{"id":3211,"date":"2026-08-31T09:37:40","date_gmt":"2026-08-31T09:37:40","guid":{"rendered":"https:\/\/modernhomejournals.com\/?p=3211"},"modified":"2026-08-31T09:37:40","modified_gmt":"2026-08-31T09:37:40","slug":"the-push-toward-at-home-care-is-caught-in-trumps-anti-fraud-crusade","status":"publish","type":"post","link":"https:\/\/modernhomejournals.com\/?p=3211","title":{"rendered":"The Push Toward At-Home Care Is Caught in Trump\u2019s Anti-Fraud Crusade"},"content":{"rendered":"<div>\n<div>\n<\/div>\n<div>\n<p>Thousands of Californians unable to feed, bathe and dress themselves have struggled to find caregivers, prompting the state to swell its in-home care program.<\/p><p>Read more <a href=\"https:\/\/modernhomejournals.com\/?p=3209\">Election Officials Brace for Chaos Over Trump\u2019s Mail-in Ballot Rule<\/a><\/p><p>That effort is now being thrown back in its face.<\/p>\n<p>The Trump administration is citing the rapid growth of California\u2019s in-home services as evidence of fraud, withholding more money from it than any other single health program in the country.<\/p><p>The administration has paused $2.2 billion in Medicaid funds to the state, most of that \u2014 $1.7 billion \u2014 for California\u2019s In-Home Supportive Services, putting the program at risk for cuts. The funds are being held as part of the administration\u2019s high-profile crusade against fraud in federal safety net programs, led by Vice President JD Vance.<\/p>\n<section>\n<div>\n<h2>\n<span>Trending<\/span>\n<\/h2>\n<\/div>\n<div>\n<div>\n<ul>\n<li>\n<div>\n<div>\n<div>\n<div>\n\n<figure class=\"wp-block-image size-large\">\n<figure class=\"wp-block-image size-medium_large\"><img loading=\"lazy\" decoding=\"async\" alt=\"Burgum\" class=\"wp-image-3118\" height=\"506\" src=\"https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/d7b533497f5a2b88073ac38e5e25d585-768x506.jpg\" width=\"768\" srcset=\"https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/d7b533497f5a2b88073ac38e5e25d585-768x506.jpg 768w, https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/d7b533497f5a2b88073ac38e5e25d585-300x198.jpg 300w, https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/d7b533497f5a2b88073ac38e5e25d585.jpg 1024w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/><\/figure>\n<\/figure>\n\n<\/div>\n<\/div>\n<\/div>\n<div><h3>\n<span>\n                      Trump Is Quietly Working to Give Part of Yosemite to a Private Developer\n                    <\/span>\n<\/h3><\/div>\n<\/div>\n<\/li>\n<li>\n<div>\n<div>\n<div>\n<div>\n\n<figure class=\"wp-block-image size-large\">\n<figure class=\"wp-block-image size-medium_large\"><img loading=\"lazy\" decoding=\"async\" alt=\"Sam Hartman AP - 26241017120748\" class=\"wp-image-3199\" height=\"512\" src=\"https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/922a026f9975d1b81cbe9705a1a98645-768x512.jpg\" width=\"768\" srcset=\"https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/922a026f9975d1b81cbe9705a1a98645-768x512.jpg 768w, https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/922a026f9975d1b81cbe9705a1a98645-300x200.jpg 300w, https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/922a026f9975d1b81cbe9705a1a98645.jpg 1024w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/><\/figure>\n<\/figure>\n\n<\/div>\n<\/div>\n<\/div>\n<div><h3>\n<span>\n                      Six Takeaways From the Commanders\u2019 Roster Cuts\n                    <\/span>\n<\/h3><\/div>\n<\/div>\n<\/li>\n<li>\n<div>\n<div>\n<div>\n<div>\n\n<figure class=\"wp-block-image size-large\">\n<figure class=\"wp-block-image size-medium_large\"><img loading=\"lazy\" decoding=\"async\" alt=\"House Budget Committee Reconciliation\" class=\"wp-image-2165\" height=\"512\" src=\"https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/a8b9395a7f0c5666082629ffa4cf42c1-768x512.jpg\" width=\"768\" srcset=\"https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/a8b9395a7f0c5666082629ffa4cf42c1-768x512.jpg 768w, https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/a8b9395a7f0c5666082629ffa4cf42c1-300x200.jpg 300w, https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/a8b9395a7f0c5666082629ffa4cf42c1.jpg 1024w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/><\/figure>\n<\/figure>\n\n<\/div>\n<\/div>\n<\/div>\n<div><h3>\n<span>\n                      Edwards Mounts His Defense: \u2018Poetry Is Not Sexual Misconduct\u2019\n                    <\/span>\n<\/h3><\/div>\n<\/div>\n<\/li>\n<li>\n<div>\n<div>\n<div>\n<div>\n\n<figure