by James C. Sherlock
Medicaid and Medicare are established under the Social Security Act. They creates federal and state organizations to set rules, monitor compliance, provide funding, sanction, and ultimately exclude those who misuse funds or fail to follow the rules. ย
Federal and state governments have proven better at spending than at oversight. Virginiaโs programs are literally out of control. ย
Readers will see diagrams here that the author built describing Virginia’s two funding and oversight architectures, and may question whether such schemes could work.
In Olmstead v. L.C. (1999), the Supreme Court ruled in a major Americans with Disabilities Act (ADA) legal precedent that the unjustifiable institutional isolation of people with disabilities is discrimination. States must provide services in the least restrictive environment achievable. That ruling resulted in the shutdown of most state institutions for the intellectually disabled. Since Olmstead, intellectual disability services in Virginia are divided between state-run and private institutional services and private community-based services. ย
The funding for these programs comes from Medicaid.
The ADA and Olmstead, as executed in Virginia, have resulted in a web of virtually countless providers and services, limitless opportunities for fraud, and an oversight nightmare.














