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A KFF survey found that all 48 states that responded reported using at least one Medicaid home care program-integrity strategy beyond federal requirements. States reported cross-checking claims with electronic visit verification data, and 21 said they use, are piloting or plan to use AI; KFF cautioned that added oversight may burden providers and affect access to care.
States are adding fraud-monitoring measures to Medicaid home care programs beyond federally required electronic visit verification, according to a KFF survey of state officials. The findings describe widespread use of claims checks and growing interest in AI-based monitoring, while the report warns that extra oversight could increase administrative burdens and affect provider participation and access to care.
KFF surveyed officials responsible for Medicaid home care programs in all 50 states and Washington, D.C. from April through August 2026. Florida and South Carolina did not respond, leaving 48 state responses; Minnesota did not answer a question about program integrity. KFF says all 48 responding states reported having some form of program-integrity protocol, and each reported at least one strategy beyond federal requirements.
All surveyed states reported maintaining electronic visit verification, or EVV, data in machine-readable files and cross-checking billed claims against EVV data. KFF also reported that 42 states used the eight oversight strategies included in its survey. The provided findings do not specify which particular strategies accounted for that figure, so it should not be read as a count of states using every listed measure.
Twenty-one of the 48 responding states said they were using AI, piloting it or planned to use it in program-integrity and data-monitoring tools. The states identified as currently using AI were Washington, Montana, Nevada, Arizona, New Mexico, Texas, Missouri, Arkansas, Indiana, Michigan, North Carolina and Connecticut. The survey groups current use, pilots and future plans in one figure; it does not establish that all 21 have deployed AI in active fraud investigations.
Oversight May Affect Home Care Access
Medicaid home care oversight concerns both public spending and whether eligible people can receive services. Cross-checking claims with EVV records gives states a way to compare billed visits with recorded service information, while data-monitoring tools may help flag claims for further review. The survey documents states’ reported approaches, but it does not measure how many cases of fraud these measures detect or how much money they recover.
KFF’s warning highlights a potential trade-off: added checks may discourage improper billing, but can also require providers to meet more documentation or administrative demands. If those demands affect provider participation, access to home care could be affected. The report presents that as a risk, not as a measured outcome of the surveyed policies.
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Federal EVV Rules Set the Baseline
The 21st Century Cures Act of 2016 required states to use EVV for personal care and home health services delivered in the home. EVV systems collect information such as visit times and attendance, along with care-plan details entered by workers at the point of care. Georgia Medicaid describes the technology as a way to automate recordkeeping and reduce in-home care fraud.
The KFF report places states’ additional checks against that federal baseline. It also notes that states have used measures such as pausing new provider enrollments and suspending providers as part of efforts to address suspected fraud. The Centers for Medicare & Medicaid Services specifically recommended that states consider Medicaid provider-enrollment moratoria in documentation concerning a national moratorium on new Medicare home health enrollments. That recommendation is separate from the survey’s findings about state Medicaid home care practices.
“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
electronic visit verification (EVV) system
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Fraud Results and Access Effects Unknown
The survey reports what state officials said their programs do or plan to do; it does not provide a common measure of fraud detected, dollars recovered or improper payments prevented. It also does not show whether the additional controls have reduced provider participation or limited services. KFF identifies access effects as a potential concern rather than a documented finding.
The AI figure combines states already using tools with those piloting them or planning future use. The report material provided does not specify what systems those states use, how decisions are reviewed, or how often an AI-generated flag leads to an investigation. The results also do not include responses from Florida and South Carolina, and Minnesota did not answer the program-integrity question.
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States Continue Monitoring Programs
The report describes ongoing state activity rather than announcing a single new federal rule or a shared implementation deadline. States may continue to refine their claims reviews, EVV data systems and AI pilots, while deciding how to balance oversight with provider workload. The available findings do not identify a coordinated next step across states.
Further reporting would be needed to establish whether these controls produce measurable changes in fraud or improper spending and whether they affect provider participation or beneficiaries’ access to home care. Readers should also distinguish announced plans and pilots from tools already in operation as states disclose more about their programs.
Medicaid home care monitoring devices
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Key Questions
What did the KFF survey find about Medicaid home care fraud oversight?
KFF said all 48 responding states reported at least one program-integrity strategy beyond federal requirements. All surveyed states also reported maintaining EVV data in machine-readable files and comparing billed claims with EVV records.
What is electronic visit verification?
Electronic visit verification (EVV) records information about in-home services, including visit times and attendance. Federal law requires its use for specified Medicaid personal care and home health services delivered in the home.
How many states reported using or considering AI?
Twenty-one states said they were using AI, piloting it or planned to use it in program-integrity and data-monitoring tools. That total combines current use with pilots and future plans.
Did KFF find that the new checks reduced fraud?
The findings provided do not quantify fraud detected, savings or improper payments prevented. They describe the strategies states reported using or considering, not their measured results.
Could added fraud checks affect access to care?
KFF’s authors said extra oversight could add administrative burdens, limit provider participation and potentially reduce access. The report presents this as a possible risk, not a confirmed effect measured by the survey.
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