class=\"wp-block-image size-large\">\n<figure class=\"wp-block-image size-medium_large\"><img loading=\"lazy\" decoding=\"async\" alt=\"US Department of the Treasury\" class=\"wp-image-2969\" height=\"512\" src=\"https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/48ba3e51a27a513915112940936f59ad-768x512.jpg\" width=\"768\" srcset=\"https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/48ba3e51a27a513915112940936f59ad-768x512.jpg 768w, https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/48ba3e51a27a513915112940936f59ad-300x200.jpg 300w, https:\/\/modernhomejournals.com\/wp-content\/uploads\/2026\/08\/48ba3e51a27a513915112940936f59ad.jpg 1024w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/><\/figure>\n<\/figure>\n\n<\/div>\n<\/div>\n<\/div>\n<div><h3>\n<span>\n                      Billionaire\u2019s WSJ Op-Ed Criticizing Bessent Was Written With AI\n                    <\/span>\n<\/h3><\/div>\n<\/div>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/section>\n<p>California officials say there\u2019s no evidence the state\u2019s personal-care program, among the nation\u2019s most generous, has especially high levels of fraud. They fear the Trump administration is undermining the community-based approach Democrats and Republicans have supported for decades.<\/p><p>\u201cIf CMS is able to point out strong or major fraud concerns, we\u2019d be happy to know about it,\u201d said California Medicaid Director Tyler Sadwith. \u201cUnfortunately, they haven\u2019t done that.\u201d<\/p><p>California\u2019s expansion effort began in 2021 when the state\u2019s auditor  a crucial flaw in the program that pays family members and caregivers to assist more than 900,000 disabled and elderly Californians with their daily personal care.<\/p><p>\u201cYou feel stuck,\u201d Ligia Andrade Z\u00fa\u00f1iga, a 47-year-old disabled San Mateo resident, told NOTUS of life without a caregiver. \u201cThe four walls of your room become like a jail.\u201d<\/p>\n<p>A 2009 car accident paralyzed Z\u00fa\u00f1iga from the chest down. Since then, she has struggled for years at a time to find a consistent caregiver. She didn\u2019t like asking her elderly mother to help her get out of bed, use the bathroom, brush her teeth and eat breakfast \u2014 but sometimes she had to. It strained their relationship, and she felt isolated, depressed and fought thoughts of self-harm.<\/p><p>\u201cOne of the biggest issues in this space over the past 10 years has been lack of caregivers and not sufficient services to meet demand,\u201d Damon Terzaghi, vice president for Medicaid and home care policy at the National Alliance for Care at Home, a membership organization that represents providers.<\/p><p>But to Vance\u2019s anti-fraud task force \u2014 which has deferred unprecedented sums of Medicaid payments to California and Minnesota this year \u2014 California\u2019s expansion appears nefarious.<\/p><p>Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, told reporters in July that spending on in-home programs went up by 24% in California over the last two fiscal years, compared with 12% on average for the rest of the country.<\/p><p>California says it\u2019s complying with CMS\u2019s requests for more information as the agency evaluates its funding in a process that could take months or more to work through. CMS did not respond to requests for comment.<\/p><p>The anti-fraud task force has dialed up the government\u2019s focus on scams and deceit to previously unseen levels. Vance has regularly issued dire threats against scammers who officials say have been bilking the nation\u2019s safety net programs unchecked for years.<\/p>\n<p>Everyone agrees there\u2019s some degree of fraud in entitlement programs. States have always worked on prosecuting it, some more earnestly than others. And personal-care providers have indeed been convicted of Medicaid fraud at  nationally than other types of health care workers.<\/p><p>Yet the administration\u2019s anti-fraud work has taken a sharp political tack. So far, it has held up large sums only from California and Minnesota \u2014 but not Florida, home to many massive fraud schemes. Nor has it provided specific evidence for withholding so much from California\u2019s home-care program, merely citing faster growth in California\u2019s program compared to other states, as well as \u201cstatistical anomalies\u201d in the state\u2019s data.