HCBS Anti-Fraud Reporting Act of 2026
- Sponsor
- Sen. Moody, Ashley [R-FL]
- Committees
- Finance Committee (primary)
- Last action
- Sep 30, 2026
Bottom line
This bill requires states to submit annual reports to the federal government detailing anti-fraud measures and detected fraud within their Medicaid Home and Community-Based Services programs.
What it actually does
This bill amends Section 1915(c)(2) of the Social Security Act to mandate that states annually report to the Secretary of Health and Human Services on waste, fraud, or abuse detected within their Medicaid Home and Community-Based Services (HCBS) waivers. The reports must also detail the efforts undertaken by states to prevent such issues. This new reporting requirement will apply starting from the year 2026.
Proponents argue
Supporters argue that this legislation is a crucial step towards enhancing transparency and accountability within the Medicaid HCBS program, which represents a significant federal and state expenditure. By requiring states to report on their anti-fraud activities and findings, the bill provides the federal government with essential data to identify vulnerabilities, share best practices, and ensure that taxpayer funds are used effectively to deliver services to eligible beneficiaries.
Opponents contend
Opponents might contend that while the objective of combating fraud is important, this bill imposes an additional administrative burden on states. They could argue that states already have incentives and existing mechanisms to detect and prevent fraud, and that new, potentially unfunded, reporting mandates could divert resources from direct service provision or more impactful fraud prevention activities, rather than genuinely improving program integrity.
The bill is exceptionally concise and clearly written, allowing any informed reader to quickly grasp its provisions and implications.
Section 2, amending Section 1915(c)(2) of the Social Security Act (42 U.S.C. 1396n(c)(2))
State Reporting on HCBS Anti-Fraud Measures
This provision mandates that, beginning in 2026 and for every subsequent year, each state must submit a report to the Secretary of Health and Human Services. These reports are required to detail any instances of waste, fraud, or abuse that the state has detected in connection with services provided under its Medicaid Home and Community-Based Services (HCBS) waiver. Additionally, the reports must outline the specific actions and efforts the state has implemented to prevent such waste, fraud, and abuse from occurring within its HCBS program.
Supporters argue
Supporters argue that this reporting requirement is crucial for safeguarding the financial integrity of the Medicaid HCBS program. By compelling states to document their anti-fraud activities and detected issues, the federal government can gain a clearer picture of where vulnerabilities exist, identify effective prevention strategies, and ultimately ensure that public funds are directed towards legitimate care for beneficiaries.
Critics contend
Critics might argue that while the intent to combat fraud is commendable, this specific provision adds an unneeded layer of bureaucracy. They may contend that states already have strong incentives and existing mechanisms to address fraud, and that this new federal mandate could impose significant administrative costs and divert resources that could otherwise be used for direct fraud investigation or service delivery, without necessarily yielding substantial new insights.
Tradeoffs
This provision navigates the tension between the federal government's desire for greater accountability and oversight in a large federal-state program, and states' concerns about increased administrative burdens. It aims to improve transparency and reduce fraud, but its effectiveness will depend on the clarity of federal guidance, the quality of state reporting, and the federal government's capacity to analyze and act upon the collected data.