Why This Matters
State governments across the country are paying private consulting firms tens of millions of dollars to retool their computer systems so they can enforce the One Big Beautiful Bill Act, President Donald Trump’s tax and domestic spending law that tightens eligibility for Medicaid and the Supplemental Nutrition Assistance Program, or SNAP.
These systems decide whether low-income residents qualify for health coverage and food assistance. Errors or added red tape in those systems can mean people who are still eligible lose access to a doctor, prescriptions, or groceries, according to an investigation by KFF Health News and reporting by CBS News.
The law also marks a historic shift in federal policy. For the first time since Medicaid was created in 1965, millions of adults in most states will have to prove they are working, in school, or volunteering at least 80 hours a month in order to keep coverage, unless they qualify for an exemption.
Key Facts and Quotes
According to documents obtained by KFF Health News, consulting giants Deloitte, Accenture, and Optum have told state officials that system changes tied to the law will cost at least $45.6 million across five states so far. In many places, the same systems are used to determine eligibility for both Medicaid and SNAP.
In Wisconsin, Deloitte estimated nearly $6 million for Medicaid work-requirement updates and another $4.2 million for SNAP changes. Iowa expects at least $20 million in Medicaid changes under an Accenture contract. Vermont projects about $5 million in costs in 2027, including $1.8 million to Optum, which runs its Medicaid and Affordable Care Act marketplace platform.
Kentucky has already spent $1.6 million on initial changes to its integrated eligibility system, which Deloitte operates under a five-year contract worth more than $157 million, state records show. Illinois officials were told that at least $12 million in modifications will be needed. Because federal regulations cover up to 90% of state Medicaid system development costs and 75% of maintenance, national taxpayers will fund most of these upgrades.
The law requires adults in 42 states and Washington, D.C., to document at least 80 hours of work or similar activities each month to keep Medicaid coverage, unless exempt. New SNAP rules expand work requirements and end exemptions for many veterans, homeless people, and former foster youth. Other provisions bar some refugees, people granted asylum, and certain survivors of abuse or trafficking from Medicaid and Affordable Care Act coverage, and require states to verify eligibility twice a year for millions of adults.
The Congressional Budget Office estimates the law’s Medicaid provisions will leave 7.5 million more people uninsured by 2034, including about 5.3 million due specifically to work requirements, and that roughly 2.4 million people will lose cash assistance for food. “This is a pretty big payday,” said Adrianna McIntyre, a health policy scholar at Harvard University, referring to the consulting work generated by the changes. Vermont official Adaline Strumolo called the mandate “a big, big lift,” while Wisconsin advocate Bobby Peterson questioned why the state would “throw $6 million to their contractors” instead of investing more in helping residents keep coverage.
What It Means for You
For people who rely on Medicaid or SNAP, the biggest near-term change will be more paperwork. Beneficiaries in many states will have to report work hours or other qualifying activities, respond quickly to mail or online notices, and may face more frequent eligibility checks. Advocates warn that people who move often, lack internet access, or juggle multiple jobs are at higher risk of losing coverage even if they still qualify.
For taxpayers and health providers, the stakes are also high. Federal dollars will cover most of the technology upgrades, while hospitals and community clinics could see more uninsured patients if projections hold. Court challenges or future legislation could still alter how far the work rules and other limits go, so residents may want to watch how their own state agencies, governors, and legislators respond in the months ahead.
How do you think states should balance fraud prevention and budget savings with the risk that eligible people lose access to basic health care and food aid?
Sources
- CBS News report by Samantha Liss and Rachana Pradhan, March 30, 2026.
- KFF Health News investigation on Medicaid and SNAP eligibility systems and consulting contracts, 2026.
- Congressional Budget Office estimates on Medicaid and SNAP impacts of the One Big Beautiful Bill Act, cited in 2026 reporting.
- U.S. federal regulations on Medicaid eligibility system funding, Code of Federal Regulations Title 42, current as of 2026.
