Senator Paul makes a factual claim about federal funding (90% federal, 10% state for Medicaid expansion) and an economic argument about state incentive to investigate fraud. The funding ratio is accurate, but the argument oversimplifies — states still pay 10% of expansion costs and bear larger shares for traditional Medicaid populations. While the generous federal match does reduce some fiscal pressure on states, it doesn't eliminate their incentive to prevent fraud. States operate fraud control units that recovered $2 billion in 2025, showing they do investigate eligibility problems despite the funding structure. The vague reference to "one young man with a camera" uncovering unreported fraud cannot be confirmed from current sources. Multiple large Medicaid fraud cases are currently being prosecuted nationwide following a federal takedown charging 455 defendants for $6.5 billion in schemes, which demonstrates that government inspectors and investigators are actively working these cases. This context shows the problem isn't being ignored, even if Paul's post doesn't acknowledge it. Paul's broader criticism about federal-state incentive misalignment raises a real policy question worth debating, but the claim that states have essentially zero reason to check eligibility doesn't match how the system actually works. States face real financial and legal pressure to manage their programs properly, even with federal dollars covering most costs.