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									Medicaid - Michigan Healthcare Freedom Forum				            </title>
            <link>https://mihealthfreedom.org/community/medicaid/</link>
            <description>Michigan Healthcare Freedom Discussion Board</description>
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                        <title>Authorities Dismantle Louisiana Medicaid Fraud Web of Islamic Terror Financiers</title>
                        <link>https://mihealthfreedom.org/community/medicaid/authorities-dismantle-louisiana-medicaid-fraud-web-of-islamic-terror-financiers/</link>
                        <pubDate>Sun, 11 Oct 2026 03:51:39 +0000</pubDate>
                        <description><![CDATA[The nexus of terror, government funding, and healthcare fraud becomes more clear. Actually, these criminals committed at least two types of fraud.
Check out Daily Signal&#039;s hotlinked sources...]]></description>
                        <content:encoded><![CDATA[<p>The nexus of terror, government funding, and healthcare fraud becomes more clear. Actually, these criminals committed at least two types of fraud.</p>
<p>Check out Daily Signal's hotlinked sources.</p>
<p>https://www.dailysignal.com/2026/10/08/louisiana-medicaid-fraud-islamic-terror-financiers/</p>
<p></p>
<p><span style="font-size: 14pt"><strong>Authorities Dismantle Louisiana Medicaid Fraud Web of Islamic Terror Financiers</strong></span></p>
<p>Pedro Rodriguez    |    October 8, 2026<br /><br />Federal and Louisiana state authorities dismantled a network of Hamas financiers in late September who were accused of committing fraud against the state’s Medicaid program totaling more than $224,000 between 2021 and 2025.<br /><br />Louisiana Attorney General Liz Murrill announced the arrests Wednesday of Abdel Adhami, Iman H. D. Srour, Omar Adhami, Amani Abu Zenah, and Mohammad I. Adhami, residents of St. Tammany Parish. The suspects face state felony charges of government benefits fraud and theft for allegedly underreporting their income between 2021 and 2025 to receive taxpayer-funded benefits.<br /><br />“While terrorist sympathizers were funding the death of American citizens and countless others across the world, the hard-working men and women of Louisiana were funding their medical care. No matter where you are or who you are, if you steal from the people of Louisiana, you will face Louisiana justice,” Murrill said in a statement shared with the Daily Signal.<br /><br />Abdel Adhami and Omar Adhami also face federal charges for providing more than $100,000 to a terrorist financing network that funneled more than $1.7 million to help fund Hamas.<br /><br />Prior to the arrests, federal and local authorities uncovered that the Adhami brothers had taken part in a campaign to help fund Hamas, a designated foreign terrorist organization responsible for the slaughter of more than 1,200 Israeli civilians on Oct. 7, 2023.<br /><br />The Louisiana Bureau of Investigation then worked with the Louisiana Department of Health to uncover possible Medicaid fraud. The charges will be prosecuted by St. Tammany Parish District Attorney J. Collin Sims.<br /><br />Wednesday’s announcement adds to the total of more than $80 million in government funds recovered from fraudsters by the attorney general’s office.<br /><br />“Through leadership and collaboration with federal, state, and local partners, we are ending systemic Medicaid fraud, waste, and abuse,” Murrill continued.</p>
<p></p>]]></content:encoded>
						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>Abigail Nobel</dc:creator>
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                        <title>Fund patients, not insurance companies: progress report</title>
                        <link>https://mihealthfreedom.org/community/medicaid/fund-patients-not-insurance-companies-progress-report/</link>
                        <pubDate>Fri, 09 Oct 2026 14:50:13 +0000</pubDate>
                        <description><![CDATA[&quot;Let them shop&quot; would solve high-cost complexity in Medicaid, Medicare, and beyond. Are we making any progress?
First an overview, then updates.
Sally C. Pipes is the president, CEO, and T...]]></description>
                        <content:encoded><![CDATA[<p>"Let them shop" would solve high-cost complexity in Medicaid, Medicare, and beyond. Are we making any progress?</p>
<p>First an overview, then updates.</p>
<p>Sally C. Pipes is the president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute, a San Francisco–based think tank founded in 1979.</p>
<p>https://benjaminrush1776.substack.com/p/sally-pipes-trump-has-a-subsidy-alternative</p>
<p></p>
<p><span style="font-size: 14pt"><strong>Sally Pipes: "Trump Has a Subsidy Alternative, We Should Take it Seriously"</strong></span></p>
<p><span style="font-size: 12pt"><strong>Direct vouchers for patients—not payouts to insurance companies—is a real path to lowering costs and improving coverage.</strong></span></p>
<p>Nov 21, 2025</p>
<p>The following is an excerpt from an article by Sally Pipes, Founder &amp; Chair of the Benjamin Rush Institute, published in Newsmax. Click here to read the full article in your browser.<br /><br />In a social media post earlier this month, President Trump laid out his own alternative to the enhanced Obamacare subsidies that fueled the record-breaking 43-day government shutdown.<br /><br />Thanks for reading Benjamin Rush Institute! Subscribe for free to receive new posts and support my work.<br /><br />Type your email...<br />Subscribe</p>
<p>“I am recommending to Senate Republicans that the Hundreds of Billions of Dollars currently being sent to money sucking Insurance Companies in order to save the bad Healthcare provided by ObamaCare, BE SENT DIRECTLY TO THE PEOPLE SO THAT THEY CAN PURCHASE THEIR OWN, MUCH BETTER, HEALTHCARE, and have money left over.”<br /><br />Colorful language aside, the idea is worth considering.<br /><br />Individual Americans deserve more control over how their healthcare dollars are spent. Injecting more consumerism into the health insurance market can help restore efficiency — and sanity — to our healthcare system.<br /><br />It’s hard to argue with Trump’s basic critique of the generous COVID-19-era Obamacare subsidies. If extended beyond their scheduled expiration at the end of this year, these subsidies will cost taxpayers $350 billion over the next decade, according to the Congressional Budget Office (CBO).<br /><br />And as the president notes, that money doesn’t go to patients — it goes directly into the pockets of giant insurance companies.<br /><br />Trump’s proposed solution to this mess is also compelling — at least in principle. If the government is going to spend enormous sums subsidizing health insurance, much better to give those funds to individuals and let them use the money to buy coverage of their choosing — or even pay for care directly.<br /><br />An army of consumers with control over healthcare dollars is a recipe for healthier competition among insurers — and higher-quality, better-value coverage in the long run.<br /><br />But why stop at Obamacare?<br /><br />Why not look at voucherizing other parts of the health insurance system?<br /><br />Consider Medicare.<br /><br />The government currently spends over $1 trillion each year on the healthcare entitlement for seniors.<br /><br />That amounts to nearly $15,000 per Medicare beneficiary.<br /><br />Yet instead of giving those funds directly to patients — and allowing them to purchase private coverage — the federal government funds a sprawling health insurance bureaucracy that employs thousands of federal workers.<br /><br />Transitioning the program to a system of vouchers, in which every enrollee is allotted a set amount of money to pay for healthcare each year, could lower costs and improve the quality of coverage for seniors.<br /><br />Or let’s extend Trump’s idea for the individual market further.<br /><br />Why not encourage employers to give their employees untaxed dollars to purchase health insurance that suits their unique needs on the individual market, rather than buying a one-size-fits-all plan for everyone in their employee population?<br /><br />President Trump created a vehicle for voucherizing employer-sponsored coverage — the individual coverage health reimbursement arrangement, or ICHRA — in his first term.<br /><br />These accounts can give employers more control over their own healthcare costs — and can encourage employees to spend their healthcare dollars more wisely.<br /><br />The upshot is more competition within the healthcare market — and downward pressure on prices over time.<br /><br />The Trump administration has yet to build out a legislative vehicle based on the president’s social media post. But Sen. Bill Cassidy, R-La., has already floated one approach.