Fiscal oversight of Virginia’s Medicaid program matters. With more than 1.5 million Virginians relying on Medicaid and the program representing one of the largest components of the commonwealth’s budget, safeguarding taxpayer dollars is not optional, it is essential.
But oversight alone is not the solution. Too often, when there are concerns about rising utilization of services or suspected misuse, Virginia’s response is to restrict access to services. That approach may reduce short-term spending, but it does not solve the underlying problem, and it puts vulnerable Virginians at risk.
Medicaid fraud, waste and abuse are persistent problems in Virginia. That is not because the Commonwealth lacks agencies tasked with addressing them. In fact, the opposite is true. Oversight and enforcement responsibilities are spread across multiple entities, including the Department of Medical Assistance Services (DMAS), managed care organizations, licensing bodies, law enforcement, and the Office of the Attorney General.
Each plays an important role, but they often operate in silos.
The result is a system with strong oversight components in place, but with gaps in coordination and information sharing that limit their collective impact. Providers who operate in good faith regularly report confusion about expectations and duplicative requirements, while bad actors exploit gaps between agencies. When fraud is suspected but not effectively identified or addressed, policymakers are pushed toward broad, one-size-fits-all responses like tightening eligibility, limiting services or adding administrative hurdles, rather than targeted actions aimed at the actual sources of abuse.
There are two examples of this in the budget introduced by outgoing Gov. Glenn Youngkin. One proposes the elimination of an entire service, Community Stabilization, with no plan to replace the service or redirect those relying on it to help them stabilize when experiencing a mental health crisis. The second proposal would severely constrain access to evidence-based, time-sensitive Applied Behavior Analysis (ABA) services for children, undermining early intervention at a stage when delays can cause lasting harm.
Proposals like these are the wrong approach.
Constraining access does not eliminate fraud. It simply shifts the burden onto patients who legitimately need care, including children with severe needs, individuals with serious mental illness, seniors and families already navigating complex systems. When access is restricted, care is delayed, conditions worsen, and costs often increase elsewhere in the system.
Virginia does not need less oversight. It needs better oversight.
That is why directing DMAS to convene a multi-agency Commonwealth Task Force to Eliminate Medicaid Fraud is both practical and overdue.
A task force that brings together all the relevant agencies, law enforcement partners, managed care organizations, and providers would allow the commonwealth to finally answer the hard questions: Where is fraud actually occurring? Who is responsible for detecting it? What tools are working and which are not? Where are coordination failures allowing problems to persist? Where is provider education needed to ensure services are delivered properly?
The goal is not simply to reduce fraud at the margins, but to eliminate it without threatening access to care. That means identifying gaps in data sharing, clarifying regulatory expectations, improving coordination between agencies and adopting proven best practices from other states.
It also means listening to providers who see firsthand where the system breaks down and where enforcement efforts miss the mark.
Virginia can protect taxpayers and protect individuals and families struggling with mental illness at the same time, but only if we stop treating access restrictions as a substitute for effective fraud prevention. A coordinated, multi-agency approach focused on understanding and fixing the system we have today is the responsible path forward.
Fiscal oversight is necessary. It just isn’t enough.
Mindy Carlin is Executive Director of the Virginia Association of Community-Based Providers (VACBP). The VACBP is the largest association representing private-sector, community-based organizations that provide behavioral health, substance use disorder and ABA services to vulnerable residents throughout Virginia.