Every state that answered KFF's 2026 survey question on Medicaid home care fraud controls uses checks that go beyond what federal law requires, and 42 of the 48 use all eight strategies KFF asked about. KFF published the findings Oct. 5 in an analysis of its annual survey of state home care programs, which states completed between April and August 2026.
EVV is now a billing check
Federal law requires electronic visit verification for Medicaid personal care and home health visits in the home, but it does not say how states must store the data or use it to pay claims. States have gone further:
| Strategy | States using it (of 48) |
|---|---|
| Keep EVV data in machine-readable files | 48 |
| Cross-check billed claims against EVV data | 48 |
| Analyze EVV data for unusual billing patterns | 47 |
| Analyze claims by provider for unusual billing | 48 |
| Check claims against care plan authorizations before paying | 47 |
| Update care plans and authorizations at least yearly | 47 |
| Require in-person assessments to set authorizations | 46 |
| Analyze claims by enrollee for unusual patterns | 45 |
Ohio requires valid EVV data as a condition of payment in its waivers for people with I/DD and for older adults and people with physical disabilities. A claim with no matching EVV record is denied, not paid and audited later.
AI tools arrive
Twelve states reported already using AI-enabled tools to look for fraud, waste and abuse in at least one program: Arizona, Arkansas, Connecticut, Indiana, Michigan, Missouri, Montana, Nevada, New Mexico, North Carolina, Texas and Washington. California is piloting such tools, and eight states plan to add them. Five states use AI tools in their I/DD waivers. North Carolina said it uses AI-built algorithms in its waiver for older adults and people with physical disabilities, and Missouri said it uses AI to pull together information on critical incidents and grievances.
Florida and South Carolina did not answer the 2026 survey, and Minnesota skipped this question. KFF adds that extra anti-fraud steps can create paperwork and push some providers out, which may reduce access to care.
Why this matters for providers and DSPs
For provider agencies, the visit record is now evidence for the claim, not just a time sheet. Missed clock-ins, edited visits and services billed outside the authorized units in a care plan are exactly what these checks flag, and in a state that ties payment to EVV the claim is simply denied. DSPs who check in and out on time, at the right location, protect their agency's payment. Supervisors should treat EVV exceptions as a daily task rather than leaving them for billing to fix at the end of the month.