States rely on consultants to enforce Trump-era Medicaid work rules

States are paying Deloitte, Accenture, Optum and other contractors millions to update Medicaid and SNAP eligibility systems to implement Trump’s work requirements, a move likely to drive up upfront costs while analysts project about 7.5 million fewer people could be uninsured by 2034 and roughly 2.4 million losing food assistance; Wisconsin, Iowa, Kentucky, Illinois and Vermont are among states lining up multi-million-dollar contracts as the federal government foots most of the bill.