<br /><br />The Senate HELP Committee chairman has proposed to redirect enhanced subsidy money into individual Flexible Spending Accounts, or FSAs.<br /><br />Patients would have 15 months to use those funds to purchase health coverage, or else forfeit the money back to the government.<br /><br />Republicans can do better.<br /><br />For starters, they should not commit to extending Obamacare’s enhanced subsidies permanently. Second, they must pair any form of federal health insurance voucher with reforms that relax Obamacare’s insurance market regulations.<br /><br />Or, make lower-cost short-term health plans, which are not subject to those regulations, more widely available.<br /><br />Indeed, unless the GOP takes steps to deregulate the health insurance market and make a wider array of affordable plan options available to patients, transitioning to direct subsidy payments won’t create a healthy coverage market.<br /><br />It could even precipitate a “death spiral,” in which patients flee the exchanges, leaving no one but high-cost, high risk patients in the Obamacare risk pools.<br /><br />Spending less on corporate welfare for insurers, and more helping patients through direct financial assistance, is precisely the right idea — one whose moment may have finally arrived.</p>
<p></p>
<p>Note that her two final recommendations are already in place: the unsustainable, extended ACA subsidies are gone, and short-term plans are more widely available.</p>]]></content:encoded>
						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>Abigail Nobel</dc:creator>
                        <guid isPermaLink="true">https://mihealthfreedom.org/community/medicaid/fund-patients-not-insurance-companies-progress-report/</guid>
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                        <title>3 People Convicted of $11M Medicaid Fraud in Virginia</title>
                        <link>https://mihealthfreedom.org/community/medicaid/3-people-convicted-of-11m-medicaid-fraud-in-virginia/</link>
                        <pubDate>Sun, 13 Sep 2026 02:58:29 +0000</pubDate>
                        <description><![CDATA[The Trump Administration’s Task Force to Eliminate Fraud strikes again: wire fraud and health care fraud, health care fraud, aggravated identity theft, payment of kickbacks, and transactiona...]]></description>
                        <content:encoded><![CDATA[<p>T<span>he Trump Administration’s Task Force to Eliminate Fraud strikes again: wire fraud and health care fraud, health care fraud, aggravated identity theft, payment of kickbacks, and transactional money laundering</span> in the Old Dominion. (<a href="https://www.justice.gov/usao-edva/pr/federal-jury-convicts-three-conspirators-11m-medicaid-fraud-and-kickback-scheme" target="_blank" rel="noopener">DOJ press release.</a>)</p>
<p>Busy place. The governor is replacing a failed task force, too.</p>
<p>https://www.dailysignal.com/2026/09/11/three-people-convicted-of-11m-medicaid-fraud-in-virginia/</p>
<p></p>
<p><span style="font-size: 14pt"><strong>3 People Convicted of $11M Medicaid Fraud in Virginia</strong></span></p>
<p>Rich Tucker    |    September 11, 2026<br /><br />A federal jury in Richmond convicted three people this week on charges that they defrauded Medicaid out of more than $11 million. The charges relate to billing by their company, Divine Youth Counseling LLC.<br /><br />The three people, 31-year-old twin sisters E’mon and Armone’ Ambers, as well as 32-year-old Traquan Brown, billed Medicaid for a service known as Crisis Stabilization and Mobile Crisis. <br /><br />“The defendants falsely claimed that two mental health professionals simultaneously provided services to Medicaid recipients, when in truth, at most a single mental health professional was present for the service,” the Justice Department wrote. “The false claims that two professionals provided ‘Team Treatment’ services caused millions of dollars of loss to Medicaid.”<br /><br />In addition to the billing fraud, the three were also convicted on charges that they illegally provided hotel rooms for Medicaid recipients to encourage them to obtain Medicaid services from Divine Youth.<br /><br />E’mon Ambers could be sentenced to up to 92 years in prison, while Armone’ Ambers could be sentenced to 42 years in prison. Traquan Brown could be sentenced to up to 10 years in prison.<br /><br />On Dec. 14, the court will hold a hearing to consider whether to claw back some of the money that the trio misappropriated. “The assets subject to forfeiture include $5,937,156.30 in funds seized pursuant to a federal seizure warrant,” the Justice Department noted.<br /><br />Elsewhere in Richmond, Gov. Abigail Spanberger launched an effort this week to improve state services and reduce the size and scope of bad state contracts. The Democrat named Andrea Fletcher to be the first director of the Virginia Digital Service. Fletcher previously worked as the first chief digital strategy officer at the Centers for Medicare and Medicaid Services.<br /><br />Spanberger had called for the creation of the team earlier this year as part of the compromise that allowed lawmakers to pass a budget in June. “Virginia Digital Service will bring together expert technical talent to modernize state systems, improve government websites, and speed up the delivery of the services that families rely on every day,” the governor said.<br /><br />The creation of the team follows last month’s revelation that a previous reform effort launched by then-Gov. Glenn Youngkin had fallen short. “We uncovered a $52 million loss at the Department of Social Services on a failed effort to replace the commonwealth’s antiquated child support enforcement system,” Spanberger said. “Virginia paid serious money, and all we got were tools that barely worked.”<br /><br />Spanberger also tapped Daniel Young to be the state’s next inspector general. Young has spent years working for the federal government, including stints at the Public Company Accounting Oversight Board, the U.S. Securities and Exchange Commission, and as an assistant United States attorney.<br /><br />“I have worked to combat fraud and corruption throughout my career in public service, and I look forward to fighting fraud, waste, and abuse in this new role,” Young said last week. “The dedicated public servants who work in the Office of the State Inspector General are committed to making government more transparent and more accountable for all Virginians, and it is a privilege to support their efforts.”<br /><br />If his nomination is approved by the General Assembly, Young would serve a four-year term investigating allegations of waste, fraud, and abuse in Virginia’s state government.</p>
<p></p>]]></content:encoded>
						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>Abigail Nobel</dc:creator>
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                        <title>Cleaning the Augean Stables Of Medicaid Financing</title>
                        <link>https://mihealthfreedom.org/community/medicaid/cleaning-the-augean-stables-of-medicaid-financing/</link>
                        <pubDate>Wed, 19 Aug 2026 00:14:41 +0000</pubDate>
                        <description><![CDATA[One of the great tales of Greek mythology is Hercules cleaning the Augean stables of King Augeas.  The stables had become incredibly filthy due to decades of neglect, filled with an unimagin...]]></description>
                        <content:encoded><![CDATA[<p>One of the great tales of Greek mythology is <a title="Hercules and the Augean Stables, 5th Labor" href="https://www.greekmyths-greekmythology.com/hercules-cleaning-the-augean-stables/" target="_blank" rel="noopener">Hercules cleaning the Augean stables of King Augeas</a>.  The stables had become incredibly filthy due to decades of neglect, filled with an unimaginable amount of manure and detritus. The stench was so overpowering that it permeated the entire region.  This is an apt analogy for the financing mechanisms of Medicaid, a trillion dollar program whose financing has gotten totally out of control over the decades.</p>
<p><em>The Debt Dispatch</em> just hosted a Capitol Hill event on Medicaid financing with Michael F. Cannon (Cato Institute), Chris Pope (Manhattan Institute), and Brian Blase (Paragon Health Institute).  It is clear that a Herculean effort will be required, not just physical strength but also ingenuity, perseverance, and the transformative power of overcoming challenges.  There will be no rivers of cash to divert to Medicaid:</p>
<p>https://debtdispatch.substack.com/p/fixing-medicaids-financing-structure</p>
<p></p>
