the majority leadership of the US House and the federal Medicaid agency to turn attention from access and affordability to Medicaid fraud. Of particular concern to families of children who rely on Medicaid-funded home care and waivers is the focus of the federal fraud allegations on home care and waivers. Medicaid fraud is a serious problem that takes money away from services children need. Pennsylvania has recognized that and has been addressing it aggressively for some time.

Despite those successes, the US House Committee that is responsible for Medicaid legislation and oversight started an inquiry into potential Medicaid fraud in Pennsylvania involving home health, waivers, behavioral health, and some other Medicaid services without good reason. They have asked for a large number of reports and data from the Department of Human Services. At the same time, the federal agency that administers Medicaid (Centers for Medicare and Medicaid Services or CMS) has recently announced a new approach to fraud that will rely more heavily on options to pause or withhold significant amounts of federal funding in cases of potential fraud, which could have broad implications for Pennsylvania’s Medicaid program and the individuals that rely on it. To learn more, click here.