Posted on 05/10/2026 6:35:18 AM PDT by MtnClimber
Medicaid is the joint federal/state program that provides free medical care to the poor and near-poor in the U.S. Who could be against that?
A website called Statista collects data on various subjects of interest and presents them in useful charts. One subject is the total federal plus state spending on the Medicaid program by year since inception of the program back in the 1960s through the latest year of 2024. Here is that chart:
Looking at the chart, a few things leap out. One is rapid and unbroken growth year after year from the beginning up to the most recent year. Another is two particularly rapid periods of growth, first in the 1990s (Bill Clinton was President), and then again in the most recent period of 2020-2024. That last five-year period began in the last year of Trump’s first term (the pandemic year), but then continued throughout the four years of the Biden term. Between the end of 2019 through 2024 the program grew from $627 billion to $949 billion. That’s more than a 50% increase in 5 years, and more than an 8% compound annual rate of growth. The word “unsustainable” doesn’t begin to describe it.
When you think of medical care for the poor, you likely have a mental picture of what all this money is paying for. Probably, your mental picture involves hospitals, doctors, nurses, injuries, diseases, treatments and pharmaceuticals. But how much of the Medicaid spending — and particularly of the recent explosion in Medicaid spending — falls in those categories?
We are recently learning that much or even most of the recent cost explosion falls into other categories that have come under the Medicaid spending umbrella by reason of various “waivers,” and that do not involve hospitals or doctors or medical professionals or medical treatments. Major examples include: in-home assistance, often provided by family members, for things like cooking and housekeeping; transportation to medical appointments; palliative end-of-life care, again often provided in the home (sometimes called “hospice”); autism counseling; and more.
Any of these services could well be legitimate in many cases. But as people have started to look at and publicize exploding expenditures in these categories over the past several years, we learn of one situation after another where the spending appears to exceed anything that could possibly be legitimate. And almost all of the provision of these services is supposedly taking place in homes or other personal spaces where it is difficult to impossible to check if the service is actually being provided.
For today I’ll provide just a few examples recently in the news.
In about 2023 initial news reports indicated that somehow there were some 1800 hospices operating in the Los Angeles area, constituting approximately 6 times the per capita level of such businesses elsewhere in the country. In March, CBS News investigated what they called “ground zero for hospice fraud” in Los Angeles. Excerpt:
Three years ago, California’s state auditor sounded the alarm that Los Angeles County had seen a 1,500% increase in hospice companies since 2010 – more than six times the national average relative to its elderly population. . . . The state says it proceeded to investigate and revoke the licenses of 280 hospices. But since then, the problem has continued to fester. CBS News examined the business and financial records of every hospice currently operating in LA County, applying the same indicators identified by the state. Indications of fraud have not stopped. In fact, they’ve grown.
(Note that the hospice fraud issue involves the Medicare program, as well as Medicaid.)
In the area of in-home personal services, a reporter named Luke Rosiak at the Daily Wire is just out with a three-part series involving what appears to be widespread fraud in the Columbus, Ohio area. Here are links to Part 1 (May 4), Part 2 (May 5), and Part 3 (May 7). This alleged fraud, like the Minnesota free-meals scandal, involves a large community of almost entirely Somali-Americans. The entire series is well worth your attention. Besides revealing specific instances of fraud, the series goes into how the level of spending is completely implausible given the population to be served. Here is an indicative excerpt from Part 2:
The seven buildings along East Dublin Granville Road in Columbus, Ohio, are filled with hundreds of office suites, all owned by a company named Cordoba Real Estate. A large majority of the tenants in the buildings bill Medicaid, the taxpayer-funded medical program for the impoverished, as a “home health care” business that provides low-skilled, usually non-medical care to elderly or disabled people. The Daily Wire has spent weeks analyzing Medicaid data released by the Trump administration’s Department of Government Efficiency in an effort to weed out wasteful government spending. The buildings owned by Cordoba stuck out, each housing dozens of businesses that bill Medicaid. In all, the Cordoba-owned buildings in Columbus housed 288 businesses registered with Medicaid, The Daily Wire investigation found. Together, they charged taxpayers more than a quarter of a billion dollars between 2018 and 2024. That’s in a city where only 6,273 people 75 or older are on Medicaid.
And don’t get the idea that explosive growth of Medicaid spending on home health aides is confined to a few Somali communities in the Midwest. New York State has one of the most out-of-control Medicaid-funded home health aide programs. Here is an April 2025 report on the issue from the Empire Center. Excerpt:
New York’s home health employment is continuing to soar, growing by 57,000 jobs or 10 percent from 2023 to 2024, according to newly released data from the U.S. Bureau of Labor Statistics. The state’s workforce of home health and personal care aides grew to an estimated 623,000 as of May 2024, according to BLS’s Occupational and Occupational Employment and Wage Statistics, an annual survey posted Tuesday. That equated to 171 aides per 1,000 residents aged 65 or older, which was the highest rate in the U.S. – 153 percent higher than the national average and 24 percent ahead of the No. 2 state, California.
