Christopher Rufo and others have exposed a large problem in California’s in-home care system, alleging extensive fraud, a costly payoff loop between caregivers, unions, and Governor Gavin Newsom, and questions about state oversight and political incentives.
Christopher Rufo, a senior fellow at the Manhattan Institute and contributing editor at City Journal, pushed this story into the spotlight with a forceful critique of how the state runs its in-home care program. He says the program’s structure and weak enforcement make it an easy target for abuse, and he ties those failures to political dynamics that reward those who benefit from the status quo. The claim is that what looks like compassion may have become a conduit for waste and influence-peddling.
The program pays people to stay home and care for family members with health issues, and it is mostly run on a trust model that relies on self-reporting. Critics argue that same trust is being exploited, with independent estimates putting fraud between 20 and 40 percent despite state denials. That degree of alleged theft translates into billions lost every year if those estimates are accurate.
State spending on the program is massive. Rufo points to $30 billion a year in taxpayer funds flowing into in-home services while at-home caregivers channel roughly $150 million annually to labor unions. That money, say critics, cycles back into political support for Governor Gavin Newsom and bolsters the unions who back him. The arrangement, as painted by detractors, creates a clear incentive to preserve and expand a program that should be tightly policed.
“So the scam is California’s in-home supported services or In-Home Care Program,” Rufo said. “It spends about 30 billion dollars a year. It’s one of the state’s largest programs, and it pays 800,000 Californians to stay home, mostly with relatives, to take care of them, to cook, clean, watch television.”
Rufo frames the program as politically convenient, not merely well-intentioned. He and others point to historical weaknesses in oversight that stretch back through multiple administrations, and they warn that lax audits and honor-system reporting invite exploitation. Where oversight has been tightened in some areas, critics say other loopholes multiply in response.
“On the surface, it’s compassionate, you’re taking care of your grandfather or a child with disabilities. But experts say, and this is dating back to the Schwarzenegger administration and getting worse and worse and worse, that between 20 and 40 percent of this program is just pure fraud,” he continued. “Fraudulent timesheets, fraudulent billing, it operates on the honor system. Experts say it’s losing between six and twelve billion dollars a year to people who are taking this compassionate program and ripping it off.”
That level of fiscal loss would be a major strain on state budgets and on public trust, and it raises practical questions about how claims are verified and payments approved. Investigations by federal and independent bodies, along with journalistic efforts, have reported billions in questionable payouts. Meanwhile, state officials have often dismissed such probes as politically motivated, further fueling partisan dispute.
“These in-home care providers give about a hundred and fifty million dollars a year to the labor unions, which are of course Gavin Newsom’s number one kind of political power base. And so it is a cycle of corruption,” Rufo said. “Newsom gives 30 billion dollars in taxpayer money to these in-home caregivers, including huge numbers of fraud. These caregivers give money to the unions, the unions give the money back to Gavin Newsom. This is the dirty business of California and we’ve blown it wide open.”
When Fox News aired the issue, Governor Gavin Newsom defended the state’s actions and highlighted prior steps. “In 2021, we did a moratorium on new hospice program 280 we shuttered. We’ve been after this for years and years and years,” Newsom said. “We want an open hand, not a closed fist. We absolutely are here to be a partner to go after waste, fraud, and abuse. No one’s denying these issues, but let’s also not deny. This is purely political.”
Rufo and others reject that defense and point to policy choices they say have expanded the program and weakened enforcement. “Well, of course, that’s not true. Gavin Newsom, despite all of these concerns from Democrats and some Republicans, actually has expanded the program at every turn and dismantled enforcement mechanisms,” he said. “And the question is, why is he doing this? So one reason is because this is now California’s largest single occupation. This in-home care program, subsidized by taxpayers, represents about half of all new jobs created under Newsom. He wants to keep that number up. But also, because these in-home care providers give about a hundred and fifty million dollars a year to the labor unions, which are, of course, Gavin Newsom’s number one kind of political power base.”
Federal investigators, independent reporters, and political challengers have flagged similar concerns, reporting billions in suspect payments this year alone. Despite those findings, state spokespeople have not offered clear refutations or comprehensive data that addresses all the specific allegations. The gaps in transparency leave a lot of questions for voters and watchdogs.
