\n<\/p>\n
States are paying contractors such as Deloitte, Accenture, and Optum millions of dollars to help them comply with the One Big Beautiful Bill Act \u2014 a law that will strip safety-net health and food benefits from millions.<\/p>\n
State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly referred to as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a KFF Health News investigation showed.<\/p>\n
These benefits, provided to the poorest Americans, can mean the difference between someone obtaining medical care and having enough to eat \u2014 or going without.<\/p>\n
States are now racing to update their eligibility systems to adhere to President Donald Trump\u2019s sweeping tax and domestic spending law. The changes will add red tape and restrictions. They are coming at a steep price \u2014 both in the cost to taxpayers and coverage losses \u2014 according to state documents obtained by KFF Health News and interviews.<\/p>\n
The documents show government agencies will spend millions to save considerably more by removing people from health benefits. While states sign eligibility system contracts with companies and work with them to manage updates, the federal government foots most of the bill.<\/p>\n
The law\u2019s Medicaid policies will cause 7.5 million people to become uninsured by 2034, according to the nonpartisan Congressional Budget Office. Roughly 2.4 million people will lose access to monthly cash assistance for food, including those with children.<\/p>\n
In five states alone, company estimates developed for state officials and reviewed by KFF Health News show that changes will cost at least $45.6 million combined.<\/p>\n
\u201cThis is a pretty big payday,\u201d said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard\u2019s T.H. Chan School of Public Health.<\/p>\n
The law, which grants tax breaks to the nation\u2019s wealthiest people, requires most states to tie Medicaid coverage for some adults to having a job, and imposes other restrictions that will make it harder for people with low incomes to stay enrolled. SNAP restrictions began to take effect in 2025. Major Medicaid provisions begin later this year.<\/p>\n
Documents prepared by consulting firm Deloitte estimate that a pair of computer system changes for Medicaid work requirements in Wisconsin will cost nearly $6 million. Two other changes related to the state\u2019s SNAP program will cost an additional $4.2 million, according to the documents, which Deloitte drafted for the Wisconsin Department of Health Services.<\/p>\n
In Iowa, changes to its Medicaid system are expected to cost at least $20 million, according to an estimate prepared by Accenture, a consulting firm that operates the state\u2019s eligibility system.<\/p>\n
Optum \u2014 which operates the platform Vermont residents use for Medicaid and marketplace health plans under the Affordable Care Act \u2014 estimated that it could cost roughly $1.8 million to evaluate and incorporate new health coverage restrictions.<\/p>\n
Initial changes in Kentucky, which has had a contract with Deloitte since 2012, have cost the state $1.6 million. And in Illinois, Deloitte estimated modifications will cost at least $12 million.<\/p>\n
A Historic Mandate<\/strong><\/p>\n For six decades after President Lyndon Johnson created the government insurance program in 1965, Congress had never mandated that Medicaid enrollees have a job, volunteer, or go to school.<\/p>\n That will change next year. The tax and spending law enacted by Trump and congressional Republicans requires millions of Medicaid enrollees in 42 states and the District of Columbia to prove they\u2019re working or participating in a similar activity for 80 hours a month, unless they qualify for an exemption. The CBO projected, based on an early version of the bill, that 18.5 million adults would be subject to the new rules \u2014 nearly half of those enrolled.<\/p>\n Vermont Medicaid officials expect it will cost $5 million in fiscal 2027 to implement changes in response to the federal law, said Adaline Strumolo, deputy commissioner of the Department of Vermont Health Access. About $1.8 million is for Optum to make eligibility system adjustments. Optum is a subsidiary of UnitedHealth Group.<\/p>\n The One Big Beautiful Bill Act will subject nearly 55,000 Vermont Medicaid recipients to work requirements \u2014 about a third of the state\u2019s enrollees.<\/p>\n The law forced the state \u201cto essentially drop everything else we were doing,\u201d Strumolo said in an interview. \u201cThis is a big, big lift.\u201d<\/p>\n Optum\u2019s contract with the state was worth $125.6 million as of October.<\/p>\n Nearly two-thirds of adult Medicaid enrollees nationally are already working, according to KFF. Advocacy groups for Medicaid recipients say work requirements will nonetheless cause significant coverage losses. Enrollees will face added red tape to prove they\u2019re complying. And eligibility systems already prone to error will have to account for employment, job-related activities, and any exemptions.<\/p>\n An estimated 5.3 million enrollees will become uninsured by 2034 due to work requirements, the CBO reported.<\/p>\n In Wisconsin, state officials estimate roughly 63,000 adults could lose coverage after work requirements take effect. Not covering those people would save $532.6 million in Medicaid spending for one year.<\/p>\n Wisconsin\u2019s eligibility system for Medicaid and SNAP \u2014 known as CARES \u2014 was implemented statewide in 1994, and initially was a transfer system from Florida, according to a 2016 state document.