States Pay Millions to Deloitte, Accenture to Implement Medicaid Work Requirements

When Wisconsin officials needed to overhaul the computer systems that determine who qualifies for Medicaid and food assistance under new federal law, they turned to Deloitte. The consulting giant's internal estimate for that work came to nearly $6 million for two changes tied to Medicaid work requirements alone, plus an additional $4.2 million for SNAP-related modifications.

Wisconsin is not an outlier. In at least five states, cost estimates prepared for state officials put the price of compliance with the One Big Beautiful Bill Act in the tens of millions of dollars, with major consulting and technology firms including Accenture and Optum positioned to capture much of that spending. While states sign the contracts, the federal government reimburses a significant share of the tab, making the engagements particularly lucrative for vendors regardless of which party controls state government.

Harvard health policy professor Adrianna McIntyre described the financial stakes plainly: "This is a pretty big payday."

The contracts are not simply IT upgrades. The Congressional Budget Office projected that the law's design will leave 7.5 million people uninsured by 2034, while roughly 2.4 million could lose their monthly cash assistance for food. The eligibility systems being retooled by Deloitte, Accenture and Optum are the precise mechanisms that will execute those coverage changes, processing work requirement verifications and SNAP eligibility determinations for millions of low-income Americans.

That technical responsibility carries a documented record of failure. Previous investigations and congressional inquiries into contractor-built Medicaid eligibility platforms found persistent problems: incorrect notices, lost paperwork and outages that produced erroneous coverage losses. Consumer advocates and some lawmakers argued that rushed or poorly tested updates to those same systems would generate new waves of wrongful terminations, with beneficiaries losing access to medical care and food while disputes and software fixes worked through the backlog.

Proponents of the law countered that the changes were designed to promote work and self-sufficiency. But the fiscal math created an uncomfortable paradox: states and federal taxpayers were spending tens of millions of dollars to implement a policy whose stated purpose was to shrink enrollment. The administrative cost of building barriers into benefits systems landed primarily with the same small group of large technology and consulting firms that have long dominated public-sector eligibility infrastructure.

The rollout of some SNAP-related changes was already underway as states finalized contracts and vendors began system modifications, compressing timelines for testing and quality assurance. For the applicants on the other side of those systems, a software error carries concrete consequences: a missed insurance card, a terminated food benefit, and a bureaucratic correction process that may take weeks to resolve.