RFK Jr.'s Medicaid Fraud Claim Targets Disabled Children's Caregivers

Robert F. Kennedy Jr. stood before a House committee in April and told the country that families getting paid to care for their disabled relatives are defrauding Medicaid. In Starr County, where more than a dozen home health agencies employ local residents and a third of families already live below the poverty line on a median household income near $38,000 a year, that accusation lands differently than it does in Washington.

Kennedy singled out programs that pay relatives to care for disabled or elderly family members, describing the arrangement as compensation for tasks people "used to do as family members for free," citing examples like balancing a checkbook or driving someone to a doctor's appointment. "This is rife with fraud," he said, arguing that the federal government has no reliable way to verify whether the paid duties actually happen.

More than 11 million Americans currently receive payment through programs of this kind, according to recent research, a population far larger than the isolated fraud cases that have drawn prosecution. Meanwhile, more than 600,000 disabled and elderly people sit on waitlists nationwide for home care services, and a chronic shortage of professional caregivers, driven by low wages and difficult conditions, has left many rural families with no alternative but to provide the care themselves.

The comment reduces a complex caregiving relationship to bookkeeping errands, and that reduction has drawn sharp rebuke from disability advocates. Families managing children with significant medical needs describe a daily routine that bears little resemblance to picking up groceries. Administering medication on schedule, operating and troubleshooting medical equipment, coordinating between insurers, therapists, and specialists, and recognizing the early signs of a respiratory crisis or a behavioral episode require a level of vigilance closer to clinical work than domestic assistance. Many parents leave jobs entirely to provide it, not because the work is easy, but because no outside caregiver matches a parent's accumulated knowledge of a child's specific patterns.

Kennedy's framing also runs against the available evidence on how these programs function fiscally. Federal rules require states to show that optional services like home and community-based care cost less than the alternative before those programs get approved, and nursing homes and other institutional settings generally carry far higher price tags than paying a relative to provide equivalent care at home. That math is part of why both Republican and Democratic state governments have expanded these waiver programs over the past two decades. Disability rights groups have pointed out that destabilizing the system does not eliminate the underlying need; it simply shifts people into institutional care that costs Medicaid more.

Federal and state prosecutors have pursued and won cases against operators who billed for home care services never rendered, some involving tens of millions of dollars. But advocates note that states already require documentation and training for family caregivers, undercutting Kennedy's claim that there is no mechanism to confirm the work occurred. Painting an entire system as fraudulent because some actors have exploited it conflates a real problem with a much larger population of families doing exactly what the program intends.

Lawmakers in several states have begun reconsidering home and community-based services funding as they brace for recent federal budget legislation, which the Congressional Budget Office projects will cut federal Medicaid and CHIP spending by roughly $1.02 trillion through 2034. Kennedy has rejected that framing, telling PBS NewsHour there are "no cuts to Medicaid," only "restrictions in the growth of Medicaid over the next decade." The nonpartisan budget office's math and the administration's preferred language describe the same trajectory in very different terms.

In Starr County alone, more than a dozen home health and home care agencies operate, employing residents in a region where multigenerational caregiving is already the norm rather than the exception. That employment matters more here than the national averages suggest. A county where a third of residents already live in poverty has little room to absorb the loss of caregiver wages, and even less room to absorb the cost of replacing family-provided care with institutional alternatives that Medicaid, not the family, would ultimately have to fund. A federal retreat from paid caregiver programs would not just strain individual families. It would ripple through an employment sector that the county depends on, and it would push more medically complex children and adults toward institutional settings that almost certainly cost more, in dollars and in dignity, than letting their families do what they are already doing.

The people Kennedy did not mention in his testimony are the ones receiving the care. In Starr County, many of them are children with complex medical needs whose parents left paid employment to provide care that no outside agency has been able to replicate. If that care becomes financially impossible to sustain, those children do not stay home. They enter institutional settings staffed by people who have never met them, never learned their patterns, and never noticed what their breathing sounds like before a respiratory crisis sets in.

@Santitos

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