<\/p><p>Vance and other Cabinet members in the task force trumpet their largely blue-state-focused efforts ahead of the midterm elections, insisting prosecution has been insufficient and promising to root out fraud once and for all.<\/p><div>\n<\/div><p>\u201cWe\u2019ve got a party that is fighting for fraud, and a party that is fighting against fraud,\u201d Vance told an audience in Milwaukee in early July. \u201cWhen you come to vote in November, are you going to vote for the pro-fraud party?\u201d<\/p><p>While it\u2019s normal for the Centers for Medicare and Medicaid Services to temporarily pause some Medicaid payments to states to double-check receipts, administrations have never deferred so much money for entire categories of services, experts say.<\/p><p>Public health administrators are also taken aback by the administration\u2019s targeting of home health services, fearing the Trump administration is undermining policies federal and state lawmakers have prioritized for nearly 50 years.<\/p>\n<p>Former President Ronald Reagan signed a law in 1981 that pushed people from institutional care to home services, as the public health community settled on home care as the more humane and less expensive approach. In 1999, the Supreme Court found that unnecessarily institutionalizing people with disabilities is illegal discrimination under the Americans with Disabilities Act. The federal government has long interpreted that decision as requiring states to offer home- and community-based services in most cases.<\/p><p>Now, the Trump administration is reconsidering that legal mandate.<\/p><p>Earlier this summer, the Justice Department said it <span><u>won\u2019t<\/u><\/span> enforce its own guidance implementing that Supreme Court decision as it writes new guidelines. It also released a <span><u>memo<\/u><\/span> calling into question how that decision about not institutionalizing people with disabilities has been interpreted for decades.<\/p><p>Oz has also repeatedly questioned whether the government should pay family members to care for loved ones at home.<\/p><p>\u201cPersonal care services: these help Medicaid patients do something that our families would normally do for us, like carrying groceries,\u201d Oz said in a social media <span><u>video<\/u><\/span> in March about a CMS probe focused on New York, adding that the program is being abused.<\/p><p>Read more <a href=\"https:\/\/modernhomejournals.com\/?p=3207\">After a Much-Needed Win, the Spirit Hopes to Regain Momentum<\/a><\/p><p>He acknowledged at a July press conference that \u201cdone correctly, these programs could make sense.\u201d<\/p>\n<p>Hagar Dickman, an advocate for long-term services in California at the nonprofit Justice in Aging, said Oz\u2019s comments show a misunderstanding of how personal care works. In most cases, to be eligible for In-Home Supportive Services, a patient must require around-the-clock care beyond what a typical family member with a full-time job could offer.<\/p><p>\u201cThe most generous interpretation of that statement is that it\u2019s out of touch with what Americans and what Californians need financially in order to be secure in their homes,\u201d Dickman said. \u201cMost Californians require a two-income household.\u201d<\/p><p>For the first 15 years of Amanda Andresen\u2019s life, her mother, Rosa, didn\u2019t know she could get paid for caring for her. Amanda\u2019s brain lacks a critical bridge of fibers separating its left and right halves. She is 28 years old but cognitively around 15 months old.<\/p><p>Rosa is constantly by Amanda\u2019s side. She keeps Amanda safe during daily seizures. She changes her diapers. She shreds Amanda\u2019s chicken into tiny pieces that she\u2019s able to swallow. She keeps Amanda from wandering away in the grocery store.<\/p><div>\n<\/div><p>\u201cFrom the moment she gets up, I have to help her,\u201d Rosa told NOTUS.<\/p><p>After Rosa\u2019s husband died in 2013, leaving her without income, she learned she could qualify to be paid $19.65 an hour under IHSS.<\/p>\n<p>She applied, submitted to a background check and attended training. A social worker visited her home to determine how many hours of paid care Amanda qualified for. At first, Amanda was granted just two hours a day, but after Rosa appealed the decision, it was upped to roughly nine hours a day \u2014 the maximum a patient can get.<\/p><p>Now Rosa brings in around $5,560 a month plus smaller supplemental security income checks \u2014 enough to pay their $2,700 rent and cover living expenses with help from food stamps. To get paid, she enters her hours in an online portal. She can\u2019t work more than 283 hours a month.