States Bet Millions on Contractors to Enforce Trump-Era Medicaid Work Rules

States are paying Deloitte, Accenture, and Optum millions to overhaul Medicaid and SNAP eligibility systems to enforce work requirements under the Trump-era One Big Beautiful Bill Act. The changes are expected to shrink safety-net coverage, with the CBO projecting 7.5 million uninsured under Medicaid by 2034 and about 2.4 million SNAP recipients cut off; five states alone estimate at least $45.6 million in upfront costs for the modifications. Federal funding covers most ongoing costs and CMS has touted discounts, but audits note systemic errors that could worsen eligibility mistakes for the poorest Americans.