Former House Speaker Newt Gingrich has argued that reforming Medicaid requires a fundamental shift in program incentives to combat waste, fraud, and abuse. Writing for Fox News Digital, Gingrich stated that the current financing structure of the federal-state partnership often encourages improper practices while hindering sustained oversight.
Gingrich drew a comparison to the Personal Responsibility and Work Opportunity Reconciliation Act passed 30 years ago, which he contended succeeded by rewarding responsibility, accountability, and innovation. He believes applying similar principles to Medicaid could lead to states making better decisions when granted greater flexibility and accountability for outcomes.
"Human nature is predictable," Gingrich wrote. "Whenever government creates a system involving hundreds of billions of dollars, services that are difficult to measure, and payment models that reward volume, some people will exploit it. But the larger problem is program design."
He highlighted Applied Behavior Analysis (ABA) therapy as an example, noting that while federal law mandated its coverage by Medicaid in 2014, leading to significant spending increases, the combination of billable hour payment models and inconsistent oversight has created vulnerabilities. Investigations have uncovered improper billing and practices that prioritized maximizing services over patient outcomes, and in some cases, disturbing allegations of abuse against children.
Gingrich also pointed to challenges in other Medicaid services, including hospice care, home health services, and medical equipment, suggesting a recurring pattern where accountability lags behind spending. He cited Georgia's experience, where efforts to strengthen oversight of ABA services have faced political resistance from legislators and provider groups concerned about funding and access.
"Protecting access and protecting accountability, however, are not competing goals. Families deserve both," Gingrich stated. He urged state legislatures to support, rather than undermine, efforts by Medicaid agencies and the Trump administration to improve program integrity.
Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz has identified strengthening Medicaid program integrity as a national priority, launching initiatives to improve provider oversight and combat waste, fraud, and abuse. However, Gingrich contended that simply addressing misconduct by a few providers is insufficient, emphasizing the need to fix the underlying program design and its incentive structures.
"Thirty years ago, welfare reform demonstrated that lasting public policy improvements begin by aligning incentives with the public interest," Gingrich concluded. "Medicaid needs the same lesson today."