State-administered federal programs like Medicaid have long operated with outdated eligibility systems, fragmented data, and limited capacity for real-time verification, all under often arcane and overly burdensome rules and policies. Auditors have routinely found the same problems in other states across the country, including improper payments, weak internal controls, and backlogs in mandatory facility inspections. Despite being on the front lines of program administration, most states lack the modern tools, skilled personnel, and procurement speed needed to root out error and fraud at scale. Legacy systems built decades ago were never designed for today’s volume or sophistication of bad actors. In other words, the issue. The deeper issue, however, is structural and it can best be addressed by modest, structural changes directed by Congress. | 