New York State has only about 10 million jobs total, so 623,000 of these home health aide jobs is more than 6% of all jobs in the state. Are all these people doing legitimate work, or are they just taking advantage of the taxpayers to get paid for hanging out at home with mom? How could you tell?
Autism counseling is another big area. Autism is something without any clear definition, or any good metric for determining if counseling does any good. As one example among many, here is a January 2026 report from the HHS Inspector General about improper payments in the small state of Maine. Excerpt:
The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) has released an audit report revealing that Maine made at least $45.6 million in improper fee-for-service Medicaid payments for rehabilitative and community support (RCS) services provided to children diagnosed with autism. . . . In the span of five years, Medicaid payments for RCS services in Maine grew significantly, from $52.2 million in 2019 to $80.6 million in 2023.
While we have barely been looking, the Medicaid program has morphed from medical care to widespread payments for aides and personal services provided by non-professionals. Cooking? Housecleaning? No problem, the taxpayers will pick that up.
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Do you think our health care system will become like the systems in Canada and UK?
Kambiz Merabi, owner of the Van Nuys Morabi Professional Medical Plaza (see above), told CBS News that Medicare officials visited his building two years ago to look at hospice agencies. He told the outlet that, “in his view,” the businesses appear to be “legitimate.”
The Van Nuys Morabi Professional Medical Plaza became notorious for listing nearly 90–150 plus “licensed hospice agencies”..... far exceeding the buildings physical capacity.
CBS News noted that several of the hospice companies registered to Merabi Professional Medical Plaza had been billing Medicare “for years.”
Kambiz Merabi, the owner of the plaza, says “in his view,” the businesses appear to be “legitimate”........
Huh? Is Merabi that stupid?
Morabi’s several Instagram videos seem to “invite fraudster rentals,” saying he specializes in “virtual offices”.......meaning renters can pay to use his building just as their address.
However, hospices are required by federal law to have a physical office.
The revelations about the Merabi Professional Medical Plaza come amid the Trump administration’s renewed focus on fraud.
The “home health” program is a scam. Basically, paying your kids to take care of elder parents.......that is what you are supposed to be doing. There are ads all over TV ( a sure sign there is unchecked $$ floating around ).
The real problem is there are plenty of people who think everything should be free. They want someone to do something....that someone is someone else. SCUM
Title XIII of the American Recovery and Reinvestment Act prompted the creation of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which set aside money for creating a nationwide network of electronic health records and prompted the beginning of the Meaningful Use program. With the Meaningful Use program, healthcare providers were given incentives to use technology to improve healthcare.
the HITECH Act of 2009 increased penalties for HIPAA violations and strengthened criminal and civil enforcement of the HIPAA.
Constitutionally speaking?
None.
L
Waste, fraud and abuse aside Obamacare greatly increased the cost of medicaid through expansion:
ChatGPT
The Medicaid expansion under the Patient Protection and Affordable Care Act — commonly called “Obamacare” — expanded Medicaid eligibility to many lower-income adults who previously did not qualify.
What changed
Before the law, Medicaid was generally limited to specific categories of people such as:
children
pregnant women
some parents
elderly people
people with disabilities
Many low-income adults without children were excluded, even if they had very little income.
The ACA expanded Medicaid to nearly all adults under age 65 with incomes up to about 138% of the federal poverty level.
This kind of manipulation is common in misleading charts for a few reasons:
What really jumps out is that red exponential regression curve fit line. Talk about "unsustainable"!
The hyperinflation from trillions in fraud hurts the truly poor and the working class. The fraud millionaires buy fine real estate, etc., and drive up prices.
Medicaid should be reformed to reduce fraud incentives: A government store provides very basic food to prevent starvation (government cheese, powdered eggs, powdered milk, etc., from USDA surplus programs), and everyone must go to a government medical facility for minimum necessary care from government doctors (who probably could not get a job anywhere else).
Everyone should have to reapply for Medicaid, with multiple approvers to weed out government workers who approve the wrong people. Abusive workers should be arrested for fraud.
Case 1: Mom has a difference residence from caregiver
If she moves in with a caregiver:
1. what she pays for rent can be given by her to the caregiver, or
2. her house can be sold and the proceeds used her care
If the caregiver moves in with her:
1. caregiver no longer needs to pay rent (or a mortgage)
2. caregiver would probably qualify for highly subsidized PPACA premiums
Case 2: Mom has same residence caregiver
Her Social Security can pay for rent (or the mortgage).
