Senators Press Deloitte, Other Contractors On Errors In Medicaid Eligibility Systems

Senators person launched an enquiry into companies paid billions successful payer dollars to build eligibility systems for Medicaid, expressing interest that error-riddled exertion and looming activity requirements "will origin Americans to suffer Medicaid sum to this bureaucratic maze."

The letters, dated Oct. 10, were sent to 4 companies and travel a KFF Health News investigation that exposed wide issues successful states utilizing Deloitte-run systems to measure Medicaid eligibility for millions of people. Failures person resulted successful nan erroneous nonaccomplishment of wellness sum and different captious safety-net benefits for low-income people. Malfunctions successful those systems tin costs millions and return years to fix.

As astir states hole to institute activity requirements mandated by nan taxation and home spending rule President Donald Trump signed successful July, senators wrote it is each company's work to build functioning systems, "rather than to prioritize their bottommost line."

Democratic senators Ron Wyden of Oregon, Elizabeth Warren of Massachusetts, and Raphael Warnock of Georgia, arsenic good arsenic Sen. Bernie Sanders (I-Vt.), sent nan letters to respective companies nan Centers for Medicare & Medicaid Services identified arsenic eligibility strategy contractors: Deloitte, GDIT, Gainwell Technologies, and Conduent.

"They're fundamentally wellness attraction middlemen that are successful nan business of reddish tape, and they profit erstwhile Americans don't get wellness care," Wyden, nan apical Democrat connected nan Senate Finance Committee, which oversees Medicaid, said successful an interview.

"They've sewage a history of mediocre capacity erstwhile it comes to determining eligibility aliases successful helping Americans enroll successful Medicaid," Wyden said. "Without stronger oversight and existent accountability, these contractors are conscionable going to get a jumbo windfall for creating systems that really harm Americans trying to get wellness care."

Spokespeople for nan 4 companies did not supply comments for this article.

As of June, 70.5 cardinal group were enrolled successful Medicaid, according to CMS.

A fistful of states run their ain Medicaid eligibility and enrollment systems, but astir trust connected contractors to build and tally them. KFF Health News recovered that Deloitte, a world consultancy that generated $70.5 cardinal successful gross successful fiscal twelvemonth 2025, dominates this portion of authorities business. Twenty-five states person awarded Deloitte contracts for eligibility systems. The agreements, successful which nan institution commits to design, develop, implement, aliases run state-owned systems, are worthy astatine slightest $6 billion, dwarfing immoderate of its competitors.

Kinda Serafi, a partner astatine Manatt Health, is advising states connected really to reconfigure their systems to incorporated activity requirements.

States are successful a "major sprint" to make changes by 2027, she said, and they’re being "inundated" pinch pitches from vendors looking to unafraid contracts. It underscores nan business opportunity these strategy changes correspond for contractors.

"I deliberation we person to really beryllium vigilant to make judge that these vendors are implementing nan requirements accordant pinch nan law," Serafi said.

Companies motion contracts pinch authorities governments, but nan national authorities pays nan bulk of nan cost. The national authorities covers 90% of states' costs to create and instrumentality authorities Medicaid eligibility systems and 75% of ongoing attraction and operations expenses, according to national regulations.

The Senate letters mention problems pinch Deloitte-run eligibility systems that KFF Health News identified. Among different issues, nan Florida eligibility strategy erroneously trim benefits for caller moms, and a problem successful Kentucky prevented sum applications from getting done online, which costs $522,455 and took 10 months to resolve.

"Unfortunately, these are conscionable a fewer examples of third-party systems' nonaccomplishment to service their very function: to reliably and accurately find an individual's eligibility for Medicaid sum and services," nan senators wrote.

The senators asked nan companies to respond by Oct. 31 to their questions, specified arsenic whether companies' contracts pinch states see financial incentives tying costs to nan removal of Medicaid enrollees and whether nan companies are penalized for sum terminations made successful error. The senators besides demanded an accounting of nan company's lobbying expenditures for nan past 5 years and protocols for making strategy changes.

By 2027, nan Congressional Budget Office projected, based connected an early type of nan bill, 18.5 cardinal Medicaid beneficiaries will person to activity aliases complete different qualifying activities for 80 hours a period to support their benefits, unless they suffice for an exemption. The CBO estimates that 5.3 cardinal enrollees will suffer sum by 2034.

The caller activity requirements are conscionable 1 of respective federally mandated Medicaid changes that are forcing states to accommodate their eligibility systems.

Medicaid activity requirements person been plagued pinch problems successful nan fewer states wherever they've been tested. Medicaid enrollees person been disappointment successful trying to navigate byzantine rules and glitchy technology. Work requirements person besides travel astatine awesome cost.

Georgia has not adopted nan ACA Medicaid description , which has granted benefits to millions of adults earning up to 138% of nan national poorness level. Instead, nan authorities offers benefits to immoderate group earning up to nan poorness statement who tin beryllium they're moving aliases participating successful akin activities for 80 hours a month. Nearly 110,000 Georgians had applied to nan state's Georgia Pathways to Coverage programme done May, but only 9,157 group were enrolled arsenic of mid-August. Under emblematic ACA description rules, 336,000 adults would beryllium eligible for coverage, according to KFF.

The Georgia programme has costs $109 million, pinch $34 cardinal spent connected wellness benefits and much than $20 cardinal allocated to trading contracts, according to a KFF Health News study of authorities reports. Deloitte built Georgia's eligibility strategy and is nan superior advisor for nan Pathways program.

Before Medicaid activity requirements became national law, Arizona besides submitted a petition to national regulators to motorboat its ain type that would use to astir 190,000 people.

The state's exertion provided penetration into nan types of strategy changes states whitethorn soon request to make to negociate nan caller national activity requirement.

Arizona Medicaid officials said they would stitchery accusation connected enrollees' activity hours, training, and education. The state's eligibility system, which is operated by Accenture, would besides request to cheque whether personification is exempt.

States are successful nan early stages of determining changes they request to make to instrumentality activity requirements.

Tessa Outhyse, a spokesperson for nan California Department of Health Care Services, said nan authorities expects upgrades to beryllium processed "through nan existing contractual alteration bid process." State contracts pinch eligibility companies often group speech millions to screen nan costs of changes, but systems whitethorn require upgrades beyond nan agreed-upon work.

In Missouri, upgrades are expected to costs astir $33 million, according to a authorities fund document.

The authorities has a statement pinch backstage institution RedMane to grip immoderate of its Medicaid eligibility processing. Missouri plans to prosecute an further contractor to guarantee it decently institutes Medicaid activity requirements, according to Baylee Watts, a spokesperson for Missouri's Department of Social Services.

Medicaid eligibility contractors "have a batch of leverage and expertise to power contracts, to triumph contracts," Wyden said. "They tin do a batch more, to nan worth of what we're giving them."

KFF Health News elder analogous Renuka Rayasam and analogous Sam Whitehead contributed to this report.