States are paying contractors such as Deloitte, Accenture, and Optum millions of dollars to help them comply with the One Big Beautiful Bill Act — 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 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 that can cut off benefits to eligible people, a KFF Health News investigation showed.
States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax-and-spending law. The changes will add red tape and restrictions. They are coming at a steep price ― both in the cost to taxpayers and coverage losses ― according to state documents obtained by KFF Health News and interviews.
The documents showgovernment agencieswill spend millionsto saveconsiderablymorebyremovingpeople fromhealth benefits.While statessigneligibility system contracts with companiesandwork with them to manageupdates, the federal governmentfootsmost of the bill.
The law’s Medicaid policies will cause7.5 million peopletobecome uninsuredby 2034, according to the nonpartisan Congressional Budget Office.Roughly2.4 million peoplewill loseaccess tomonthly cashassistanceforfood, including those with children.
In five statesalone,company estimates developedfor state officialsand reviewed by KFF Health Newsshow that changeswill cost at least $45.6millioncombined.
The lawrequires most statestotieMedicaid coveragefor some adultstohavingajob,andimposes other restrictions that will make it harder forpeoplewith low incomesto stay enrolled.SNAP restrictions began to take effect in 2025. Major Medicaid provisionsbeginlater this year.
Documentsprepared by consulting company Deloitteestimatethat a pair ofcomputer systemchangesforMedicaid work requirementsin Wisconsinwill. Two other changesrelatedto the state’s SNAP program will cost an additional $4.2million, according to the documents, which Deloitte drafted for the Wisconsin Department of Health Services.
In Iowa, changes to its Medicaid system are expected to cost at least $20 million, according toanestimate prepared by Accenture, a consulting company thatoperatesthe state’seligibility system.
Optum—whichoperatesthe platform Vermont residents usefor Medicaid and marketplacehealthplans under the Affordable Care Act—estimated thatcostroughly$1.8 milliontoevaluate andincorporatenewhealthcoverage restrictions.
Initial changes in Kentucky, which has had a contract with Deloitte since 2012,havecostthestate$1.6 million. And in Illinois,Deloitte estimated modificationswill cost at least $12 million.