Home‑care Program as Fraud Magnet

State-run in‑home care programs can become large conduits for fraud when oversight is limited and payments are made to informal, often family, caregivers. Large program scale (California’s IHSS: ~$30B, ~800k providers) plus rules that block random home visits create opportunities for sustained multi‑billion‑dollar leakage and political capture via union dues and local networks. — If true, this dynamic reshapes debates about Medicaid integrity, state budgeting, union political influence, and oversight design for care work nationwide.