Caregiver would probably qualify for highly subsidized PPACA premiums.
Citizens covered / legitimate
Illegal Aliens / illegitimate
Do the population math.
We
Are
Being
Robbed
Blind
Yes, a linear X axis would really show the reality of this issue.
“A government store provides very basic food to prevent starvation (government cheese, powdered eggs, powdered milk, etc., from USDA surplus programs)”
ALDI sells cheese, eggs and normally milk cheap.
There are ALDIs in NYC and elsewhere.
“Medicaid should be reformed to reduce fraud incentives” — not possible. Wherever there is taxation there is fraud. The worst thing is the pols use programs like to this to blatantly buy votes. So it’s a double whammy — the pols using our tax money to buy votes to keep them in office and keep the gravy flowing and the crooks, fraudsters, cheats, mountebanks, and charlatans rob the system blind. But the pols turn a blind eye to all that fraud and cheating because they value getting themselves re-elected to that sinecure above everything else.
It’s been this way for millennia.
“everyone must go to a government medical facility for minimum necessary care from government doctors (who probably could not get a job anywhere else)”
Doctors can hire physician assistants. The doctors already cover the overhead.
The government programs actually have far less overhead and pay out a higher percentage to the end user (biller). Government has no incentive to deny payment ... just stamp them "approved."
It is that the things "covered" has grown to include a ton of sketchy items, and people smelling a gold mine exploit it. A pathetic amount of the "fraud" is just government as usual.
Send 60 million illegals home—and we’d have plenty of medical capacity with a much smaller Medicaid bill.
[1996 article]
In 1995, Medicaid provided health and long-term care for 34.8 million low-income, elderly, and disabled Americans at a cost of $157.3 billion, $151.8 billion for services and $5.5 billion for administration.
Between 1988 and 1995, the number of Medicaid beneficiaries grew 58 percent, from 22.0 million to 34.8 million (Figure 1). In part, the recession increased welfare and thus Medicaid enrollment. But much of this growth occurred between 1992 and 1994 and resulted largely from federal and state expansions in coverage of low-income pregnant women and children.
In addition, greater coverage of people with AIDS and actions that expanded SSI eligibility for disabled children increased coverage of disabled Medicaid beneficiaries. Eligibility expansions to assist low-income Medicare beneficiaries also increased the number of elderly Medicaid beneficiaries.
Between 1988 and 1992, Medicaid’s total (state and federal) costs more than doubled, growing from $53.5 billion in 1988 to $119.9 in 1992.
The rise in Medicaid’s costs between 1988 and 1992 was equally attributable to three factors: health care inflation, state financing practices (including the use of provider taxes and donations and disproportionate share hospital (DSH) payments) and expansions in enrollment due to legislative changes and the recession. Expansion in coverage of low-income women and children, the lowest cost Medicaid beneficiaries, accounted for most of the enrollment growth but only a fraction of the spending growth.
https://www.kff.org/medicaid/where-is-medicaid-spending-headed-fact-sheet/
“Send 60 million illegals home—and we’d have plenty of medical capacity with a much smaller Medicaid bill.”
The illegals tend to be pretty healthy.
As for EMTALA abuse, I have proposed:
EMTALA (and Medicaid ER) Reform
To get care under the EMTALA or Medicaid for yourself or custodial child, the hospital might require you to
1. pay $100 in cash or by financial organization card accepted at the emergency care facility,
2. hand over your valid SNAP card and tender a matching valid domestic governmental picture ID,
3. hand over your valid domestic driver’s license,
4. hand over your valid US passport,
5. hand over your operable Apple or Samsung cellphone model listed by a current regulation issued by a Secretary of HHS, or
6. hand over a valid domestic governmental picture ID of yours and
a tender matching financial institution statement less than 70 days old showing a domestic governmental or employer direct deposit of at least $150, both for hospital photocopying and recordkeeping.
States might be allowed to authorize emergency care facilities to contemporaneously debit SNAP cards for EMTALA incidents.
Items handed over may be retained by the emergency care facility until retrieved within one month by the responsible party by paying $100, or more, for the care, plus a retrieval fee not exceeding $20 in a manner the facility accepts. Items not timely retrieved may be disposed of in a legally allowable manner.
NOTE: People can get the care they need, but only by paying $100, forfeiting an expensive cellphone, or going through the hassle of replacing a SNAP card or government picture ID.
HOSPITAL EMTALA COST ASSISTANCE
I would allow hospitals collect up to $1,000 per incident of EMTALA service from patient related employers, with payment not in excess of $50 per week per employee concerned being due to any and all EMTALA providers and not for more than 100 weeks after service. Such payments on behalf of an employee would be considered to be a debt of the employee to the employer. Employers could collect back from employees and ex-employees (and require EMTALA incident employees to participate in an employer plan).
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