<\/p>\n Deloitte submitted its cost estimates for Medicaid and SNAP changes to the state in September and December. Elizabeth Goodsitt, a spokesperson for the Wisconsin Department of Health Services, declined to answer questions about whether additional changes will be needed, how much it will cost to make all eligibility system changes to comply with the new federal law, and whether the state negotiated prices with Deloitte.<\/p>\n Bobby Peterson, executive director of the public interest law firm ABC for Health, said Wisconsin has invested \u201cvery little\u201d to help people navigate the Medicaid eligibility process, which soon will become more difficult.<\/p>\n \u201cBut they\u2019re very willing to throw $6 million to their contractors to create the bells and whistles,\u201d Peterson said. \u201cThat\u2019s where I feel a sense of frustration.\u201d<\/p>\n New Hurdles for Vets and Homeless People<\/strong><\/p>\n Medicaid work requirements are only one change required by Trump\u2019s tax law that will make it harder to obtain safety-net benefits.<\/p>\n Starting in October, the law prohibits several immigrant populations from accessing Medicaid and ACA coverage, including people who have been granted asylum, refugees, and certain survivors of domestic violence or human trafficking. Beginning Dec. 31, states must verify eligibility twice a year for millions of adults \u2014 doubling state officials\u2019 workload. And the law restricts SNAP benefits by requiring more adult recipients to work and by removing work exemptions for veterans, homeless people, and former foster youth.<\/p>\n Days after Trump signed the bill in July, Kentucky health officials raced to make changes to the state\u2019s integrated eligibility system, which verifies eligibility for Medicaid, SNAP, and other programs. Deloitte operates the system under a five-year contract worth more than $157 million. According to documents obtained by KFF Health News, initial changes costing $1.6 million were labeled a \u201chigh priority\u201d and approved on an \u201cemergency\u201d basis, with some of the changes to the nation\u2019s largest food aid program going into effect almost immediately.<\/p>\n Officials with Kentucky\u2019s Cabinet for Health and Family Services declined to answer a detailed list of questions, including how much it will cost to make all the modifications needed.<\/p>\n Deloitte spokesperson Karen Walsh said the company is working with states to implement new requirements but declined to answer questions about cost estimates in several states. \u201cWe are delivering the value and investments we committed to,\u201d Walsh said.<\/p>\n In most states, government agencies rely on contractors to build and run the systems that determine eligibility for Medicaid. Many of those states also use such computer systems for SNAP. But the federal government \u2014 that is, taxpayers \u2014 covers 90% of state costs to develop and implement state Medicaid eligibility systems and pays 75% of ongoing maintenance and operations expenses, according to federal regulations.<\/p>\n \u201cFive, 10 years ago, I\u2019m not sure if you would hear much mention of SNAP from a Medicaid director,\u201d Melisa Byrd, Washington, D.C.\u2019s Medicaid director, said in November at an annual conference of Medicaid officials. \u201cAnd particularly for those with integrated eligibility systems \u2014 as D.C. is \u2014\u00ad I\u2019m learning more about SNAP than I ever thought.\u201d<\/p>\n The federal law was the topic du jour at last year\u2019s gathering in Maryland, held at the Gaylord National Resort and Convention Center, the largest hotel between New Jersey and Florida.<\/p>\n Consulting companies had taken notice. Gainwell, an eligibility contractor and one of the conference\u2019s corporate sponsors, emblazoned its logo on hotel escalators. Companies set up booths with materials promoting how they could help states and handed out snacks and swag.<\/p>\n \u201cConduent helps agencies work smarter by simplifying operations, cutting costs and driving better outcomes through intelligent automation, analytics, and innovation in fraud prevention,\u201d read one such handout from another contractor. \u201cTogether, we can better serve residents at every step of their health journeys.\u201d Conduent holds Medicaid eligibility and enrollment contracts in Mississippi and New Jersey, their Medicaid agencies confirmed to KFF Health News.<\/p>\n In handouts, Deloitte touted its role in \u201cbuilding a new era in state health care\u201d and as \u201ca national leader in Medicaid program and technology transformation, building a strong track record across the federal, state, and commercial health care ecosystem.\u201d KFF Health News found that Deloitte, a global consultancy that generated $70.5 billion in revenue in fiscal 2025, dominates this slice of government business.<\/p>\n \u201cWith Medicaid Community Engagement (CE) requirements, states are tasked with adding a new condition of Medicaid eligibility to support state and federal objectives,\u201d added another brochure. \u201cDeloitte offers strategic outreach and responsive support to help states engage communities, lower barriers, and address access to coverage.\u201d<\/p>\n A $20.3 Million Bill in Iowa<\/strong><\/p>\n Before Trump signed the One Big Beautiful Bill Act, Iowa lawmakers wanted to impose their own version of work requirements. They would have applied to 183,000 people before any exemptions. The new law would necessitate a change to Iowa\u2019s Medicaid eligibility system, according to documents prepared by Accenture, which operates Iowa\u2019s system through a contract worth more than $60 million.