CMS Estimates $37.39B Medicaid Improper Payments, Mostly Documentation

Across Ohio and Colorado, Medicaid spending and program design are drawing scrutiny. Ohio gubernatorial candidate Vivek Ramaswamy says the state should target waste, fraud and abuse and retain a larger share of recovered funds, while Colorado analysis links the state program’s broader-than-private-insurance coverage to rising costs and pressure on other budget priorities. Separately, federal eligibility and documentation requirements are increasing compliance demands on states and contracted health plans; smaller, community-based plans may have fewer resources to manage corrective actions and financial penalties. CMS says most fiscal 2025 improper payments stemmed from insufficient documentation, not fraud.