How Medicaid Contractors Stand To Gain From Trump’s Policy
States are paying millions of dollars to contractors like Deloitte, Accenture and Optum to help them comply with the One Big Beautiful Bill Act – a law that will strip millions of people of health and nutrition benefits.
State governments rely on these companies to design and operate computer systems that evaluate whether low-income people qualify for Medicaid or food assistance through the Supplemental Nutrition Assistance Program, commonly known as food stamps. These state systems have a history of errors that can strip eligible people’s benefits, a KFF Health News investigation showed.
States are now racing to update their eligibility systems to comply with President Donald Trump’s sweeping tax and spending law. The changes will add red tape and restrictions. They are expensive — both in taxpayer costs and coverage losses — according to official documents obtained by KFF Health News and interviews.
The documents show that government agencies will spend millions to save far more by cutting people off 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.
The law’s Medicaid policies will leave 7.5 million people uninsured by 2034, according to the nonpartisan Congressional Budget Office. Around 2.4 million people, including those with children, will no longer have access to monthly cash assistance for food.
In five states alone, company estimates developed for state officials and reviewed by KFF Health News show the changes will cost at least $45.6 million in total.
The law requires most states to tie Medicaid coverage for some adults to employment, and imposes other restrictions that will make it harder for low-income people to stay enrolled. SNAP restrictions began to take effect in 2025. Major provisions of Medicaid will take effect later this year.
Documents prepared by consulting firm Deloitte estimate that a pair of computer system changes to meet Medicaid work requirements in Wisconsin will. Two other changes related to the state’s SNAP program will cost an additional $4.2 million, according to documents prepared by Deloitte for the Wisconsin Department of Health Services.
In Iowa, changes to the Medicaid system are expected to cost at least $20 million, according to an estimate prepared by Accenture, a consulting firm that manages the state’s eligibility system.
Optum — which operates the platform that Vermont residents use for Medicaid and marketplace health plans under the Affordable Care Act — estimated the cost of evaluating and integrating new health coverage restrictions to be about $1.8 million.
The first changes in Kentucky, which has had a contract with Deloitte since 2012, cost the state $1.6 million. And in Illinois, Deloitte estimates the changes will cost at least $12 million.
