Disability advocates are calling out top federal health officials for suggesting that Medicaid’s home and community-based services program pays for assistance that should be provided by families for free.
Recent comments from U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. and Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, have targeted fraud concerns in Medicaid waiver programs allowing family members to be paid to provide care for people with disabilities and aging individuals.
“The waivers allow people, family members who are taking care of an elderly parent to get paid for balancing the checkbook, for picking up the groceries, for driving somebody to a doctor’s appointment,” Kennedy said while testifying before lawmakers on Capitol Hill last week.
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“These are family members who are getting paid to do things that they used to do as family members for free,” he said. “This is rife with fraud because we have no way at CMS to determine whether they actually perform that duty or not. We don’t know whether you drove your grandmother to a doctor’s office.”
The comments mirror similar sentiments from Oz who described personal care services as helping “Medicaid patients do something that our families would normally do for us, like carrying groceries,” in a recent social media video.
The statements from federal officials charged with overseeing the Medicaid program have disability advocates alarmed.
“The undervaluing of HCBS demeans the very real, complex and difficult work that caregivers — whether paid or unpaid — provide,” said Barbara Merrill, CEO of the American Network of Community Options and Resources, or ANCOR, which represents disability service providers nationally.
Merrill called the comments “deeply concerning” and took issue with the implication that “family members should remain out of the workforce to care for a loved one or relative.”
President Donald Trump created a task force last month to “combat widespread fraud, waste, and abuse in federal benefit programs.” The Centers for Medicare and Medicaid Services has also initiated health care fraud investigations in multiple states and Oz announced new expectations this week for every state as part of the anti-fraud efforts.
The focus on fraud comes as lawmakers in several states are considering scaling back home and community-based services as they prepare for the impact of the One Big Beautiful Bill Act. The law, which Republicans pushed through Congress last summer, is expected to chop federal Medicaid spending by nearly $1 trillion.
Katy Neas, CEO of The Arc of the United States, said that the comments from Kennedy and Oz mischaracterize the role of home and community-based services and ignore the lived reality of people with disabilities and their families who are dealing with a severe shortage of direct care workers.
“We can all agree that protecting the integrity of the programs that provide these supports is important. But making broad and unsupported claims that HCBS, particularly services delivered by family caregivers, are ‘rife with fraud’ puts adults and children with disabilities, and their families, at risk of losing the help they need to live in the community,” she said. “For many families, a family member is not just often a preferred caregiver. They are the only reliable option.”
