Recent investigative reporting and federal prosecutions have highlighted Minnesota as a hotbed of fraud for autism services and housing-related services, which are largely paid for by taxpayers through Medicaid. State data indicate that Minnesota would be a likely state for such fraudsters to hide in plain sight: Minnesota’s Medicaid spending on able-bodied, working-age people made eligible by the Affordable Care Act’s expansion is 51 percent higher than in other states, and 2.7 times the national average for disabled Medicaid enrollees.
State Medicaid expenditure data can indicate other states that are likely to have extreme Medicaid fraud that state officials overlook. According to the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), its work “consistently demonstrates that patients may be vulnerable to fraud and abuse in home and community-based settings.” Services in these settings are usually delivered by home health aides, who provide help with activities of daily living as well as monitoring medications, vital signs, and prescribed exercises, or by personal care aides, who generally have a more limited role focused on helping with activities of daily living, such as bathing, dressing, and light household tasks.
As shown in this Paragon PIC, New York stands out as an extreme outlier in the employment of home health aides. The Empire State has three times more home health and personal care aides per resident than the average of all other states: 314 per 10,000 residents versus just 105 for the rest of the country. California, the state with the second-largest concentration of these workers and where there is almost certainly significant fraud and waste in this area, has 222 per 10,000 residents, almost a third fewer than New York.
Home health and personal care aides accounted for 38 percent of New York’s job growth from 2023 to 2024. There are almost three times as many of these workers as there are in retail sales—or one for every 16 of the almost ten million New Yorkers working in nonfarm jobs. This growth is even more concerning because New York recently decided to consolidate all these services under one statewide fiscal intermediary—and is stonewalling watchdogs demanding transparency about how this sweetheart deal came about, amid suspicions that politicians made the deal before the bid was publicized.
