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States are paying contractors such as Deloitte, Accenture, and Optum millions of dollars to help them comply with the One Big Beautiful Bill Act 鈥� 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 referred to as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a 麻豆女优 Health News investigation showed.

These benefits, provided to the poorest Americans, can mean the difference between someone obtaining medical care and having enough to eat 鈥� or going without.

States are now racing to update their eligibility systems to adhere to President Donald Trump鈥檚 sweeping tax and domestic spending law. The changes will add red tape and restrictions. They are coming at a steep price 鈥� both in the cost to taxpayers and coverage losses 鈥� according to state documents obtained by 麻豆女优 Health News and interviews.

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.

The law鈥檚 Medicaid policies will cause to become uninsured by 2034, according to the nonpartisan Congressional Budget Office. Roughly will lose access to monthly cash assistance for food, including those with children.

In five states alone, for state officials and reviewed by 麻豆女优 Health News show that changes will cost at least $45.6 million combined.

鈥淭his is a pretty big payday,鈥� said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard鈥檚 T.H. Chan School of Public Health.

The law, which grants tax breaks to the nation鈥檚 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.

Documents prepared by consulting company Deloitte estimate that a pair of computer system changes for Medicaid work requirements in Wisconsin will . Two other changes related to the state鈥檚 SNAP program will cost an additional $4.2 million, according to the documents, which for the Wisconsin Department of Health Services.

In Iowa, changes to its Medicaid system are expected to cost at least $20 million, , a consulting company that operates the state鈥檚 eligibility system.

Optum 鈥� which operates the platform Vermont residents use for Medicaid and marketplace health plans under the Affordable Care Act 鈥� to evaluate and incorporate new health coverage restrictions.

Initial changes in Kentucky, which has had a contract with Deloitte since 2012, . And in Illinois, will cost at least $12 million.

A Historic Mandate

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.

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鈥檙e 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 鈥� .

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.

The One Big Beautiful Bill Act will subject nearly 55,000 Vermont Medicaid recipients to work requirements 鈥� about a third of the state鈥檚 enrollees.

The law forced the state 鈥渢o essentially drop everything else we were doing,鈥� Strumolo said in an interview. 鈥淭his is a big, big lift.鈥�

Optum鈥檚 contract with the state was as of October.

of adult Medicaid enrollees nationally are already working, according to 麻豆女优. Advocacy groups for Medicaid recipients say work requirements will nonetheless cause significant coverage losses. Enrollees will face added red tape to prove they鈥檙e complying. And eligibility systems already prone to error will have to account for employment, job-related activities, and any exemptions.

An estimated 5.3 million enrollees will become uninsured by 2034 due to work requirements, the .

In Wisconsin, state officials estimate could lose coverage after work requirements take effect. Not covering those people would in Medicaid spending for one year.

Wisconsin鈥檚 eligibility system for Medicaid and SNAP 鈥� known as CARES 鈥� in 1994, and initially was a transfer system from Florida, according to a 2016 state document.

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.

Bobby Peterson, executive director of the public interest law firm ABC for Health, said Wisconsin has invested 鈥渧ery little鈥� to help people navigate the Medicaid eligibility process, which soon will become more difficult.

鈥淏ut they鈥檙e very willing to throw $6 million to their contractors to create the bells and whistles,鈥� Peterson said. 鈥淭hat鈥檚 where I feel a sense of frustration.鈥�

New Hurdles for Vets and Homeless People

Medicaid work requirements are only one change required by Trump鈥檚 tax law that will make it harder to obtain safety-net benefits.

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 鈥� doubling state officials鈥� 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.

Days after Trump signed the bill in July, Kentucky health officials raced to make changes to the state鈥檚 integrated eligibility system, which verifies eligibility for Medicaid, SNAP, and other programs. Deloitte operates the system under a five-year . , initial changes costing $1.6 million were labeled a 鈥渉igh priority鈥� and approved on an 鈥渆mergency鈥� basis, with some of the changes to the nation鈥檚 largest food aid program going into effect almost immediately.

Officials with Kentucky鈥檚 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.

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. 鈥淲e are delivering the value and investments we committed to,鈥� Walsh said.

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 鈥� that is, taxpayers 鈥� to develop and implement state Medicaid eligibility systems and pays 75% of ongoing maintenance and operations expenses, according to federal regulations.

鈥淔ive, 10 years ago, I鈥檓 not sure if you would hear much mention of SNAP from a Medicaid director,鈥� Melisa Byrd, Washington, D.C.鈥檚 Medicaid director, said in November at an annual conference of Medicaid officials. 鈥淎nd particularly for those with integrated eligibility systems 鈥� as D.C. is 鈥斅� I鈥檓 learning more about SNAP than I ever thought.鈥�

The federal law was the topic du jour at last year鈥檚 gathering in Maryland, held at the Gaylord National Resort and Convention Center, the largest hotel between New Jersey and Florida.

