Electronic visit verification already adds safeguards against fraud in Medicaid home care, and a new CMS spending dataset could mislead people about where fraud is happening, according to a KFF brief published Feb. 24, 2026. KFF wrote it as the Trump administration points to home care as a source of fraud.
KFF estimates that more than 5 million people use Medicaid home care, which helps with bathing, dressing, eating and other daily tasks.
Why home care draws scrutiny
Home care carries higher fraud risk because services happen in private homes, often for people less able to speak up, the brief says. It also has extra safeguards. The 21st Century Cures Act of 2016 requires electronic visit verification (EVV) for Medicaid personal care and home health visits, and states had until 2023 to fully implement it. EVV must record six items: the person served, the caregiver, the type of service, the location, the date and the start and end times.
What the conviction data show
KFF cites an HHS Office of Inspector General report: in fiscal 2024, Medicaid fraud control units recorded 298 convictions involving personal care attendants, 36% of all their convictions and more than any other provider type. From 2015 to 2022, before EVV was fully in place, such convictions averaged well over 400 a year and 43% of the total.
The CMS dataset
On Feb. 14, 2026, CMS released provider-level spending data it said could help spot unusual billing. KFF says the data have only seven fields and omit key details. Personal care visits that range from under 30 minutes to a full day fall under one procedure code, while other services, such as emergency visits, are split by complexity or length. KFF warned that the data could lead to mistaken conclusions.
The brief also puts growth in context. Home care rose from 1% of Medicaid long-term care spending in 1981 to 64% in 2023, and users grew by more than 750,000 between 2019 and 2023, reflecting deliberate policy choices to serve people at home.
Why this matters for providers and DSPs
Home care agencies are under a spotlight, and raw spending figures can make legitimate growth look suspicious. Accurate EVV records and clear documentation are among providers' best defenses.