<\/p>\n Adding the ability to verify work status would cost up to $7 million, an Accenture estimate from March 2025 showed. By July, the cost to implement the One Big Beautiful Bill Act\u2019s work requirements and other Medicaid provisions skyrocketed to roughly $20.3 million. Accenture\u2019s analysis said the federal law necessitated additional changes to Iowa\u2019s system. An estimated 32,000 Iowans could lose coverage by making employment a condition of Medicaid benefits, according to a 2025 state document.<\/p>\n Cutting 32,000 people from coverage could save $183 million in one year, a fraction of the $8.9 billion Iowa and the federal government spend on Medicaid in a given year.<\/p>\n In Cedar Rapids, most of Eastern Iowa Health Center\u2019s patients rely on Medicaid, CEO Joe Lock said. He questioned the government\u2019s logic of spending tens of millions of dollars on a policy to remove Iowans from Medicaid.<\/p>\n Most of the health center\u2019s patients live at or below the federal poverty level \u2014 currently $33,000 for a family of four.<\/p>\n \u201cThere is no benefit to this population,\u201d Lock said.<\/p>\n Danielle Sample, a spokesperson for Iowa\u2019s Department of Health and Human Services, did not answer questions about how much it will cost to implement changes to the state\u2019s separate SNAP eligibility system.<\/p>\n In Illinois, the state\u2019s work this year is largely focused on meeting major provisions of the One Big Beautiful Bill Act. The state estimates that as many as 360,000 residents could lose Medicaid, largely due to the work requirements, said Melissa Kula, a spokesperson for the Illinois Department of Healthcare and Family Services.<\/p>\n Kula confirmed that most of the work detailed in one of Deloitte\u2019s estimates \u2014 priced at $12 million \u2014 is related to Trump\u2019s law. The estimate also mentions other work. Kula said Deloitte is charging the state a $2 million fixed fee related to work requirements.<\/p>\n The Trump administration has acknowledged that the work is coming at a cost. In January, top officials for the Centers for Medicare & Medicaid Services said government contractors, including Deloitte, Accenture, and Optum, have promised to offer discounts and reduced rates through 2028 to help states incorporate system changes.<\/p>\n \u201cThe companies were extremely excited to do this,\u201d said Daniel Brillman, the top CMS Medicaid official. \u201cEveryone\u2019s really focused on getting to work.\u201d<\/p>\n CMS spokesperson Catherine Howden declined to answer questions about the discounts.<\/p>\n Goodsitt, the Wisconsin Medicaid spokesperson, declined to answer questions about whether Deloitte has discounted its rates. Officials with Kentucky\u2019s Cabinet for Health and Family Services did not answer a detailed list of questions, including whether Deloitte extended discounts to make these changes.<\/p>\n It\u2019s unclear what discounts, if any, Deloitte and Accenture have offered to individual states. Walsh, the Deloitte spokesperson, declined to answer detailed questions about the discounts the Trump administration announced this year. Accenture did not respond to repeated requests for comment.<\/p>\n Strumolo, the Vermont health official, said state officials discussed the announcement with Optum \u201cin detail.\u201d<\/p>\n Optum pledged to offer discounts for a specific module related to Medicaid work requirements. That product is unworkable for Vermont because it would mean \u201cmoving to a new system when we don\u2019t have to.\u201d When asked about whether the company offered discounts, Strumolo said \u201cnot explicitly.\u201d<\/p>\n In a statement, UnitedHealth Group spokesperson Tyler Mason said Optum supports state implementation of new federal requirements \u201cwith a range of options to meet their unique cost and policy needs.\u201d<\/p>\n He declined to specify whether Optum discounted Vermont\u2019s rates and how it calculated the costs of doing its work. \u201cOptum is helping mitigate upfront implementation expenses so states can focus on approaches that reduce duplication, accelerate implementation, and manage costs over time \u2014 supporting better outcomes for individuals covered by Medicaid,\u201d Mason said.<\/p>\n Strumolo said Optum\u2019s initial changes in Vermont cover items that take effect this year and in 2027 \u2014 Medicaid work requirements, checking eligibility every six months, and prohibiting certain immigrants from qualifying for health programs.<\/p>\n \u201cThere\u2019s a lot more that could come,\u201d she said.<\/p>\n<\/div>\n Samantha Liss and Rachana Pradhan States are paying contractors such as Deloitte, Accenture, and Optum millions of dollars to help them comply with the One Big Beautiful Bill Act \u2014 a law that will strip safety-net health and food benefits from millions. State governments rely on such companies to design and operate computer systems that<\/p>\n","protected":false},"author":1,"featured_media":7263,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":{"0":"post-7262","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthy"},"_links":{"self":[{"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/posts\/7262","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7262"}],"version-history":[{"count":0,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/posts\/7262\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/media\/7263"}],"wp:attachment":[{"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7262"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7262"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7262"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\n#States #Pay #Deloitte #Millions #Comply #Trump #Law #Cut #Medicaid #Rolls
\nStates Pay Deloitte, Others Millions To Comply With Trump Law To Cut Medicaid Rolls<\/p>\n","protected":false},"excerpt":{"rendered":"