House Energy and Commerce Republicans say Medicaid home and community-based services are among the program's most fraud-prone areas and want CMS to set national screening standards for the workers who deliver personal care. The committee's majority staff report, The Real Costs of Fraud, lays out 13 findings and 37 recommendations, according to the committee's Sept. 29, 2026 release. HomeCare magazine summarized the report on Oct. 6, and McKnight's Home Care noted on Oct. 9 that it cites Medicaid HCBS as a high-fraud area.

The report came out the same day as the committee's 14-bill anti-fraud package, which includes an annual HCBS fraud reporting bill. It is a staff report, not legislation. Its recommendations are aimed at Congress, CMS and the states.

What it says about HCBS

  • High-risk services. The report lists applied behavior analysis (ABA), non-emergency medical transportation, HCBS, adult day care and substance use disorder treatment as Medicaid services with high rates of fraud.
  • Fast growth. It says states expanded benefits quickly under 1915(c) waivers without enough safeguards. Citing a Mathematica analysis for CMS, it puts Medicaid HCBS spending at $97.1 billion in 2019 and $145.91 billion in 2023, a 50% rise, while enrollment grew 13.5%.
  • Low barriers to entry. Some HCBS providers face easier entry and billing rules than traditional health care providers, and may not need a National Provider Identifier. The report says self-directed care by relatives or friends gets little oversight because it happens in the home with no other providers around.
  • An old recommendation still open. In 2016, HHS's Office of Inspector General recommended minimum federal qualifications and screening standards, including background checks, for personal care workers. The report says CMS hasn't implemented it.
  • State examples. It faults New York for not assigning screening risk levels to most Medicaid-only provider types, aside from ABA, 1915(c) waiver services and licensed home care agencies. It also describes Maine's "state review queues" for certain HCBS and behavioral health providers.

Recommendations that reach HCBS providers

  • CMS should set minimum qualifications and screening risk standards for Medicaid providers, especially high-risk provider types.
  • CMS should adopt OIG's 2016 recommendation on personal care worker qualifications and background checks.
  • CMS should standardize Medicaid-only provider risk levels across more provider types, and states should re-evaluate those levels regularly.
  • States should verify provider enrollment, exclusion status and claims information before paying, and should invest in AI tools for enrollment, revalidation and claims review.
  • CMS should give state Medicaid agencies more guidance and training on the risks of high-risk provider types.
  • CMS should require states to report all pre- and post-payment audits, including how much they identified compared with how much they recovered.

Why this matters for providers and DSPs

None of this is binding yet. Still, the report shows where Congress and CMS are heading: more HCBS provider agencies placed in higher screening tiers, more checks before claims are paid, and a possible federal floor for screening the personal care workforce. For I/DD agencies, that means clean enrollment and ownership records, current exclusion checks on every hire, and visit documentation that matches each claim. Those files are also what electronic visit verification reviews and state audits already look at.

Self-direction programs get specific criticism. States that respond by adding oversight could change paperwork for families and the financial management services agencies that pay self-directed workers.