Other than fraudsters, that is.

The majority of Medicaid spending now goes directly to so-called Managed Care Organizations, also known as the health insurers. Per Paragon Health Institute:

This dramatic shift raises an important question: Has Medicaid managed care actually worked? When states began moving enrollees into MCOs, advocates argued that private insurers would coordinate care better, curb unnecessary spending, and improve quality. Yet after three decades of expansion, the evidence remains remarkably weak. The Congressional Budget Office found no consistent evidence that managed care improves outcomes.