Public database gives reporters, advocates, and policymakers access to contracts governing systems that determine who receives Medicaid
WASHINGTON, D.C. – The National Health Law Program (NHeLP) today launched a new interactive map identifying the private companies that states hire to build and operate the automated systems that determine whether millions of people qualify for Medicaid.
The map provides access to Medicaid eligibility system contracts and related documents NHeLP and partners in the Benefits Tech Advocacy Hub have obtained through public records requests and online research. It offers a new window into a largely opaque contracting system involving billions of dollars in public spending and decisions that can determine whether people receive essential health care.
The resource arrives as states prepare to implement Medicaid work requirements and other restrictions imposed by the so-called One Big Beautiful Bill Act (OBBBA). These changes will require states to rapidly redesign complex eligibility systems, creating new opportunities for technology failures, processing errors, and wrongful coverage losses.
“States are entrusting private companies with decisions that can determine whether someone gets cancer treatment, fills a prescription, or brings a newborn home with health coverage,” said Jennifer Cannistra, Executive Director of the National Health Law Program. “The public deserves to know who is building these systems, how billions of taxpayer dollars are being spent, and what accountability exists when the technology fails. Transparency is especially urgent as states rush to implement sweeping new Medicaid restrictions. States should strengthen vendor contracts with enrollee protections, stakeholder testing, transparent reporting, and safeguards that prevent system failures from wrongfully costing people their health coverage.”
Most state Medicaid agencies contract with a small group of private vendors to build, maintain, and operate their eligibility systems. Deloitte is among the most dominant vendors in this market, holding contracts across the majority of states.
Although these systems are publicly funded and used to administer a public benefit, the underlying contracts can be difficult to obtain and vary widely in the protections and performance standards they require.
When systems fail, the consequences are not merely technical. Software errors can prevent eligible people from enrolling, cause wrongful terminations, delay access to care, and force people to navigate burdensome appeals processes.
In Colorado, for example, state auditors have repeatedly documented widespread problems with the notices sent to enrollees, which are generated by the Deloitte-run computer system, such as wrong dates or contradictory information. In Texas, approximately 100,000 people lost coverage over a three-month period because of problems involving software operated by the same company.
“These failures follow a disturbingly familiar pattern,” said Shandra Hartly, senior attorney at the National Health Law Program. “A vendor builds a flawed system, people lose coverage when the system fails, and the state then pays that vendor additional money to repair it. Meanwhile, another state may already have encountered and paid to fix the same underlying problem. Without greater transparency, states can continue spending public money to repeat one another’s mistakes.”
“These contracts reveal how private vendors dictate the terms of benefits eligibility systems, impeding states’ ability to manage their own technical infrastructure and administer their public programs. This dynamic — in tandem with restrictive, convoluted eligibility rules and administrative burdens — makes the social safety net increasingly difficult to access and furthers efforts to dismantle public benefits programs,” said Emma Weil, Senior Policy Analyst at Upturn and a member of the Benefits Tech Advocacy Hub, who supported research for this project.
“Understanding the current landscape of contracts is an important step in enhancing them to ensure the community of recipients are truly centered in the design and implementation of public benefits technology,” said Ralph Martinez, technologist at the nonprofit TechTonic Justice, which often partners with the National Health Law Program and supported this project.
OBBBA gives states an unusually compressed timeline to make extensive changes to their Medicaid eligibility systems. States had substantially more time to prepare for implementation of the Affordable Care Act and the post-pandemic Medicaid unwinding, yet both transitions still produced significant system failures and wrongful coverage losses.
The new requirements will add more data exchanges, notices, reporting processes, exemptions, and eligibility checks to systems that have repeatedly struggled with large-scale changes. Errors involving any one of these functions could cause eligible people to lose health coverage.
NHeLP is continuing to obtain and review contracts from additional states. The map will be updated as more information becomes available. Explore the Medicaid Eligibility Vendor Map: https://healthlaw.org/medicaid-eligibility-system-vendor-map/
We hope that states use this moment to strengthen vendor contracts with enrollee protections, stakeholder testing, direct reporting of system glitches, and safeguards to quickly pause terminations when problems arise. Better systems mean fewer wrongful coverage losses.
For more than 30 years, NHeLP has examined how states procure, build, and operate automated Medicaid eligibility systems. NHeLP’s work combines federal and state policy advocacy, legal and technical analysis, litigation, and collaboration with state advocates and technologists.
The National Health Law Program thanks our partners in the Benefits Tech Advocacy Hub, including Upturn and TechTonic Justice, for their critical collaboration in developing this project, obtaining contracts, and analyzing their contents.
If you have information about state Medicaid eligibility system contracts, please contact [email protected]. Members of the press who would like to speak with NHeLP and our partners can contact [email protected].