Consulting companies had taken notice. Gainwell, an eligibility contractor and one of the conference鈥檚 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.

鈥淐onduent helps agencies work smarter by simplifying operations, cutting costs and driving better outcomes through intelligent automation, analytics, and innovation in fraud prevention,鈥� read one such handout from another contractor. 鈥淭ogether, we can better serve residents at every step of their health journeys.鈥� Conduent holds Medicaid eligibility and enrollment contracts in Mississippi and New Jersey, their Medicaid agencies confirmed to 麻豆女优 Health News.

In handouts, Deloitte touted its role in 鈥渂uilding a new era in state health care鈥� and as 鈥渁 national leader in Medicaid program and technology transformation, building a strong track record across the federal, state, and commercial health care ecosystem.鈥� 麻豆女优 Health News found that Deloitte, a global consultancy that generated in revenue in fiscal 2025, dominates this slice of government business.

鈥淲ith Medicaid Community Engagement (CE) requirements, states are tasked with adding a new condition of Medicaid eligibility to support state and federal objectives,鈥� added another brochure. 鈥淒eloitte offers strategic outreach and responsive support to help states engage communities, lower barriers, and address access to coverage.鈥�

A $20.3 Million Bill in Iowa

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鈥檚 Medicaid eligibility system, according to documents prepared by Accenture, which operates Iowa鈥檚 system through a .

Adding the ability to verify work status would cost up to $7 million, . By July, the cost to implement the One Big Beautiful Bill Act鈥檚 work requirements and other Medicaid provisions . Accenture鈥檚 analysis said the federal law necessitated . Making employment a condition of Medicaid benefits could cause an estimated 32,000 Iowans to lose coverage, according to a

Cutting 32,000 people from coverage in one year, a fraction of the Iowa and the federal government spend on Medicaid in a given year.

In Cedar Rapids, most of Eastern Iowa Health Center鈥檚 patients rely on Medicaid, CEO Joe Lock said. He questioned the government鈥檚 logic of spending tens of millions of dollars on a policy to remove Iowans from Medicaid.

Most of the health center鈥檚 patients live at or below the federal poverty level 鈥� currently .

鈥淭here is no benefit to this population,鈥� Lock said.

Danielle Sample, a spokesperson for Iowa鈥檚 Department of Health and Human Services, did not answer questions about how much it will cost to implement changes to the state鈥檚 separate SNAP eligibility system.

In Illinois, the state鈥檚 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.

Kula confirmed that 鈥� priced at $12 million 鈥� is related to Trump鈥檚 law. The estimate also mentions other work. Kula said Deloitte is charging the state a $2 million fixed fee related to work requirements.

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 and reduced rates through 2028 to help states incorporate system changes.

鈥淭he companies were extremely excited to do this,鈥� , the top CMS Medicaid official. 鈥淓veryone鈥檚 really focused on getting to work.鈥�

CMS spokesperson Catherine Howden declined to answer questions about the discounts.

Goodsitt, the Wisconsin Medicaid spokesperson, declined to answer questions about whether Deloitte has discounted its rates. Officials with Kentucky鈥檚 Cabinet for Health and Family Services did not answer a detailed list of questions, including whether Deloitte extended discounts to make these changes.

It鈥檚 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.

Strumolo, the Vermont health official, said state officials discussed the announcement with Optum 鈥渋n detail.鈥�

Optum for a specific module related to Medicaid work requirements. That product is unworkable for Vermont because it would mean 鈥渕oving to a new system when we don鈥檛 have to.鈥� When asked about whether the company offered discounts, Strumolo said 鈥渘ot explicitly.鈥�

In a statement, UnitedHealth Group spokesperson Tyler Mason said Optum supports state implementation of new federal requirements 鈥渨ith a range of options to meet their unique cost and policy needs.鈥�

He declined to specify whether Optum discounted Vermont鈥檚 rates and how it calculated the costs of doing its work. 鈥淥ptum is helping mitigate upfront implementation expenses so states can focus on approaches that reduce duplication, accelerate implementation, and manage costs over time 鈥� supporting better outcomes for individuals covered by Medicaid,鈥� Mason said.

Strumolo said Optum鈥檚 initial changes in Vermont cover items that take effect this year and in 2027 鈥� Medicaid work requirements, checking eligibility every six months, and prohibiting certain immigrants from qualifying for health programs.

鈥淭here鈥檚 a lot more that could come,鈥� she said.