<strong>Fixing Medicaid's Financing Structure to Reduce Waste, Fraud, and Overspending</strong><br /><em>Recap of our Capitol Hill event with Michael F. Cannon (Cato Institute), Chris Pope (Manhattan Institute), and Brian Blase (Paragon Health Institute).</em><br />By Romina Boccia and Tyler Turman - August 18, 2026<br /><br />Medicaid is one of the largest and fastest-growing items in the federal budget and is highly vulnerable to waste, fraud, and abuse.<br /><br />We took that problem to Capitol Hill, hosting a panel featuring Michael F. Cannon of the Cato Institute, Chris Pope of the Manhattan Institute, and Brian Blase of the Paragon Health Institute to discuss Medicaid’s structural weaknesses and how to address them.<br /><br />Cannon and Pope offered two competing visions for how to reform the program, each with its own trade-offs. Yet all panelists agreed that Medicaid’s flawed financing structure is at the root of many of its problems and needs an overhaul. Congress took steps in the right direction with last year’s reconciliation bill, but far more needs to be done.<br /><br /><strong>The Financing Flaw Behind Medicaid’s Dysfunction</strong><br /><br />State and federal Medicaid spending totaled $931.7 billion in fiscal year 2024. Real federal spending on the program grew by nearly 40 percent from FY 2016 to FY 2025. This outpaced Medicare, Social Security, defense, food stamps, and nearly every other spending category over the same period (Figure 1).<br /><br />Medicaid is also highly vulnerable to financial mismanagement. The Paragon Health Institute estimates that Medicaid made $1.1 trillion in federal improper payments from FY 2015 to FY 2024—nearly one of every four federal dollars spent on the program over that period.<br /><br />Medicaid’s matching grant system is at the root of many of its dysfunctions. Although states run Medicaid, the federal government matches between $1 and $9 for every dollar that states spend on the program, with no limit on total federal contributions.<br /><br />This arrangement weakens states’ incentives to police fraud and rewards them for overspending. As Blase pointed out, it also encourages states to “engage in money-laundering schemes,” such as provider taxes and state-directed payments, “to give the appearance of an actual expenditure that is just a fictional creation on paper.” States use these gimmicks to “get federal money for nothing” and off-load more of the financial responsibility for the program onto federal taxpayers.<br /><br />It’s also poorly targeted. Although poorer states receive a higher federal matching rate, the wealthiest states with larger tax bases, such as New York and California, have more money to spend on optional Medicaid benefits to claim more federal matches. In effect, this directs the most money to the states that need it least.<br /><br />Medicaid’s problems are not confined to the federal budget either. Government subsidies drive up the cost of health care for everyone while displacing private health insurance for the recipients it covers.<br /><br /><strong>Two Competing Visions for Reform</strong><br /><br />After detailing numerous problems with Medicaid’s matching grant system, Cannon and Pope presented two competing visions for replacing it. But each carries its own trade-offs.<br /><br />Cannon advocated for converting Medicaid into a fixed block grant. As he explained, this would curb the program’s spending growth, eliminate state incentives to draw federal dollars through financing gimmicks, and incentivize states to spend “much more responsibly” to better match “Medicaid spending and taxing levels  voter preferences.”<br /><br />Pope, however, argued that block grants would leave poor states, whose smaller tax bases already limit their revenue, least able to absorb the costs of higher enrollment during recessions. This, he said, would encourage states to “come begging to Washington for a bailout,” expand the program when the economy recovers, and then ask for higher bailouts during the next downturn.<br /><br />Pope instead favored fully federalizing mandatory benefits, such as hospital and physician services, for the core enrollees that states are already required to cover. Any optional benefits or eligibility expansions beyond that, such as payments to people providing home care to family members or dental services, would be left to the states to pay for. Pope argued that this would “end the moral hazard” of the federal government promising states money “for whatever obligations  incur,” including optional benefits “incidentally related to health care.” It would also reduce bailout pressure: As the federal government would fully fund mandatory benefits, states could no longer argue that those costs were unaffordable and required a bailout.<br /><br />Cannon stated that bailout pressures could be managed by states setting aside “rainy-day funds” for downturns and Congress resisting the temptation to spend more. Pope’s plan, Cannon argued, would simply shift existing state Medicaid spending onto federal taxpayers, with states being unlikely to cut spending in response. The result, he said, would be federal spending added “on top of state spending” rather than replacing it. This would increase federal Medicaid spending and drive “the federal government even closer to a debt crisis.”<br /><br /><strong>What OBBBA Did—and What it Left Behind</strong><br /><br />Faced with the program’s unsustainable fiscal trajectory, Congress made meaningful changes to Medicaid in the One Big Beautiful Bill Act (OBBBA) to rein in waste and tighten oversight. Notably, it:<br />
<ul>
<li>placed a moratorium on new provider tax schemes and reined in existing ones by gradually lowering the “safe harbor” threshold in expansion states;</li>
<li>limited state-directed payments by tying them to Medicare’s reimbursement rates rather than the far higher rates states had been allowing;</li>
<li>established work and community engagement requirements, generally 80 hours per month of employment, education, or service, for able-bodied adults in the expansion population;</li>
<li>required states to redetermine eligibility for expansion enrollees every six months rather than annually; and</li>
<li>directed the Centers for Medicare and Medicaid Services to build a system that cross-checks enrollment across states to catch people signed up for benefits more than once.</li>
</ul>
The Congressional Budget Office (CBO) estimated that OBBBA’s Medicaid reforms will save federal taxpayers roughly $1.2 trillion over the next decade.<br /><br />Yet it left Medicaid’s matching grant system and all the perverse incentives that come with it intact. Moreover, OBBBA’s reforms merely slowed Medicaid’s growth rather than cutting spending (Figure 2).<br /><br />Medicaid is still projected to grow each year and will cost federal taxpayers roughly $8.3 trillion over the next decade. As the Paragon Health Institute has pointed out, this is still more than $1 trillion above the program’s cost trajectory based on CBO’s 2021 baseline.<br /><br /><strong>Further Reforms Are Necessary</strong><br /><br />Short of structural reform, Blase argued that Congress should address the worst distortions in the matching grant system. As he points out, “The federal government provides seven times more money for every dollar a state spends” on able-bodied adults in the Medicaid expansion than on the traditional population—low-income families, the disabled, and the elderly. This weakens state incentives to accurately verify able-bodied eligibility while encouraging them to misclassify traditional enrollees as expansion enrollees. Congress can address this by eliminating the enhanced federal match for the expansion population.<br /><br />At a minimum, Congress must enforce and implement OBBBA’s new limits on provider taxes and state-directed payments and resist pressure to delay or roll them back.<br /><br />Beyond incremental fixes, Congress should weigh the structural reforms the panel debated. All three panelists agreed that the status quo is unsustainable. As federal debt climbs, Medicaid’s price tag will make it among the first programs targeted for cuts. Acting now, while Congress still has options, is much more preferable to sudden, drastic reductions under worse conditions later.<br /><br />Medicaid’s fiscally unsound matching grant system is a choice Congress made when designing the program. It’s also one Congress can change by reforming it.<br /><br /><strong>Additional Resources:</strong><br /><br /><a title="Curbing Waste, Fraud, and Abuse in Federal Welfare Programs" href="https://www.cato.org/briefing-paper/curbing-waste-fraud-abuse-federal-welfare-programs" target="_blank" rel="noopener">Curbing Waste, Fraud, and Abuse in Federal Welfare Programs</a><br /><br /><a title="Cato Handbook for Policymakers: Medicaid and the Children’s Health Insurance Program" href="https://www.cato.org/cato-handbook-policymakers/cato-handbook-policymakers-9th-edition-2022/medicaid-childrens-health-insurance-program" target="_blank" rel="noopener">Cato Handbook for Policymakers: Medicaid and the Children’s Health Insurance Program</a><br /><br /><a title="Overcharged: Why Americans Pay Too Much for Health Care" href="https://store.cato.org/products/overcharged" target="_blank" rel="noopener">Overcharged: Why Americans Pay Too Much for Health Care</a><br /><br /><a title="Slowing Optional Medicaid Spending Growth" href="https://manhattan.institute/article/slowing-optional-medicaid-spending-growth" target="_blank" rel="noopener">Slowing Optional Medicaid Spending Growth</a><br /><br /><a title="A Plan to Make Medicaid Fair, Focused, and Accountable " href="https://manhattan.institute/article/a-plan-to-make-medicaid-fair-focused-and-accountable" target="_blank" rel="noopener">A Plan to Make Medicaid Fair, Focused, and Accountable </a><br /><br /><em>The authors would like to thank intern Eleanor Barrett for her contribution to this piece.</em>]]></content:encoded>
