Able Americans

“When government responds to fraud with blunt instruments, the people who rely on these programs can become collateral damage.”

In a commentary published at The Hill, Able Americans Director Rachel Barkley commends the good intentions of those who want to root out fraud in the social safety net, but warns of a dire human toll if that effort is not done carefully. She outlines key principles for fraud reform that protects the vulnerable.

Read her entire commentary below.

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President Trump has made rooting out fraud in the social safety net a top priority this year, putting Vice President JD Vance in charge of a new “war on fraud.”  That focus is overdue. Fraud in public benefits doesn’t just waste taxpayer dollars — it corrodes trust in the very programs designed to help people in crisis and diverts resources from those who truly need them.

But there’s a quieter danger: When government responds to fraud with blunt instruments, the people who rely on these programs can become collateral damage. In disability services, the human toll can be worse than the budget impact.

Minnesota has offered a painful case study. Take Janelle “Sky” Hansen, a young woman with autism. She lived in an apartment through a Medicaid-funded program called Integrated Community Supports), meant to help adults with disabilities live independently with daily, one-on-one assistance. Hansen’s provider, American Home Health Care, was paid Medicaid dollars intended to support her housing and services. Yet the company stopped paying her rent, even as it continued to collect Medicaid funds from the state. Hansen, who did nothing wrong, was evicted and has spent months homeless.

According to KARE11’s investigation, Hansen’s records reflected a daily billing rate of roughly $421 for about 12 hours of services per day — services Hansen says she rarely received. State Medicaid billing data showed the provider has been paid more than $2.2 million in public funds since 2022. Whatever the final legal outcome, the outcome for Hansen is already catastrophic: She lost the critical stability Medicaid was supposed to secure.

Jennifer Larson, the mother of a son with autism and the founder of the Holland Center for Autism in Minnesota, testified before the U.S. House Judiciary Committee in January about what happens when fraud is allowed to metastasize. Her testimony captured the double-bind families face:

“This week, Holland and other autism programs all over Minnesota are collapsing,” she said. “Not because we committed fraud, but because a crime ring was allowed to operate inside Minnesota’s autism services system, and the government’s clumsy response is now destroying legitimate longstanding providers and devastating the families we serve.”

Larson has described payment holds that forced her organization to take on debt just to make payroll. When states freeze payments broadly — rather than surgically targeting bad actors — they don’t just punish criminals. They punish children and adults whose care depends on continuity, and they punish legitimate providers who are often the last lifeline before families spiral into crisis.

This should be the core principle as anti-fraud efforts ramp up nationally: People with disabilities cannot become collateral damage in the fight against fraud.

Across the country, Home and Community-Based Services Medicaid waivers support the daily activities that make community life possible for people with disabilities: therapies to prevent decline, personal care for tasks like showering and eating, supported employment, and the stability of living at home rather than in an institution. Even a brief interruption can trigger crisis — medical decline, job loss and housing instability — leading to months or years of setbacks.

So what should “fraud reform that protects the vulnerable” actually look like?

First: Target the criminals, not the care.

States should audit and investigate providers aggressively, but enforcement must be precise. When credible evidence suggests fraud, suspend the specific provider and the specific billing streams under suspicion — not entire categories of care. Pair any suspension with an immediate continuity-of-care plan so individuals are not left without services, housing, staffing or therapy.

Second: Build beneficiary safeguards into every fraud action. If a provider is under investigation, affected beneficiaries should have rapid reassignment options through the state or managed care organization — an expedited pathway to a new provider, temporary bridge services, and a clear point of contact. When housing is tied to a provider arrangement, states should have emergency mechanisms to pay rent directly and prevent eviction while investigations proceed.

Third: Fix the information asymmetry that lets bad actors hide. Fraud thrives where families can’t easily compare providers, verify services, or see patterns of abuse. Transparency isn’t a “nice to have” in disability services — it’s protection. Families should be able to identify reputable providers, understand available benefits, and report concerns without retaliation.

Congress has taken an important step by enacting the Think Differently Database Act, directing the federal government to create a searchable national clearinghouse of disability resources, including Medicaid community-based services. Now implementation matters. The Department of Health and Human Services should move quickly to make the database comprehensive, user-friendly, and genuinely helpful to families navigating complex systems.

Fourth: Measure success by outcomes, not headlines. A serious fraud crackdown should be judged by three metrics: fraud dollars recovered, prosecutions achieved and whether eligible people kept getting the services they needed without disruption. If fraud recoveries rise and homelessness and crisis rise too, the system is still failing.

The Trump administration is right to pursue fraud. The country needs integrity in public benefits. But integrity requires more than enforcement — it requires competence and care. If we want taxpayers to trust the safety net and vulnerable Americans to rely on it, we must design fraud reform that protects the very people these programs exist to serve.

Fraud should be rooted out. Families and people with disabilities should not be uprooted with it.

 

Rachel Barkley is director of the Able Americans project at the National Center for Public Policy Research. This was first published at The Hill.