Frankfort, Kentucky — A new state audit has exposed serious failures in Kentucky’s oversight of nursing homes, finding that the vast majority of required health and safety inspections were conducted late — some by more than four years — while hundreds of deceased residents remained incorrectly listed as Medicaid-eligible.
Kentucky State Auditor Allison Ball released the second part of the state’s annual audit for fiscal year 2025 on Monday, calling the findings a reflection of “serious problems the Commonwealth must address to ensure it is protected from waste, fraud and abuse.”
Inspections Missed by Years, Not Days
Federal law requires nursing homes to receive health and safety inspections at least every nine to 15 months. Kentucky’s audit found the Cabinet for Health and Family Services (CHFS) fell far short of that standard. Of 190 inspections conducted during the review period, 162 were late. The most egregious cases were overdue by 51 months — more than four years past the federal deadline.
The backlog drew fire from Ball’s office, which noted the issue had been flagged repeatedly over the past two years. After the auditor raised the alarm, CHFS brought in contractors to address the inspection backlog. State officials confirmed that as of March 2026, all 268 facilities required to receive federally mandated surveys are now in compliance.
“This shows that all of the problems uncovered in our report can be fixed by following our recommendations,” Ball said.
Dead Residents Still Receiving Medicaid Benefits
The audit also found alarming gaps in Medicaid eligibility tracking. According to Ball’s office, 358 people who died before January 1, 2024, were still listed as Medicaid-eligible during the 2025 fiscal year. CHFS failed to remove them from the rolls — a lapse auditors said put the state out of compliance with federal law.
Beyond the deceased beneficiaries, 22 Kentuckians received temporary Medicaid coverage more than once during the year, which isn’t permitted under the state plan. The state said it will add internal controls to prevent recurrences.
Auditors also flagged 844 duplicate Medicaid payments and an additional $3.3 million in federal expenditures that were misreported as state and local share spending.
A Pattern of Repeat Findings
The Medicaid enrollment failures aren’t new. Ball’s office said the inspection backlog and duplicate Social Security number issues have appeared as “repeat findings” for more than three years. A system update planned for October 2026 will add safeguards against duplicate Social Security numbers and prevent improper duplicate coverage.
Kentucky’s situation adds to a growing national picture of state-level oversight gaps in long-term care. As federal enforcement of healthcare fraud has intensified, state auditors are increasingly shining a light on the local systems meant to keep nursing home residents safe.
Ball framed Monday’s findings as progress, but with clear conditions attached. “After being a repeat finding for over three years,” she said, “CHFS has finally taken steps to rectify the backlog.” The question now is whether those steps hold — and whether other states facing similar inspection gaps are paying attention.