						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>10x25mm</dc:creator>
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                        <title>Wolves in White Coats: Hospitals Billed $ 120 Million For Juvenile Sex-change Procedures</title>
                        <link>https://mihealthfreedom.org/community/medicaid/wolves-in-white-coats-hospitals-billed-120-million-for-juvenile-sex-change-procedures/</link>
                        <pubDate>Sat, 15 Aug 2026 18:27:40 +0000</pubDate>
                        <description><![CDATA[The charges since 2019 included over 5,500 surgeries and 8,500 courses of hormones or puberty blockers, according to a new report commissioned by the Department of Health and Human Services ...]]></description>
                        <content:encoded><![CDATA[<p>The charges since 2019 included over 5,500 surgeries and 8,500 courses of hormones or puberty blockers, according to a new report commissioned by the Department of Health and Human Services (HHS).  The report is titled: <a title="Wolves In White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine&quot;" href="https://www.hhs.gov/sites/default/files/hhs-wolves-in-white-coats.pdf" target="_blank" rel="noopener">Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine"</a>.</p>
<p>Some providers used misleading or potentially fraudulent billing codes to get insurers to cover the interventions, according to HHS. The department identified nearly $ 50 million in claims for puberty blockers given to children aged nine to 17 under a general hormone-disorder code without a gender-related or early-puberty diagnosis on the same claim.<br /><br />Hospitals and clinics identified in the report have been referred to the Department of Justice and investigators from the Department of Health and Human Services (HHS) for potential violations of federal law. According to HHS, the observed billing patterns require additional investigation.<br /><br />Another $ 11 million was billed for puberty blockers for hundreds of patients aged 13 to 17 under a diagnosis for unusually early puberty. HHS said that this diagnosis does not apply at those ages.<br /><br />The report said the procedures offered hospitals a long-term source of revenue, as minors who begin hormone drugs can remain in medical care for years. Citing outside estimates, it put lifetime costs at up to $ 75,000 without surgery and as much as $ 170,000 when operations are included.</p>
<p>Here is the HHS Executive Summary of this 64 page report:</p>
<p>https://www.hhs.gov/sites/default/files/hhs-wolves-white-coats-executive-summary.pdf</p>
<p>https://www.hhs.gov/sites/default/files/hhs-wolves-in-white-coats.pdf</p>
<p></p>
<strong>Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine”</strong><br />A report commissioned by the U.S. Department of Health and Human Services<br />
<p><strong>EXECUTIVE SUMMARY</strong></p>
<p>In the 2010s, financial incentives contributed to the rapid expansion of pediatric gender clinics and programs by creating long-term revenue opportunities for these medical establishments. Unlike most traditional pediatric services, which involve episodic or short‑term care, children receiving puberty blockers, cross-sex hormones, surgeries, and related services may require recurring endocrinology visits, laboratory monitoring, prescriptions, mental‑health services, surgical procedures, and follow‑up care extending into adulthood. This pediatric medical field effectively creates “captive patients.”</p>
<p>All‑payer claims and cost data indicate nearly $120 million in billed charges for sex‑rejecting procedures involving minors since 2019. These charges include more than 5,500 surgical procedures and 8,500 courses of hormones or puberty blockers. The analysis concludes that these continuing interventions have created financially valuable patient populations for hospitals and associated specialties.</p>
<ul>
<li>Cross-sex hormone therapy entails average yearly payer costs per patient ranging between $545 (androgens), $735 (estrogens), and $16,385 (for the more costly puberty-blocker GnRH). Surgical interventions, such as mastectomies, mammoplasties, and phalloplasties, can range from $12,000 to over $130,000.</li>
</ul>
<p><strong>Potentially Fraudulent Medical Coding</strong></p>
<p>An analysis of the data suggests that some providers may have used diagnosis codes that did not accurately reflect patients' underlying conditions in order to obtain insurance coverage for sexrejecting procedures, particularly with ICD-10 code E34.9 (“endocrine disorder, unspecified”) and the ICD-10 codes for central “precocious puberty.”</p>
<ul>
<li>Between 2015 – 2025, public and private insurance was billed nearly $50 million for puberty blocking drugs in patients aged 9-17 with Endocrine Disorder diagnoses (excluding precocious puberty, the typical indication for puberty blockers).</li>
<li>During this same timeframe, nearly $11 million was billed for puberty blockers, including to Medicaid and Medicare, for hundreds of patients between the age of 13 and 17 with a diagnostic code for precious puberty. By definition, anyone 13 or older cannot have a diagnosis of precocious puberty and should not be given puberty blockers at that age for this indication</li>
</ul>
<p><strong>Federal Policy and Institutional Pressure</strong></p>
<p>The Biden Administration, particularly HHS, under the leadership of Secretary Becerra and Admiral Levine, contributed to the expansion and normalization of sex-rejecting interventions through nondiscrimination policies, insurance requirements, agency guidance, litigation positions, federal employee benefits, and other federal programs.</p>
<p><strong>Influence of Professional Medical Organizations</strong></p>
<p>Organizations like World Professional Association for Transgender Health, the Endocrine Society, the American Psychological Association, and the American Academy of Pediatrics contributed to the promotion of pediatric sex-rejecting interventions, even while undercutting their own evidence base. This professional network created an institutional environment in which sex-rejecting medical interventions became increasingly accepted, while opposing clinical perspectives, uncertainties, and potential risks that caused irreversible damage received insufficient consideration.</p>
<p><strong>Patient and Parent Experiences</strong></p>
<p>Eight first-hand testimonies from patients and parents illustrate weakness in clinical safeguards and informed-consent processes. Common themes include distress related to a child’s sex and rapid medical interventions, insufficient examination of underlying psychological, developmental, social, or trauma-related factors, limited discussion of irreversible damage, pressure placed on parents to<br />approve “treatment,” adverse physical and psychological outcomes, and difficulty obtaining appropriate medical care after stopping treatment or detransitioning. These testimonies underscore the imbalance between the structured healthcare pathways available for initiating medical transition and the comparatively limited clinical infrastructure available to patients seeking to discontinue treatment, address complications, or detransition.</p>
<p><strong>Conclusion</strong></p>
<p>The expansion of pediatric sex-rejecting procedures resulted from an interaction among financial incentives, potentially illegal billing practices, ideological and professional influences, federal policy, and inadequate oversight. The medical establishment and the government failed innocent children. This report exposes how these calculated financial and political efforts left children irreversibly harmed and abandoned at the very moments when they needed real support.</p>
