When the Great Society Congress passed the Social Security Act of 1965, there was more in the law than Medicare for senior citizens.
Title 19 of the Act established guidelines for Medicaid Program that states could adopt to provide medical services for welfare recipients. The federal government would cover half of the cost, and the states would have to pay the other half.
Since that time, Medicaid has grown into a government behemoth.
Today there are over 85 million enrolled (25% of the nation’s population).
As for the costs, they are out of control.
For example, in 2003, total federal and state costs were $268 billion.
In 2023, it was a staggering $919 billion.
The Foundation for Government Accountability (FAG) reported that the biggest driver of Medicaid enrollment “is the increase of able-bodied adults in the program, burdening taxpayers and the truly needy alike. In the past decade, about 85% of the increase is attributable to able bodied workers."
FAG also noted that 20 cents of every dollar spent on Medicaid is improper.
"More than 80% of these improper payments are caused by eligibility errors, meaning individuals enter the program despite being ineligible or remain on the program long after becoming ineligible."
And federal auditors have reported that $249 million in Medicaid payments were made to dead enrollees in 2023.
Projections indicate improper payments over the next 10 years could hit $2 trillion.
Medicaid waste, fraud, and abuse have reached pandemic levels — particularly in my home state of New York.
After Medicaid was established in 1965, then-Gov. Nelson Rockefeller quickly sent a bill to the New york State Assembly to adopt it.
Liberal Democrats had a field day.
They added numerous amendments that offered coverage not just for welfare recipients, but also for those they more broadly defined as "poor."
The law also mandated that welfare officials must seek out potential beneficiaries, and it exempted all relatives from any responsibility for the care of indigent family members.
It was designed to make dependency a way of life in New York.
And so, it did.
What began as a modest program that cost $532 million in 1968, ballooned to $98 billion annually by 2024.
Medicaid spending per state resident hit $4,942, the highest in the nation.
Believe it or not, spending is higher than California which comes in at $3,984 per capital.
Presently there are 6.8 million New Yorkers enrolled in Medicaid.
That translates to 38% of the total population.
As for the number of illegal immigrants on Medicaid, that number has jumped over 1,200% since 2014 and stands at 440,000.
Of those recipients, 74% reside in New York City.
The Empire Center for Public Policy reported in July 2023 that as many as 3 million Medicaid recipients were ineligible — at a cost of $20 billion a year.
As for Medicaid fraud — it's a way of life in New York. Here’s a sampling:
- In April 2015, New York State comptroller, Tom DiNapoli released an audit that identified $513 million in improper Medicaid payments and $316 million questionable transactions.
- In February 2018, the state’s comptroller and attorney general sought $8.7 million in damages from a pharmacy that allegedly bilked Medicaid for cancer medications never dispensed.
- In May 2023, a comptroller audit revealed $37.4 million in improper payments.
- In March 2024 two Schenectady residents were indicted for a $1 million Medicaid transportation scheme. In 2025, they were found guilty and sentenced to 3 to 9 years in prison.
- In October 2025, an Orange County couple were charged with stealing $2 million in false Medicaid provider claims.
- In January 2026, two defendants pleaded guilty to defrauding Medicaid of $68 million.
And to top things off . . .
This month two Queens County men were indicted for allegedly bilking Medicaid of $120 million. They are accused of bribing people to enroll in day care centers and for submitting fake prescriptions to drug stores.
The state budget of Gov. Kathy Hochul, D-N.Y., for the fiscal year beginning on April 1, calls for Medicaid costs to increase by 11.5% — four times the inflation rate.
In testimony before a state legislature committee, Bill Hammond of the Empire Center said, "Since 2022, the state share of Medicaid has soared by 60%, or roughly 5 times the inflationary.
That increase amounts to an additional $16 billion per year on top of what was already the highest per capita Medicaid spending in the US. The executive proposal will continue the unsustainable upward trend. . . . "
Unsustainable Medicaid costs, never ending fraud, diminishing quality of hospital care, declining accountability.
New York is truly the poster child for Medicaid waste, fraud and abuse.
George J. Marlin, a former executive director of the Port Authority of New York and New Jersey, is the author of "The American Catholic Voter: Two Hundred Years of Political Impact," and "Christian Persecutions in the Middle East: A 21st Century Tragedy." Read more George J. Marlin Insider articles — Click Here Now.
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