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A KFF survey found that all 48 responding states use at least one Medicaid home care program-integrity strategy beyond federal requirements, including checks comparing claims with electronic visit verification data. Twenty-one states said they use, pilot or plan to use AI for monitoring; KFF cautioned that added oversight may also burden providers and limit access to care.
All 48 states that responded to a KFF survey reported using at least one measure to check Medicaid home care program integrity beyond federally required electronic visit verification, including cross-checking billed claims against visit records. The findings show states expanding oversight of publicly funded in-home care, while KFF’s authors warn that added scrutiny could raise administrative burdens and affect access to services.
KFF surveyed officials who administer Medicaid home care programs in all 50 states and the District of Columbia between April and August 2026. Florida and South Carolina did not respond. Minnesota did not answer a question about program integrity. Of the 48 responding states, all reported using some form of program-integrity protocol, and all reported at least one strategy beyond the federal EVV requirement.
Among the measures in the survey, 42 states reported using eight oversight strategies. These included keeping electronic visit verification data in machine-readable files and comparing that information with claims for services. The survey also found that 21 of the 48 responding states were using AI, piloting it or planning to use it in program-integrity and data-monitoring tools. Those categories combine current use with trials and plans; the survey does not mean all 21 have deployed AI in routine operations.
KFF identified states currently using AI as Washington, Montana, Nevada, Arizona, New Mexico, Texas, Missouri, Arkansas, Indiana, Michigan, North Carolina and Connecticut. The report also describes states using measures such as enrollment moratoria for new Medicaid providers and provider suspensions. The source material does not give a state-by-state account of how often these actions are used or their results.
Fraud Checks May Affect Care Access
Medicaid home care helps people receive services in their homes, and stronger checks are intended to help states identify potentially improper billing and protect program funds. Comparing billed claims with visit records gives administrators another way to flag discrepancies for review. The survey documents widespread adoption of strategies, but does not establish how much fraud they detect or how much money they save.
KFF’s authors also point to a trade-off: additional oversight can mean more documentation and compliance work for providers. If that burden leads providers to leave Medicaid or makes participation less practical, people who rely on home care could face fewer options. The report presents this as a potential risk, not a measured outcome of the surveyed policies.
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Federal EVV Rules Set the Baseline
The federal baseline stems from the 21st Century Cures Act of 2016, which required states to use electronic visit verification for personal care and home health services delivered in the home. EVV systems record information such as a worker’s time and attendance and care-plan details at the point of service. Georgia Medicaid has described the technology as a way to reduce fraud in in-home care.
The KFF findings concern measures states say they add beyond that requirement. The organization is a nonpartisan, nonprofit health policy research group. Its survey asked state officials about program oversight and monitoring; it is not an audit of individual claims, providers or state fraud cases. KFF reported that program integrity was among the top three priorities for most states.
“While additional scrutiny and oversight may limit fraudulent or inappropriate Medicaid spending, additional efforts to combat fraud can create new administrative burdens and limit provider participation, potentially reducing access to care.”
— KFF report authors
Impact and AI Use Remain Unclear
The survey records states’ reported practices and plans; it does not show whether the strategies have reduced fraud, improved detection or produced savings. The AI figures combine current use, pilot projects and planned adoption, and the report summary does not specify what tasks each system performs, how states validate results or how often a flagged claim leads to action.
Responses were also incomplete: Florida and South Carolina did not participate, and Minnesota skipped the program-integrity question. The available findings do not quantify provider withdrawals, administrative costs or changes in beneficiaries’ ability to obtain care. It is therefore unclear whether expanded checks have already affected access or how large any effect may be.
States Continue Oversight Decisions
The KFF report provides a snapshot of state policies and plans based on responses collected from April through August 2026. States may continue developing monitoring tools, including AI-based systems, and deciding whether to use measures such as provider enrollment moratoria. The source material does not identify a shared national timetable or a specific next federal action tied to the findings.
Further information would be needed to judge the effects of the approaches: state-level results on confirmed improper payments, provider participation, administrative workload and access to home care. Until those outcomes are available, the survey supports a conclusion about the breadth of reported oversight—not the effectiveness or consequences of each strategy.
Key Questions
What did the KFF survey find?
All 48 responding states reported at least one Medicaid home care program-integrity strategy beyond the federal EVV requirement. The survey covered officials in all 50 states and the District of Columbia.
What is electronic visit verification?
Electronic visit verification, or EVV, records details about in-home services, such as worker time and attendance. Federal law requires states to use EVV for specified personal care and home health services delivered in the home.
How many states reported using AI?
Twenty-one of 48 responding states said they were using AI, piloting it or planning to use it for program integrity and data monitoring. The figure includes plans and pilots, not only systems already in routine use.
Does the report show that the new checks have reduced fraud?
No. The survey describes state-reported practices and plans, but the findings provided do not quantify fraud detected, savings or the effectiveness of individual strategies.
Could stronger oversight affect access to home care?
KFF’s authors say added oversight could increase administrative burdens and limit provider participation, potentially reducing access. The report does not establish that this has happened or measure its extent.
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