<div id="wpfa-16010" class="wpforo-attached-file"><a class="wpforo-default-attachment" href="//mihealthfreedom.org/wp-content/uploads/wpforo/default_attachments/1786818636-Wolves-in-White-Coats_How-Doctors-and-Hospitals-Pushed-and-Profited-from-the-Fraud-of-Gender-Medicine-by-HHS.pdf" target="_blank" title="Wolves-in-White-Coats_How-Doctors-and-Hospitals-Pushed-and-Profited-from-the-Fraud-of-Gender-Medicine-by-HHS.pdf"><i class="fas fa-paperclip"></i>&nbsp;Wolves-in-White-Coats_How-Doctors-and-Hospitals-Pushed-and-Profited-from-the-Fraud-of-Gender-Medicine-by-HHS.pdf</a></div>]]></content:encoded>
						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>10x25mm</dc:creator>
                        <guid isPermaLink="true">https://mihealthfreedom.org/community/medicaid/wolves-in-white-coats-hospitals-billed-120-million-for-juvenile-sex-change-procedures/</guid>
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                        <title>Nearly Half of Medicaid Expansion Enrollees Do Not Meet Eligibility Requirements</title>
                        <link>https://mihealthfreedom.org/community/medicaid/nearly-half-of-medicaid-expansion-enrollees-do-not-meet-eligibility-requirements/</link>
                        <pubDate>Fri, 07 Aug 2026 01:03:38 +0000</pubDate>
                        <description><![CDATA[Paragon Health Institute has done a deep dive into the Medicaid expansion, circa 2024.  Paragon researcher Liam Sigaud found that 9.2 million people - assuming a 70% Take Up Rate - do not me...]]></description>
                        <content:encoded><![CDATA[<p>Paragon Health Institute has done a deep dive into the Medicaid expansion, circa 2024.  Paragon researcher Liam Sigaud found that 9.2 million people - assuming a 70% Take Up Rate - do not meet federal requirements to qualify for enrollment under the Obamacare Medicaid expansion program.  Michigan's share of that total is 248,240 improper enrollees, about 33.5% of our 740,441 expansion enrollment.  Table 1, attached, is the money shot.</p>
<p>New York and California have the largest numbers of ineligible enrollees.  Approximately 62% of people enrolled in California are not eligible.  A thirty-five page report, so here are the <em>Executive Summary, Introduction, </em>and<em> Conclusion</em>:</p>
<p>https://paragoninstitute.org/medicaid/medicaid-expansions-growing-improper-enrollment-crisis-nearly-half-of-expansion-enrollees-likely-do-not-meet-eligibility-requirements/</p>
<p>https://paragoninstitute.org/wp-content/uploads/securepdfs/2026/08/Growing-Improper-Enrollment-Crisis_RELEASE_V4.pdf</p>
<p></p>
<p><strong>EXECUTIVE SUMMARY</strong><br /><strong>What This Paper Covers</strong><br /><br />This paper examines improper enrollment in the Medicaid expansion under the Affordable Care Act (ACA) in 2024. It builds on Paragon Health Institute’s earlier research, “Ineligible Enrollment in the ACA’s Medicaid Expansion: Evidence, Costs, and Remedies,” which estimated that roughly one in three expansion enrollees—4.9 million people—did not qualify for the program in 2019. With states’ post-COVID eligibility redeterminations now complete, this paper provides the first comprehensive assessment of how improper expansion enrollment has evolved since the pandemic.<br /><br />Using Census Bureau’s American Community Survey (ACS) data, administrative enrollment data from the Medicaid Budget and Expenditure System (MBES), and per-enrollee spending figures from the Medicaid and CHIP Payment and Access Commission (MACPAC), the paper compares actual enrollment in the expansion group at the state level against estimates of the number of eligible individuals plausibly enrolled. The difference between the two reflects improper enrollment. Improper enrollees include people receiving expansion coverage despite income above the eligibility limit; people failing to meet citizenship, immigration, or residency requirements; and people who are qualified for Medicaid through traditional pathways.<br /><br />The paper also examines:</p>
<ul>
<li>the structural features of Medicaid expansion’s financing—including the 9:1 federal match rate and state financing schemes such as provider taxes—that weaken states’ incentives to ensure proper eligibility determinations;</li>
<li>the fiscal costs of improper enrollment for the federal government and the states, including the cost-shifting produced when traditional enrollees are misclassified into the expansion group;</li>
<li>how improper enrollment changed between 2019 and 2024 both nationally and state by state; and</li>
<li>post-unwinding enrollment trends, which show that expansion enrollment remains far above pre-pandemic levels even as traditional Medicaid enrollment has largely returned to pre-pandemic levels.</li>
</ul>
<strong>What We Found and What It Matters</strong><br /><br />Improper enrollment in Medicaid expansion is widespread, and it has grown dramatically worse since 2019. Under my central assumption of a 70 percent take-up rate among eligible individuals, I estimate that 9.2 million expansion enrollees—nearly half (46 percent)—were likely ineligible for the program in 2024. That is an 88 percent increase from the 4.9 million improper enrollees I estimated for 2019, when the ineligible share was 33 percent. The finding of substantial improper enrollment is robust to alternative assumptions: Even under an implausible 100 percent take-up rate—a theoretical lower bound—more than a quarter of expansion enrollees (5.2 million people) appear ineligible.<br /><br />The fiscal consequences are severe. I estimate that improper expansion enrollment cost the federal government approximately $32.9 billion in 2024—about 6 percent of all federal Medicaid spending. California alone accounts for $10.4 billion in federal costs. Using a consistent methodology used in a previous Paragon analysis, I estimate that the federal costs stemming from improper expansion enrollment more than doubled from 2019 to 2024. Because roughly one-third of improper enrollees appear to be individuals who qualify for Medicaid through traditional pathways but were misclassified into the higher-match expansion group, states collectively saved an estimated $6.8 billion — a direct illustration of the perverse incentives built into the program’s financing.<br /><br />Improper enrollment is a nationwide problem, but a handful of states drive a disproportionate share. California alone accounts for roughly 3.1 million improper enrollees—about one-third of the national total—with an estimated ineligible rate of 62 percent. I also find substantial levels of improper enrollment in New York, Louisiana, Oregon, and Washington. Yet the deterioration is broad-based: Of the 32 states that had expanded Medicaid before 2019, improper enrollment increased in 31, and 36 of the 41 expansion states (including the District of Columbia) show detectable improper enrollment in 2024.<br /><br />These patterns are consistent with the structural incentives facing states. Because the federal government pays at least 90 percent of expansion costs—far above the roughly 60 percent average match for traditional enrollees—states bear almost none of the cost of improper expansion enrollment while reaping the political—and potentially economic—benefits of higher enrollment and more federal funding. The post-pandemic unwinding illustrates the consequences: By mid-2025, traditional Medicaid enrollment had returned close to pre-pandemic levels, but expansion enrollment remained 21 percent above its January 2020 level. The COVID-era enrollment surge in the expansion group, in other words, never reversed.<br /><br />Improper enrollment is not a victimless accounting problem. It diverts resources from the vulnerable populations Medicaid was designed to serve—children, pregnant women, the elderly, and people with disabilities—strains the health system, erodes public trust, and imposes tens of billions of dollars in improper costs on federal taxpayers each year.<br /><br /><strong>What We Recommend</strong><br /><br />Congress and the Trump administration have taken important initial steps through the One Big Beautiful Bill (OBBB) of 2025, which will require six-month eligibility redeterminations for expansion adults beginning in 2027, phase-down provider taxes and state-directed payments beginning in 2028 and impose financial penalties on states with high eligibility-related payment error rates beginning in 2030. These are meaningful guardrails, but their impact depends heavily on state implementation and federal commitments to ongoing oversight—and the estimates in this paper, based on 2024 data, predate these reforms.<br /><br />Policymakers should go further to remove improper enrollees and stem the flow of new improper enrollees into the program, including taking the following actions:<br />
