Over the course of several recent legislative sessions, the Iowa Legislature has been considering legislation that would strengthen program integrity in public assistance programs such as Medicaid and SNAP (food assistance). The objective is to prevent fraud and abuse by ensuring that only qualified recipients receive the intended benefits. Strengthening oversight and program integrity is not only important for preventing fraud, but recent federal policy changes will also begin holding states accountable for high fraud rates.
Many Americans are still shocked by the level of fraud being exposed across the country. In Minnesota, an estimated $9 billion in fraud has been revealed through the inappropriate use of Medicaid, food assistance, and other related public assistance programs. Unfortunately, Minnesota is not an exception, as similar issues are being uncovered in states across the nation.
At the federal level, policymakers are beginning to grapple with the scale of the problem. Representative Jodey Arrington (R-TX) and Rachel Greszler recently noted that “in 2025, Washington wasted approximately $186 billion in improper payments.” That figure alone is staggering, but it likely understates the full scope of fraud and abuse.
While these national figures are alarming, the underlying issue is not complicated: large, complex programs that lack strong verification systems and ongoing oversight are more vulnerable to waste, fraud, and abuse. Public assistance programs were designed to serve vulnerable populations, but over time, weak eligibility checks, outdated systems, and limited accountability have allowed improper payments to persist.
Rep. Arrington and Greszler went on to write, “Too often, these programs operate on autopilot — sending taxpayer dollars out the door with inadequate safeguards and almost no consequences for failure. In programs like the Supplemental Nutrition Assistance Program and extended Unemployment Insurance benefits, where the federal government pays the full cost, states are incentivized to capitalize on weak eligibility checks and lax oversight to maximize the flow of federal dollars into their states.”
Strengthening program integrity must be a priority. Iowa has already identified many of the common-sense steps needed to improve oversight. These include more frequent eligibility verification, cross-checking data across agencies, and conducting regular audits to ensure that enrollees still qualify for benefits. Other states that have implemented similar reviews have uncovered ineligible participants, duplicate enrollments, and even individuals using false or stolen identities to access benefits.
Program integrity is not about limiting access to those in need, it is about protecting the system so it works as intended. When individuals who do not qualify receive benefits, it diverts resources away from those who truly rely on these programs. It also erodes public trust and places additional strain on taxpayers.
This is why President Donald Trump’s “One Big Beautiful Bill” Act (OB3) is not just a tax reform measure, but it is also establishing reforms in the Medicaid and SNAP programs to prevent fraud and abuse. The provisions of OB3 will require states to pay a greater share of the administrative costs for SNAP, and states that have high error (fraud) rates will be penalized. OB3 also makes significant reforms to Medicaid, which will force states to not only scrutinize enrollments, but federal matching funds within the program will be changing.
Iowa faces both a challenge and an opportunity as Medicaid, now the fastest-growing part of the General Fund, continues to expand in cost and enrollment. By advancing stronger verification, better data sharing, and greater accountability, lawmakers are taking practical steps to ensure these programs remain focused on those they are intended to serve. Strengthening program integrity protects taxpayers, preserves the safety net, and helps ensure resources reach those who truly need them.
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