The Health and Human Services (HHS) Office of Inspector General (OIG) has added to its work plan an audit of nursing homes’ Medicaid spending. The audit, expected sometime in Fiscal Year 2026, will examine states’ requirements for minimum Medicaid spending related to resident care and identify challenges states and nursing homes have experienced in implementing these requirements.

The addition of this audit to the work plan is concerning and comes amid previous activities related to Medicaid payment transparency including the 2024 Ensuring Access to Medicaid Services final rule,  which requires that a minimum of 80% of Medicaid payments to Home and Community Based Settings (HCBS) be spent on direct care worker compensation and a second 2024 final rule that requires Medicaid state agencies to report the percentage of Medicaid payments to nursing homes that are spent on direct care worker compensation.