<ul>
<li>Rectifying the central structural flaw in Medicaid financing by reducing the 90 percent federal matching rate for expansion enrollees to the rate states receive for traditional enrollees, ensuring that improper enrollment imposes real costs on state budgets</li>
<li>Strengthening income verification at enrollment by tightening “reasonable compatibility” thresholds for self-attestation and broadening real-time wage and income data checks</li>
<li>Eliminating the federal requirement that states conduct passive (</li>
<li>Extending the Payment Error Rate Measurement (PERM) program by requiring independent, annual eligibility audits in every state, enabling swifter penalties and corrective action</li>
</ul>
<p>Without structural reform—including, above all, reforms to the financing arrangement that insulates states from the costs of their own eligibility failures—improper enrollment is likely to remain an embedded feature of Medicaid expansion rather than an isolated anomaly.</p>
<p><strong>INTRODUCTION</strong></p>
<p>The expansion of Medicaid under the ACA, broadly implemented in 2014, has become a central feature of the U.S. health system, covering about 10 percent of non-elderly adults.1 Yet the program is marred by high taxpayer costs, mediocre health outcomes,2 and pervasive deficiencies in program integrity.3 Enrollment in the expansion group has far exceeded initial projections, prompting concerns that large numbers of people who do not qualify for Medicaid may be receiving benefits under the ACA’s expansion.4 Enrollees can be ineligible for expansion coverage for a variety of reasons, including having income in excess of eligibility limits, failing to meet requirements related to citizenship/immigration status or state residency, or qualifying for Medicaid through traditional pathways. Whatever the reason, improper enrollment erodes public trust in government, diverts resources away from intended beneficiaries, and imposes unwanted costs on taxpayers.<br /><br />There are strong reasons to believe that Medicaid expansion may be particularly vulnerable to this type of abuse. The structural design of the program encourages lax eligibility enforcement. One of the core flaws is that while the states are responsible for monitoring their Medicaid rolls and preventing improper enrollment, the fiscal costs of improper enrollment are paid almost entirely by the federal government, which covers at least 90 percent of the cost of expansion enrollees—far more than the approximately 60 percent average federal match states receive for traditional enrollees such as low-income children and people with disabilities.5 As a result, when ineligible individuals receive benefits through the expansion group, states bear almost none of the cost.6 Furthermore, high enrollment under Medicaid expansion—regardless of enrollees’ true eligibility—delivers political benefits to state policymakers. These misaligned incentives are compounded by financing arrangements—such as provider taxes and intergovernmental transfers—that allow states to capture additional federal matching dollars while further reducing their effective share of program costs. Under the ACA’s 90 percent federal reimbursement rate, the rate of return on these financing schemes is roughly six times higher for expansion enrollees than for the traditional Medicaid population. These two factors raise serious concerns that states may not adequately invest in program integrity measures.<br /><br />The same incentive structure also creates fiscal motives for states to misclassify individuals eligible for Medicaid under traditional pathways into the expansion group. Because the federal match for expansion enrollees is roughly 30 percentage points higher than the average for traditional enrollees, states stand to save thousands of dollars per enrollee per year by placing them in the expansion group. Research suggests these reclassifications may be widespread, affecting millions of enrollees and substantially inflating federal Medicaid spending.7<br /><br />Federal investigations into expansion states’ Medicaid records provide direct evidence of improper enrollment in the expansion group. In an audit of New York’s Medicaid program, investigators reviewed eligibility documentation for a random sample of Medicaid enrollees New York had classified as belonging to the expansion group and for whom New York had received federal funding. The review found that 28 percent of these enrollees were ineligible.8 Similar audits in California9 and Colorado10 found that 18 percent and 23 percent, respectively, of randomly sampled enrollees in the expansion group were ineligible. In some states, auditors identified large numbers of additional enrollees who, based on incomplete records, may not have met Medicaid eligibility requirements.11<br /><br />Additional evidence of improper enrollment in the expansion group comes from statistical studies using publicly available data on income, family composition, and Medicaid enrollment. Using 2012–2017 Census Bureau data, one study showed that Medicaid take-up after the ACA’s implementation rose not just among eligible adults but also among those above the income threshold. The analysis suggested approximately 522,000 seemingly income-ineligible enrollees across nine expansion states.12 Because the study focused on a small subset of expansion states in the early years of the expansion, its results likely severely underestimate the current scale of improper enrollment nationally. A broader study using a similar methodology uncovered “egregious eligibility errors in many states,” including between 2.23 million and 3.25 million improper Medicaid expansion enrollees who had income above the eligibility threshold in 2017.13<br /><br />Last year, the Paragon Health Institute published the most recent quantitative assessment of the scope of improper enrollment under Medicaid expansion. Combining actual enrollment in the expansion group with an estimate of the number of eligible people plausibly enrolled derived from Census Bureau data, I calculated that approximately one in three expansion enrollees—4.9 million people—likely did not qualify for the program in 2019, imposing an annual cost to the federal government of $23.8 billion in improper Medicaid spending.14 The report also used the estimated rate of improper enrollment in each state in 2019 to generate estimates of improper enrollment in 2024. The extrapolation yielded an estimated 6.6 million improper enrollees in 2024 and a federal cost of $36.9 billion.<br /><br />Applying a similar methodology to more recent data, this paper estimates the magnitude of improper expansion enrollment in 2024. As enrollment in the expansion group has grown (from 14.7 million in 2019 to 20.2 million in 2024), my central estimate implies that improper enrollment has surged to nearly one in two expansion enrollees in 2024. Large increases in per-enrollee costs have further amplified the fiscal consequences, imposing additional Medicaid costs on the federal government of approximately $54.3 billion in 2024—more than double what the federal government spent on improper enrollees in 2019.15 Using a more expansive methodology that accounts for spillover effects of improper Medicaid enrollment on the ACA exchanges, I estimate that the net federal cost of improper expansion enrollment was approximately $32.9 billion in 2024.16 Moreover, the updated 2024 results presented in this paper substantially exceed the extrapolated 2024 estimates cited above from my prior analysis, indicating that program integrity has deteriorated since 2019.</p>
<p>&lt;Snip&gt;</p>
<p><strong>CONCLUSION</strong></p>
<p>The harm from improper enrollment extends beyond the federal budget. Improper expansion enrollees crowd out intended beneficiaries, including the traditional Medicaid population—children, pregnant women, the elderly, and people with disabilities—for whom the program was originally designed. Studies have documented that expansion exacerbated health system strain, resulting in longer waits for medical appointments, reduced health spending on low-income children, and worse access to emergency care.25 Restoring eligibility integrity to Medicaid expansion is not merely a matter of fiscal responsibility; it is a matter of fairness to the vulnerable populations that the program was built to serve.</p>
<p>&lt;Snip&gt;</p>
<div id="wpfa-16007" class="wpforo-attached-file"><a class="wpforo-default-attachment" href="//mihealthfreedom.org/wp-content/uploads/wpforo/default_attachments/1786064618-Paragon-Medicaid-Enrollment-Study-Table1-Estimated-Improper-Medicaid-Enrollment-By-State-2024.jpg" target="_blank" title="Paragon-Medicaid-Enrollment-Study-Table1-Estimated-Improper-Medicaid-Enrollment-By-State-2024.jpg"><i class="fas fa-paperclip"></i>&nbsp;Paragon-Medicaid-Enrollment-Study-Table1-Estimated-Improper-Medicaid-Enrollment-By-State-2024.jpg</a></div>]]></content:encoded>
