Medicare Program Integrity and Efforts to Root Out Improper Payments, Fraud, Waste and Abuse
This brief explains fraud, waste, abuse, and improper payments in Medicare and describes actions to ensure Medicare program integrity.
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This brief explains fraud, waste, abuse, and improper payments in Medicare and describes actions to ensure Medicare program integrity.
On March 15, 2025, the President signed a full-year “continuing resolution” (CR) that continues funding the federal government through the rest of the fiscal year. It maintains U.S. global health funding at the prior year (FY 2024) level ($10.8 billion).
Under the reconciliation package, federal Medicaid spending in rural areas is estimated to decline by $137 billion, more than the $50 billion appropriated for the rural health fund.
The House Committee on Appropriations approved the FY 2026 National Security, Department of State, and Related Programs (NSRP) appropriations bill and accompanying report on July 23, 2025.
This analysis allocates the CBO’s estimated reduction in federal spending in the enacted reconciliation package across states based on KFF’s state-level data and where possible, prior modeling work; and shows the federal spending reductions relative to KFF’s projections of federal spending by state under current law.
Prior KFF analysis allocated CBO’s federal Medicaid spending reductions and enrollment losses across the states, and this policy watch builds on that analysis to examine the potential impacts in expansion states compared with non-expansion states.
On May 2, 2025, the White House released preliminary details of its FY26 budget request, including funding for global health activities at the State Department, U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and the Fogarty International Center (FIC) at National Institutes of Health (NIH).
This analysis examines the share of inpatient hospital days that are covered by Medicaid nationally and by state at a time when Congress is considering potential cuts to the program. It finds that Medicaid covered at least one in five inpatient hospital days in 48 states and the District of Columbia in 2023.
Recent actions from the Trump administration could signal limits to curtail Medicaid waivers related to social determinants of health and to limit waiver financing tools and flexibility. Two major changes demonstrate this shift: (1) rescinding Biden-era guidance on covering health-related social needs (HRSN) services, and (2) phasing out federal funding for “Designated State Health Programs” (DSHP) in waivers.
The Senate Committee on Appropriations approved its FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) appropriations bill, accompanying report, and amendments on July 31, 2025.
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