<\/p><p>That\u2019s unquestionably cheaper than keeping a patient in a 24-hour facility. IHSS costs Medi-Cal roughly $17,000 a year per recipient, compared to well over $100,000 for a skilled nursing facility, according to 2021  by the state auditor.<\/p><p>\u201cThis model has been universally accepted across parties for such a long time as the most cost-effective way of providing care,\u201d said Arnulfo De La Cruz, president of SEIU Local 2015, which represents home health workers.<\/p><p>Some personal-care assistants do commit fraud. States convicted far more personal-care providers last year \u2014 326 in total \u2014 than any other type of caregiver, the Department of Health and Human Services Inspector General . (That figure may also be influenced by the type of cases prosecutors typically pursue.)<\/p><p>Home health care claims were a significant part of a massive batch of prosecutions the anti-fraud task force announced in June. Nearly half of the state cases involved personal-care assistants. Missouri had the most.<\/p>\n<p>In one case, St. Louis resident Patricia Busby billed Medicaid $18,278 for services she claimed to have provided to her adult daughter Christine Busby \u2014 even as both women worked as armed security guards for three- to 12-hour shifts.<\/p><p>Four of the cases were in California, and they all involved individuals submitting false time sheets.<\/p><div>\n<\/div><p>Yet at times the administration has tripped up in its eagerness to claim fraud. A month after Oz accused New York of turning its home-care program into a \u201cmassive jobs program,\u201d the administration <span><u>admitted<\/u><\/span> it had inaccurately claimed that nearly three-fourths of the state\u2019s Medicaid enrollees use personal-care services. CMS had misidentified the state\u2019s billing codes in its analyses.<\/p><p>Some IHSS advocates and patients worry the intense scrutiny on personal care \u2014 on top of legislation passed last year by congressional Republicans projected to reduce Medicaid spending by hundreds of billions \u2014 could make the program eligible for future cuts in California and beyond.<\/p><p>The impact could be immense: Medicaid funds well over half of all home care in the United States, according to <span><u>KFF<\/u><\/span>.<\/p><p>States must offer certain services in Medicaid, but personal care is optional, making it an easy target for reductions. Cuts have recently been on the table in California. Gov. Gavin Newsom\u2019s budget proposal released earlier this year included millions of dollars worth of cuts to IHSS, drawing sharp <span><u>pushback<\/u><\/span> from the disability community before the reductions were ultimately rejected.<\/p>\n<p>The state, like others, has already installed checks meant to prevent fraudsters from siphoning off taxpayer dollars, including unannounced home visits and data checks meant to catch bad actors. Providers have to log their work in a GPS-enabled electronic time sheet, as required by Congress in 2016.<\/p><p>Keeping fraudsters out of the program and eligible people who need assistance in it is a delicate balance, said Alice Burns, associate director of KFF\u2019s Program on Medicaid and the Uninsured. Take guardrails away, and both eligible patients and bad actors may benefit. Add too many hurdles meant to trip up fraudsters, and enrollees may have a difficult time accessing care \u2014 a problem California and many other states have already faced.<\/p><p>Access to caregivers can be life altering. Z\u00fa\u00f1iga said she has a good rapport with her current caregiver, who arrives early in the morning to help her get ready for work; she runs a disability rights nonprofit, serves on a local governance board for in-home services and is on her local school board.<\/p><p>\u201cI cannot serve my community,\u201d she said, \u201cwithout being able to get up out of my bed in the morning.\u201d<\/p><p>Read more <a href=\"https:\/\/modernhomejournals.com\/?p=3205\">Six Takeaways From the Commanders\u2019 Roster Cuts<\/a><\/p>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>The Trump administration is holding more money from California\u2019s home-care program than anywhere else.<\/p>\n","protected":false},"author":1,"featured_media":3210,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[22],"tags":[],"class_list":["post-3211","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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