Chapter 4 of 7 · 2018–2025

The Medicaid Explosion

Fourteen Medicaid programs grew from $1.5 billion to $4.3 billion a year. Prosecutors put the fraud at half or more.

House Fraud Committee: Housing Stabilization Services and Integrated Community Supports, September 17, 2025 · full record

Source: Minnesota House of Representatives (MNHouseInfo) · watch the original on YouTube. Played here unaltered except as noted on this page; rights remain with the publisher.

In one minute

  1. Minnesota was the first state to offer Housing Stabilization Services. It was expected to cost $2.6 million a year. When DHS suspended 77 providers, they had received more than $88 million. report p. 34 report p. 38
  2. An outside analysis of the 14 high-risk programs flagged 90% of autism-services (EIDBI) payments as problematic. report p. 42
  3. 97% of new assisted-living licenses statewide were for six beds or fewer, below the size that needs a full license. report p. 59
  4. A whistleblower testified he was offered an $1,800 apartment for $600 if he signed up for services, which were then billed and not delivered. report p. 51 report p. 52
  5. The First Assistant U.S. Attorney estimated that half of the $18 billion spent on the 14 programs was fraudulent. report p. 39 Thompson press conference, FOX 9 live
“However, reimbursements quickly skyrocketed beyond expectations, and the program was flooded with new providers.”
Committee majority report, p. 34
“DHS reported 77 providers with payment suspensions due to fraud. The total amount received by these fraudulent providers exceed $88 million, which represented the overwhelming majority of HSS payments”
Committee majority report, p. 38
$18Bbilled by the 14 high-risk programs since 2018, per the CMS pull Thompson read
half or moreThompson's reading of that file, December 18, 2025
$1.51B → $4.32Bthe 14 programs, 2018 to 2025
$6.1M → $443Mautism services (EIDBI), 2018 to 2025
~$250Mcharged loss in the meal case; Bock: 500 months, $243M restitution
64 → 36assistant U.S. attorneys in the Minnesota office
Program spending, millions of dollars. DHS extract via Freedom Foundation of Minnesota (Apr 13, 2026) and Minnesota Reformer (Apr 21, 2026). Blank years were not itemized.
01,0002,0003,0004,0002018201920202021202220232024202514 programs ($M)EIDBIICSHSSNight supervision

Charged dollars are the floor. The claims file is the measurement. They are different numbers and this site keeps them apart.

From the committee's own documents

Four bar charts on the EIDBI autism program: units billed by calendar year 2020-2023 (about 3.2 million rising to about 13 million; bars not labelled); number of EIDBI agencies 10 (2017), 21, 48, 88, 165, 205, 300, 368 (2024); average spending per EIDBI participant 2016-2023 (roughly $7,500 rising to about $45,000; bars not labelled); number of EIDBI participants 2015-2024 (near zero rising to about 4,400; bars not labelled).
Four bar charts on the EIDBI autism program: units billed by calendar year 2020-2023 (about 3.2 million rising to about 13 million; bars not labelled); number of EIDBI agencies 10 (2017), 21, 48, 88, 165, 205, 300, 368 (2024); average spending per EIDBI participant 2016-2023 (roughly $7,500 rising to about $45,000; bars not labelled); number of EIDBI participants 2015-2024 (near zero rising to about 4,400; bars not labelled).Committee chair presentation (same file filed 2026-03-02 as 'Chair Presentation'; slide banner 'Minnesota House GOP') · House Fraud Committee hearing of 2026-02-23 · EIDBI_Presentation_2.23.26 (003).pdf, p. 4
DHS Behavioral Health slide 'Grant Growth Outpaces Staff Resources': Behavioral Health Division contracts (bars) vs. staff FTEs (line) by year, 2011-2024. Contracts rise from 20 (2011) to 486 (2020), 660 (2021), 752 (2022), 862 (2023) and 1,147 (2024); FTEs go from 83 to 171. Shaded note: 'DHS CIS and Grant Making and Grant Management Steps Implemented Starting in 2021'.
DHS Behavioral Health slide 'Grant Growth Outpaces Staff Resources': Behavioral Health Division contracts (bars) vs. staff FTEs (line) by year, 2011-2024. Contracts rise from 20 (2011) to 486 (2020), 660 (2021), 752 (2022), 862 (2023) and 1,147 (2024); FTEs go from 83 to 171. Shaded note: 'DHS CIS and Grant Making and Grant Management Steps Implemented Starting in 2021'.DHS Behavioral Health Administration (Teresa Steinmetz, Shireen Gandhi) · House Fraud Committee hearing of 2025-03-17 · BHA_Fraud_committee_presentation_3_16_25_final.pdf, p. 9
DHS NEMT slide '2023-2024 Program Data', fee-for-service (FFS) vs managed care (MCO): unique providers 567/1,089 (2023) and 551/1,165 (2024); unique recipients 40,150/203,980 and 42,462/214,297; trips 1.3M/5M and 1.4M/5.5M; paid claims $26.3M/$108.6M (2023) and $32.2M/$119.2M (2024).
DHS NEMT slide '2023-2024 Program Data', fee-for-service (FFS) vs managed care (MCO): unique providers 567/1,089 (2023) and 551/1,165 (2024); unique recipients 40,150/203,980 and 42,462/214,297; trips 1.3M/5M and 1.4M/5.5M; paid claims $26.3M/$108.6M (2023) and $32.2M/$119.2M (2024).Minnesota Department of Human Services (slide: 'John Connoly | Deputy Commissioner', 'James Clark | Inspector General') · House Fraud Committee hearing of 2026-03-02 · NEMT_March 2 Hearing_final.pdf, p. 4

The map

Assisted-living facilities by county and the share under seven beds; provisional licenses by capacity: 298 in all, 97% under seven beds. The report states the same 97% on page 59.
Assisted-living facilities by county and the share under seven beds; provisional licenses by capacity: 298 in all, 97% under seven beds. The report states the same 97% on page 59.
Growth in customized living and waiver payments, fiscal 2018-2020, as shown in the deck.
Growth in customized living and waiver payments, fiscal 2018-2020, as shown in the deck.

Source: Assisted Living Slides, House Fraud Committee hearing, Dec 17, 2025 (committee document, as presented by Rep. Robbins)

Go deeper

Report: Housing Stabilization ServicesPages 34–41, searchable.Report: EIDBI / Autism ServicesPages 42–50, searchable.Report: Integrated Community SupportsPages 51–53, searchable.Report: Adult Day ServicesPages 54–56, searchable.Report: Assisted Living / Customized LivingPages 57–62, searchable.Report: Nonemergency Medical TransportationPages 63–66, searchable.

People

Joseph H. Thompson

The record for this chapter