						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>10x25mm</dc:creator>
                        <guid isPermaLink="true">https://mihealthfreedom.org/community/medicaid/nearly-half-of-medicaid-expansion-enrollees-do-not-meet-eligibility-requirements/</guid>
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                        <title>Michigan WIC Program Income Limit Raised $ 1,500</title>
                        <link>https://mihealthfreedom.org/community/medicaid/michigan-wic-program-income-limit-raised-1500/</link>
                        <pubDate>Thu, 06 Aug 2026 09:05:38 +0000</pubDate>
                        <description><![CDATA[The Michigan Department of Health and Human Services (MDHHS) just raised the income limit for the U.S. Department of Agriculture&#039;s (USDA) Women, Infants, and Children (WIC) Program by $ 1,50...]]></description>
                        <content:encoded><![CDATA[<p>The Michigan Department of Health and Human Services (MDHHS) just raised the income limit for the U.S. Department of Agriculture's (USDA) Women, Infants, and Children (WIC) Program by $ 1,500:</p>
<p>https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2026/08/05/wic-revised-income-guidelines</p>
<p></p>
<p><strong>Michigan WIC Program increases income threshold, more families may now qualify</strong><br />By Laina Stebbins - August 05, 2026<br /><br />The income guidelines for the Michigan Women, Infants, and Children (WIC) Program were recently adjusted due to federal guidelines, and more Michigan families may now qualify for benefits. Under the updated WIC income eligibility guidelines, a family of four can now qualify with an annual income of up to $61,050, an increase of more than $1,500. <br /><br />WIC, a U.S. Department of Agriculture (USDA) program administered by the Michigan Department of Health and Human Services (MDHHS), provides vital support to families by offering supplemental foods, nutrition education, breastfeeding support and referrals to health and social services. WIC serves low- and moderate-income pregnant, breastfeeding and postpartum women, infants and children under age 5.<br /><br />“MDHHS is committed to helping residents put food on the table for their families,” said Amy Epkey, MDHHS acting director. “Individuals in need of assistance who were not eligible in the past are encouraged to check the updated WIC income eligibility guidelines to see if they now qualify.” <br /><br />WIC has been demonstrated to lessen the number of fetal deaths, reduce infant mortality, decrease low birth weight deliveries, lower the prevalence of iron deficiency anemia and increase immunization rates. <br /><br />Each month, approximately 187,000 Michigan residents benefit from WIC services, helping families access the resources they need to remain healthy and strong. In addition to improving health outcomes, WIC contributes to local economies by supporting Michigan retailers and farmers. <br /><br />“For more than 50 years, WIC has helped families build healthier futures by providing nutritious foods, nutrition education and personalized support during pregnancy and early childhood,” said Christina Herring, Michigan WIC Program director. “With the recent income guideline adjustments, even more Michigan families may now be eligible for these important services. We encourage anyone who is pregnant, has young children or is caring for an infant to check their eligibility and discover how WIC can make a meaningful difference for their family.” <br /><br />To learn more or start your application, visit Michigan.gov/WIC or download the free WIC Connect app. <br /><br />USDA is an equal opportunity provider, employer, and lender.</p>]]></content:encoded>
						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>10x25mm</dc:creator>
                        <guid isPermaLink="true">https://mihealthfreedom.org/community/medicaid/michigan-wic-program-income-limit-raised-1500/</guid>
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                        <title>MDHHS Notifies Michigan Medicaid Recipients of 2027 Eligibility Changes</title>
                        <link>https://mihealthfreedom.org/community/medicaid/mdhhs-notifies-michigan-medicaid-recipients-of-2027-eligibility-changes/</link>
                        <pubDate>Thu, 23 Jul 2026 13:14:52 +0000</pubDate>
                        <description><![CDATA[The Michigan Department of Health and Human Services (MDHHS) is warning Medicaid recipients of the new CY 2027 eligibility requirements established by the OBBBA of 2025:]]></description>
                        <content:encoded><![CDATA[<p>The Michigan Department of Health and Human Services (MDHHS) is warning Medicaid recipients of the new CY 2027 eligibility requirements established by <a title="White House CEA White Paper On H.R.1 of 2025, the One Big Beautiful Bill Act" href="https://www.whitehouse.gov/wp-content/uploads/2025/03/The-One-Big-Beautiful-Bill-Legislation-for-Historic-Prosperity-and-Deficit-Reduction-1.pdf" target="_blank" rel="noopener">the OBBBA of 2025</a>:</p>
<p>https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2026/07/23/medicaid-work</p>
<p></p>
<p><strong>MDHHS alerts Healthy Michigan Plan beneficiaries of steps to prepare for federally required changes to Medicaid</strong><br />By Lynn Sutfin - July 23, 2026<br /><br /><em>State working to ensure families keep their health care coverage</em> <br /><br />LANSING, Mich. - The Michigan Department of Health and Human Services (MDHHS) is preparing to implement federally required changes to Medicaid due to the passage of H.R. 1. Among the changes are new work requirements and more frequent eligibility checks for some individuals enrolled in the Healthy Michigan Plan (HMP). <br /><br />“Health care coverage plays a critical role in helping people access preventative care, manage chronic conditions and stay healthy,” said Amy Epkey, MDHHS acting director. “Our priority is helping beneficiaries understand these new requirements so they can comply and we can keep as many eligible Michiganders covered as possible.” <br /><br />Beginning in January 2027, certain HMP members between the ages of 19 and 64 may need to meet new work requirements or qualify for an exemption to maintain coverage. People who are not exempt will be able to meet the requirements through various approved activities including working, volunteering, going to school or participating in a work program. Most HMP beneficiaries will also transition from annual renewals to six-month renewals. <br /><br />Individuals who qualify for an exemption will not be subject to the new work requirements. Exemptions include, but are not limited to, women who are pregnant or newly postpartum, American Indians and Alaska Natives, some individuals with complex health needs and certain caregivers. <br /><br />“Even with these new federal bureaucratic hoops, no one should assume they will lose coverage,” said Meghan Groen, MDHHS Health Services chief deputy director and state Medicaid director. “Many who need to meet this new eligibility requirement may already be doing so through work, school or other approved activities. Many others may qualify for an exemption.”<br /><br />MDHHS is reviewing newly released federal guidance and working to update systems, train staff and develop educational materials to prepare for these changes. As part of that effort, MDHHS has launched a community partner toolkit with resources organizations can use to share information with constituents and help beneficiaries prepare for these upcoming changes. MDHHS has also launched a public awareness campaign and plans to further expand outreach efforts as implementation of Medicaid changes approach. <br /><br />Implementation of the new rules will happen over time and not everyone will be affected right away. HMP beneficiaries will receive information and notices as changes approach and additional details become available. <br /><br />At this time, MDHHS encourages anyone with Medicaid coverage to: </p>
<ul>
<li>Make sure their information is current in their MI Bridges account.</li>
<li>Watch for and read notices from MDHHS regarding their health care coverage.</li>
<li>Respond promptly to any requests for information from MDHHS.</li>
<li>Visit Michigan.gov/HMP for updates and additional information about work requirements.</li>
</ul>
MDHHS will continue providing updates as planning for these changes progresses and additional details become available.]]></content:encoded>
