States pay Deloitte, others millions to comply with Trump law to cut Medicaid rolls

Key Points:

• States are spending millions of dollars on contractors like Deloitte, Accenture, and Optum to update eligibility systems for Medicaid and SNAP in order to comply with the One Big Beautiful Bill Act, which imposes work requirements and other restrictions that will reduce benefits for millions of low-income Americans.
• The law is projected to cause 7.5 million people to lose Medicaid coverage by 2034 and 2.4 million to lose SNAP cash assistance, with states investing significant funds upfront to implement changes that ultimately save money by removing people from benefits.
• Work requirements will affect nearly 18.5 million Medicaid adults nationwide, requiring them to prove employment or similar activities, with states facing increased administrative burdens and eligibility systems prone to errors, potentially causing millions to become uninsured.
• Contractors are charging states millions for system modifications, with examples including $6 million in Wisconsin, $20 million in Iowa, and $12 million in Illinois; most of these costs are federally funded, but states bear the operational challenges and coverage losses.
• The law also restricts benefits for certain immigrant groups and removes work exemptions for veterans, homeless people, and former foster youth, intensifying access barriers; despite promised contractor discounts, states are struggling with the financial and logistical burdens of compliance.