Medicaid HCBS Program Integrity Strategies
Article Publication Date
Summary
Home and Community-Based Services (HCBS) represent vital components of Medicaid, enabling millions of people with
disabilities and those who are aging to live and thrive in their communities. Effective oversight must balance robust
strategies to detect, deter, and pursue instances of fraud, waste, and abuse with sophisticated strategies that reflect the
nature of the services provided, including instances where providers may provide 24/7 support for people with
significant disabilities.
This brief, developed by ADvancing States, the National Association of Medicaid Directors (NAMD), and the National
Association of State Directors of Developmental Disabilities Services (NASDDDS), highlights strong program integrity
tools that states may consider deploying to prevent, detect, and act upon instances of fraud, waste, and abuse within
Medicaid HCBS. We acknowledge that some of the strategies suggested may require additional staff or technical
resources. Additionally, implementing these recommendations will likely require capacity building and cross-agency
collaboration. ADvancing States, NAMD, and NASDDDS stand ready to support states in assessing their system capacity
and identifying the highest-impact, most feasible interventions for their systems.
disabilities and those who are aging to live and thrive in their communities. Effective oversight must balance robust
strategies to detect, deter, and pursue instances of fraud, waste, and abuse with sophisticated strategies that reflect the
nature of the services provided, including instances where providers may provide 24/7 support for people with
significant disabilities.
This brief, developed by ADvancing States, the National Association of Medicaid Directors (NAMD), and the National
Association of State Directors of Developmental Disabilities Services (NASDDDS), highlights strong program integrity
tools that states may consider deploying to prevent, detect, and act upon instances of fraud, waste, and abuse within
Medicaid HCBS. We acknowledge that some of the strategies suggested may require additional staff or technical
resources. Additionally, implementing these recommendations will likely require capacity building and cross-agency
collaboration. ADvancing States, NAMD, and NASDDDS stand ready to support states in assessing their system capacity
and identifying the highest-impact, most feasible interventions for their systems.