There is a program in California called In-Home Supportive Services. It pays someone — often a family member — to help an elderly, blind or disabled person bathe, eat, take their medication and get through the day at home, instead of in a nursing facility. It serves roughly 875,000 to 900,000 Californians.

Everyone in health policy, in both parties, has spent decades saying this is the right way to do it. It is cheaper than institutional care and it is what people want.

The Trump administration is now treating the program's growth as evidence of fraud, and it is holding back the money.

The numbers

Federal Medicaid money reaches a state as reimbursement. The Centers for Medicare and Medicaid Services can "defer" a payment — hold it while it reviews whether the spending qualifies. Deferrals are a normal, boring part of oversight.

These are not normal. According to an accounting by Andy Schneider at Georgetown's Center for Children and Families, CMS has deferred:

• California: $2.21 billion — $1.34 billion on May 13, then $867.5 million on July 21.
• Minnesota: $550 million — across three deferrals in February, April and July.

The largest single item in the July deferral is $646.4 million tied to Community First Choice and Personal Care Services — home care. NOTUS reports that the administration is now holding $1.7 billion from California's in-home program specifically, more than it is holding from any other single health program in the country.

The stated reason is that the program grew

CMS's justification for the larger part of that item, in its own words, is "significant growth observed in California's CFC-PCS claiming, which between federal fiscal year (FFY) 2023 and FFY 2025 exceeded the average growth rate of all other states by 11.23%."

Dr. Mehmet Oz, who runs CMS, has put the same point more plainly: California's in-home spending rose 24 percent over two federal fiscal years, against about 12 percent on average for the rest of the country. The administration also refers to "statistical anomalies" in the state's data.

That is the case. Not a billing scheme. Not a phantom provider. Not a single named bad actor. A growth rate.

California gave CMS an explanation for the growth: the caseload went up, the number of hours each person needed went up, and the cost per hour went up. Those are the three variables in the program. There is no fourth.

Tyler Sadwith, California's Medicaid director, told NOTUS: "If CMS is able to point out strong or major fraud concerns, we'd be happy to know about it. Unfortunately, they haven't done that."

CMS did not respond to NOTUS's requests for comment.

What "fraud" is being used to mean

Vice President JD Vance has described the fight this way: "We've got a party that is fighting for fraud, and a party that is fighting against fraud."

Oz, in a social media video, questioned the premise of paying family members — saying these services "help Medicaid patients do something that our families would normally do for us, like carrying groceries."

Hagar Dickman, an advocate at Justice in Aging, said the most generous interpretation of that is that it is "out of touch with what Americans and what Californians need financially." It is worth sitting with why. A parent who quits a job to provide round-the-clock care for a disabled adult child is not being handed a windfall. They are doing full-time work that the state would otherwise have to pay a stranger to do, in a facility, for more money.

NOTUS's story names two of the people on the other end of this. Ligia Andrade Zúñiga, 47, has been paralyzed from the chest down since a 2009 car accident and has struggled to find consistent caregivers. Amanda Andresen, 28, has severe cognitive and physical disabilities and depends entirely on her mother Rosa, who earns about $5,560 a month through the program for caring for her.

Schneider, who spent years watching CMS do this job properly, does not think this is oversight. Deferrals, he writes, have "long been a routine part of CMS oversight" — and these are "anything but routine." He calls it a weaponization of fraud.

Why it matters beyond California

Two states are being squeezed right now. Both have Democratic governors. But the standard being used against California has nothing to do with California specifically — it is a finding that a program growing faster than average is presumptively fraudulent, applied by an agency that has not identified the fraud.

Home-care spending is rising across the country — Oz's own comparison put the rest of the country at about 12 percent over the same two years — because the population is aging and because federal policy has spent more than four decades pushing care out of institutions and into homes. Under this standard, that growth is the offense.

It also arrives on top of the Medicaid cuts Republicans passed last year, which are still phasing in. States are being told to absorb those cuts while the federal government holds back money they have already spent.

The bottom line

CMS has deferred $2.21 billion in Medicaid payments to California and $550 million to Minnesota, with $1.7 billion of the California total — including the largest single item in the July round, $646.4 million — tied to home care for elderly and disabled people. The stated basis is that California's in-home care claims grew about 24 percent over two years against about 12 percent for the rest of the country. California's explanation is that its caseload, its hours per person, and its cost per hour all rose. California's Medicaid director says CMS has not pointed to any strong or major fraud concerns, and CMS did not respond to NOTUS's requests for comment. The program in question serves roughly 875,000 to 900,000 Californians who cannot bathe, eat or take their medication without help.

Source

The Push Toward At-Home Care Is Caught in Trump's Anti-Fraud Crusade — Paige Winfield Cunningham and Natalie Alms, NOTUS, August 31, 2026. Deferral figures from Andy Schneider, Georgetown University Center for Children and Families. Photo: Vice President JD Vance and CMS Administrator Mehmet Oz at a May news conference on safety-net fraud (Jacquelyn Martin/AP).