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 known as food stamps. Those state systems have a history of errors<\/a> that can cut off benefits to eligible people<\/a>, a KFF Health News investigation showed<\/a>.<\/p>\n States are now racing to update their eligibility systems to adhere to President Donald Trump\u2019s sweeping tax-and-spending law. The changes will add red tape and restrictions. They are coming at a steep price \u2015 both in the cost to taxpayers and coverage losses \u2015 according to state documents obtained by KFF Health News and interviews.<\/p>\n The documents show\u00a0government agencies\u00a0will spend millions\u00a0to save\u00a0considerably\u00a0more\u00a0by\u00a0removing\u00a0people from\u00a0health benefits.\u00a0While states\u00a0sign\u00a0eligibility system contracts with companies\u00a0and\u00a0work with them to manage\u00a0updates, the federal government\u00a0foots\u00a0most of the bill.<\/p>\n The law\u2019s Medicaid policies will cause\u00a07.5 million people<\/a>\u00a0to\u00a0become uninsured\u00a0by 2034, according to the nonpartisan Congressional Budget Office.\u00a0Roughly\u00a02.4 million people<\/a>\u00a0will lose\u00a0access to\u00a0monthly cash\u00a0assistance\u00a0for\u00a0food, including those with children.\u00a0<\/p>\n In five states\u00a0alone,\u00a0company estimates developed<\/a>\u00a0for state officials\u00a0and reviewed by KFF Health News\u00a0show that changes\u00a0will cost at least $45.6\u00a0million\u00a0combined.\u00a0<\/p>\n The law\u00a0requires most states\u00a0to\u00a0tie\u00a0Medicaid coverage\u00a0for some adults\u00a0to\u00a0having\u00a0a\u00a0job,\u00a0and\u00a0imposes other restrictions that will make it harder for\u00a0people\u00a0with low incomes\u00a0to stay enrolled.\u00a0SNAP restrictions began to take effect in 2025. Major Medicaid provisions\u00a0begin\u00a0later this year.\u00a0<\/p>\n Documents\u00a0prepared by consulting company Deloitte\u00a0estimate\u00a0that a pair of\u00a0computer system\u00a0changes\u00a0for\u00a0Medicaid work requirements\u00a0in Wisconsin\u00a0will\u00a0cost\u00a0nearly<\/a>\u00a0$6 million<\/a>. Two other changes\u00a0related\u00a0to the state\u2019s SNAP program will cost an additional $4.2\u00a0million, according to the documents, which Deloitte<\/a> drafted<\/a> 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\u00a0an\u00a0estimate prepared by Accenture<\/a>, a consulting company that\u00a0operates\u00a0the state\u2019s\u00a0eligibility system.\u00a0<\/p>\n Optum\u00a0\u2014\u00a0which\u00a0operates\u00a0the platform Vermont residents use\u00a0for Medicaid and marketplace\u00a0health\u00a0plans under the Affordable Care Act\u00a0\u2014\u00a0estimated that<\/a>\u00a0it\u00a0could<\/a>\u00a0cost\u00a0roughly<\/a>\u00a0$1.8 million<\/a>\u00a0to\u00a0evaluate and\u00a0incorporate\u00a0new\u00a0health\u00a0coverage restrictions.\u00a0<\/p>\n Initial changes in Kentucky, which has had a contract with Deloitte since 2012,\u00a0have<\/a>\u00a0cost<\/a>\u00a0the<\/a>\u00a0state<\/a>\u00a0$1.6 million<\/a>. And in Illinois,\u00a0Deloitte estimated modifications<\/a>\u00a0will cost at least $12 million.<\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n