						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>10x25mm</dc:creator>
                        <guid isPermaLink="true">https://mihealthfreedom.org/community/medicaid/mdhhs-notifies-michigan-medicaid-recipients-of-2027-eligibility-changes/</guid>
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                        <title>HHS Pauses $ 1 Billion In Payments to California &amp; Minnesota</title>
                        <link>https://mihealthfreedom.org/community/medicaid/hhs-pauses-1-billion-in-payments-to-california-minnesota/</link>
                        <pubDate>Tue, 21 Jul 2026 16:52:36 +0000</pubDate>
                        <description><![CDATA[Secretary Robert F. Kennedy, Jr. announced today that $ 1 billion in Medicaid payments to the states of California and Minnesota would be paused due to fraud and noncompliance:]]></description>
                        <content:encoded><![CDATA[<p>Secretary Robert F. Kennedy, Jr. announced today that $ 1 billion in Medicaid payments to the states of California and Minnesota would be paused due to fraud and noncompliance:</p>
<p>https://www.reuters.com/world/us-health-secretary-kennedy-says-cms-is-pausing-medicaid-payments-california-2026-07-21/</p>
<p></p>
<p><strong>Trump administration pauses $1 billion in Medicaid payments to California, Minnesota</strong><br />By Ahmed Aboulenein - July 21, 2026</p>
<p>WASHINGTON, July 21 (Reuters) - The Trump administration is ​pausing over $1 billion in Medicaid payments to California ‌and Minnesota "because of suspected fraud and noncompliance," U.S. Health Secretary Robert F. Kennedy, Jr. said on Tuesday.</p>
<p>"If those ​states want that money they need to provide ​documentations that these payments are legitimate," Kennedy ⁠said at a news conference alongside CMS Administrator Dr. ​Mehmet Oz.</p>
<p>The pause is the latest in a ​series of payment suspensions mostly at Democratic-run states as Vice President JD Vance, Kennedy, and Oz spearhead a campaign ​the White House has called an "unrelenting" war on ​fraud.</p>
<p>Kennedy said the administration suspects that much of the questionable spending ‌in ⁠California involves in-home services, and 14 high risk areas that Minnesota's own legislative auditor identified as vulnerable to fraud.</p>
<p>Oz and Kennedy did not provide ​evidence of ​the alleged ⁠fraud.</p>
<p>Kennedy said he was also expanding exclusion authority both to the Centers ​for Medicare and Medicaid Services and ​the health ⁠department's Office of the Inspector General, allowing them to remove "bad actors" from federal healthcare programs and potentially ⁠ban ​them permanently from returning.</p>]]></content:encoded>
						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>10x25mm</dc:creator>
                        <guid isPermaLink="true">https://mihealthfreedom.org/community/medicaid/hhs-pauses-1-billion-in-payments-to-california-minnesota/</guid>
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                        <title>AG Nessel charges 4 in federal healthcare fraud sweep</title>
                        <link>https://mihealthfreedom.org/community/medicaid/ag-nessel-charges-4-in-federal-healthcare-fraud-sweep/</link>
                        <pubDate>Tue, 14 Jul 2026 22:42:10 +0000</pubDate>
                        <description><![CDATA[Hawaii was first to get its Medicaid anti-fraud funds cut by the Feds for failure to perform. New York is the latest.
Fair to say Michigan&#039;s leadership doesn&#039;t want to be next?
I&#039;d say so.]]></description>
                        <content:encoded><![CDATA[<p>Hawaii was first to get its Medicaid anti-fraud funds cut by the Feds for failure to perform. New York is the latest.</p>
<p>https://mihealthfreedom.org/community/medicaid/hhs-ig-moves-to-defund-nyss-lackadaisical-medicaid-anti-fraud-unit/#post-3111</p>
<p>Fair to say Michigan's leadership doesn't want to be next?</p>
<p>I'd say so.</p>
<p>https://www.michigancapitolconfidential.com/news/ag-nessel-charges-4-in-federal-healthcare-fraud-sweep</p>
<p></p>
<p><span style="font-size: 14pt"><strong>AG Nessel charges 4 in federal healthcare fraud sweep</strong></span></p>
<p><span style="font-size: 12pt"><strong>Detroit outreach worker charged with improperly taking $234K in autism funds</strong></span></p>
<p>Scott McClallen | July 8, 2026<br /><br />Michigan Attorney General Dana Nessel announced criminal charges against four Michigan individuals in June as part of the U.S. Department of Justice’s National Health Care Fraud Takedown.<br /><br />The campaign is a nationwide law enforcement action targeting healthcare fraud. In most cases, the defendants are accused of billing taxpayers for goods or services that were never provided.<br /><br />“Our Health Care Fraud Division works every single day to protect the hard-earned money of Michiganders from Medicaid fraud,” Nessel announced June 23. “They do exceptional work delivering for our residents, and these four cases are no exception. We will continue to protect taxpayer dollars and this vital program.”<br /><br />The four Michigan cases include:<br /><br />Wayne White, 63, of Detroit, was charged with three felony counts of larceny by conversion – $20,000 or more, in the 36th District Court in Detroit. Each count carries up to 10 years in prison. Between August 2024 and April 2025, it is alleged White, while working as a part-time community outreach contractor for Detroit Wayne Integrated Health Network, improperly received more than $234,000 intended for autism services.<br /><br />Claudia Payne, 47, of Mt. Pleasant, was charged with five felony counts of Medicaid Fraud — False Claim in the 54B District Court in East Lansing. Each count is punishable by up to four years in prison. The state alleges that Payne was paid by Medicaid to provide caretaking services for an elderly disabled man in Mt. Pleasant between October 2023 and November 2024. Despite receiving payment, Payne allegedly failed to provide these services and left the victim severely neglected.<br /><br />Kurt Hammond, 56, of Ann Arbor, was charged with one count of Medicaid Fraud — False Claim in the 54B District Court in East Lansing. Hammond, a pharmacist at Central Pharmacy located in Lansing from 2020 to 2024, allegedly dispensed and billed for a significant number of female condoms that the pharmacy never acquired from any wholesaler.<br /><br />John Kempainen, 43, of Oak Park, was charged with six counts of Medicaid Fraud — False Claim in the 54B District Court in East Lansing. Kempainen allegedly billed Medicaid for care he agreed to provide to a vulnerable adult who lived alone in a senior living complex in Oak Park. Kempainen reportedly failed to provide any care for her for at least four months between February 2026 and June 2026, when he was living out of state.<br /><br />These cases are being handled by the Department of Attorney General’s Health Care Fraud Division. The cases against Hammond and Kempainen will be prosecuted by Assistant Attorney General Dennis Pheney Jr., while Division Chief David Tanay will prosecute the cases against Payne and White.<br /><br />As part of the federal sweep, the U.S. Department of Justice’s Eastern District of Michigan has also charged seven individuals and extracted a $1.9 million fine from McLaren Health Care Corporation to resolve a False Claims Act lawsuit. Among neighboring states, Illinois saw the highest number of prosecutions, with 16 people charged by the state and two by federal prosecutors. In Indiana, eight people are facing state charges, while Wisconsin saw two people charged by the state and three by the federal government. Eight Ohioans have been charged by the state and one by the Justice Department.<br /><br />One way to commit healthcare fraud is by abusing programs meant to help people who are on the autism spectrum. From October through January 2025, 10 prepaid inpatient health plans in Michigan cost more than $130 million, according to a March 1, 2025, report. Many of those services are legitimate, but some aren’t.<br /><br />In June, the state charged a dentist with 43 felony counts of Medicaid fraud for allegedly billing the state for dental procedures she never performed.<br /><br />The Health Care Fraud Division is the federally certified Medicaid Fraud Control Unit for Michigan, and it receives 75% of its funding from the U.S. Department of Health and Human Services under a grant award totaling $5.5 million for fiscal year 2026. The remaining 25%, totaling $1.8 million, comes from the state budget.</p>
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						                            <category domain="https://mihealthfreedom.org/community/medicaid/">Medicaid</category>                        <dc:creator>Abigail Nobel</dc:creator>
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