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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The Missus and I can be against "that?" Without firm controls of services paid, this is a sieve. When "the poor and near-poor" go to an emergency facility for a head cold or flu, that's an expensive "take to aspirin and go to bed" gambit.
And then, according to the Guttmacher Institute, "...21 states use state funds to cover abortion care through Medicaid."
That's an expensive box of condoms.
I'm guessing between 70-80% and declining as States learn that Medicaid dollars are a cash infusion.
Keeping track of it could be a Real job for AI
The Van Nuys, California, hospice fraud is a massive, multi-year, and ongoing healthcare scandal, described as an “epidemic” centered in the San Fernando Valley and greater Los Angeles area.
Federal and state investigations have identified a “kingdom of fraud” involving hundreds of millions of dollars in false billings to Medicare and Medi-Cal, often characterized by phony hospice companies, stolen identities, and the exploitation of healthy individuals.
An office building in Van Nuys (the Morabi Professional Medical Plaza) became notorious for listing nearly 90–150 plus “licensed hospice agencies”..... far exceeding the buildings physical capacity.
<><>Many of these were “shell” companies with no staff, dead phone lines, or a paper sign on a door.
<><> Fraudsters bought or stole personal information from the dark web,
<><>they enrolled unsuspecting, healthy people,
<><>then billed Medicare/Medi-Cal for services never provided.
<><>As of April 2026, Ca AG Rob Bonta dismantled $267 million in fraudulent claims,
<><>21 suspects are charged.
<><>kickbacks were paid to doctors to falsely certify phantom patients as “terminally ill.”
<><>This resulted in several suspects arrested
<><>the seizure of over $757,000 in cash, along with firearms.
<><>The US House Oversight Committee launched a probe, wrt reports of “rampant fraud”.
Perpetrators often signed up patients who were not terminally ill, or in many cases, knew nothing about their enrollment. Investigators found cases where a single doctor’s name was listed on thousands of claims across over 100 different hospices. Some “hospices” reported high patient numbers but near-zero mortality, which is a red flag for hospice care, as patients receiving Medicaid are required to have six months or less to live.
California implemented a moratorium on new hospice licenses in 2021 to stop the surge of fraudulent operators, with reports indicating over 60% of applicants in the area were denied. Many victims only learned they were listed as “dying” when seeking care for other illnesses, with one woman discovering her benefits were hijacked while trying to seek physical therapy.
The investigation is ongoing, with officials continuing to work through hundreds of open cases related to this specific fraudulent network.
1%
One-percent of it is legitimate.
There are a myriad of conditions that are beyond diagnosis...
I.E. The government needs to rely on the physician’s honesty and integrity to actually diagnose an individual who is presenting a series of well documented symptoms, which the patient claims they are suffering from. A simple blood test, or x-ray can’t help with the determination of the diagnosis.
For instance... HDHD, PTSD, COD, Depression, etc., etc. The problem being... Offering compensation through tax breaks and handouts to those diagnosed with these undiagnosable disease relies on honesty... And sadly, there a lot of dishonest shysters who take advantage of these programs.
The US government managed to screw things up, royally.
We have managed to create the WORST of two worlds.
You have the government today basically in the background running healthcare through a “standard of care” they get to define. That’s the American approach to rationing health care and controlling costs. This standard of care is defined through the NIH, DEA, and FDA mostly.
BUT, then you have a private store front, businesses trying to maximize their profits, hospitals, big pharma, doctors, insurance companies. That’s where you get the 5 different bills from for a simple outpatient procedure where they try to creatively figure out what they can charge for.
What the US really created and it went absolutely crazy under the Obama era, is a mediocre Western style socialized health care system (it’s rationed care) that’s really expensive.
Don’t forget about Medicare/Medicaid dual eligibles.
Those are still a large percentage of the caseload in my neck of the woods.
Nobody wants to talk about that, though.
My point is that fraud surely contributes to the problem, but that’s not the primary cause.
If we take Maine as an example which the article mentions. (((DOUBLE))) what their IG claimed was fraud for the whole state, multiply that times 50 states, and you come up with merely a little more than 1% of our nation healthcare costs.
The problem is the “system.”
It’s a poorly conceived system that never addressed the causes of rapidly rising health care costs in the first place. It merely rationed care and provided a shield/protection against litigation for malpractice. Its socialized health care which made the doctors and insurance companies (people were punished/fined unless they buy this product) happy.
Yes, the nickel and dime stuff adds up, but that's not where the big bucks are which is in the NICU and for end of life care in the hospital (more controlled). Hence my estimate.
Healthcare is a states' issue.
NUKE FEDERAL HEALTHCARE!!!!!
A very good piece, but not good for my blood pressure.
Somewhere between 0 and 1%.
90% of it goes to fund the government infrastructure along with paying for the salaries and lavish benefits of government employees attempting to manage the monstrosity.
90% of what’s left is fraud.
That leaves about 10 billion making into the hands of the people it was “intended” to serve.
The advent of Medicare and Medicaid in 1965 was meant (by the creators) to initiate a slow (5-7 years) but inevitable transition to a Universal Health Care system.
What has been going on for the past 61 years is a low level political civil war between people who will accept nothing less and people who don’t want it.
All of the battles have been won by the UHC faction (DRGs, EMTALA, HiTech, PPACA) and while all of those things have been meant to destroy what existed before 1965, the end of what’s left of pre-1965 medicine hasn’t been visible - until now.
“then again in the most recent period of 2020-2024”
I believe that’s because during Covid a rule was set in place that people couldn’t be dropped from the program.
I believe that rule has come to an end.
Hospital costs can be reduced by splitting most hospitals ~50/50 between two companies.
Medicaid costs can be reduced by gently nudging people away from the program, discouraging ER use and making nursing home care cheaper. Start with $2/month Medicaid premiums and raise them by $2 for each month and each ER use. The time-based Medicaid premium amount to not exceed the monthly Medicare premium.
Premiums to be lowered by $1 for each week you subsequently have private PPACA-scope coverage.
Nursing homes could be two side-by-side eight-bed units primarily staffed by four live-in caregivers assisted by one 10pm-7am staffer and one 11am-7pm staffer for each unit.
Sorry for the machine gun postings.
The third way to look at it:
The primary cost drivers are pharma, hospitals, doctors, medical devices and insurance.
Those were not addressed.
All government did, in its usual fashion of fixing anything, is to “ration care” for the consumer.
Today, the average American, no different than a German or a Brit, gets rationed care THROUGH what is defined as a “standard of care.”
America managed to create a really over priced / expensive socialized health care system that only appears to be private at the consumer interface level, but in the background it’s defined by government more than anything else.
When they came up with this system, they never addressed the actual causes of what are driving the costs!
I assume to get buy in by those that might resist (pharma, insurance, hospitals, doctors), to reduce the resistance, they created this mess which ONLY focuses on you, the patient receiving the care and what they are willing to pay for as well as what recourse you or family have if left crippled, deformed or deceased.
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