Marie Noon takes eight medications a day. One keeps her heart rate from spiking to avoid a stroke. One prevents debilitating headaches. Another ensures she doesn\u2019t retain excess fluid.<\/p>\n
More than a decade ago, Noon said, she was diagnosed with adult-onset Still\u2019s disease, a rare type of inflammatory arthritis that can cause rashes, debilitating pain, and fevers. The disease upended her life.<\/p>\n
She had been living a typical suburban life in Michigan, shuttling her two kids to activities like cheerleading, choir practice, and track. She was active in the PTA. She managed a bank.<\/p>\n
She went from that to crawling to the bathroom because she was in so much pain, \u201cjust crying all day long\u201d from being so sick.<\/p>\n
Noon, who is disabled, said she couldn\u2019t work for eight years \u2014 a time marked by hospital stays that stretched for weeks.<\/p>\n
\u201cI honestly thought I was going to die,\u201d Noon said.<\/p>\n
So it was a shock when Michigan denied her application for Medicaid benefits last year after she lost private insurance. Worse yet, it came down to an IT error, according to an attorney who helped Noon overturn the denial.<\/p>\n
\u201cI can\u2019t afford my medical care. I have to have insurance,\u201d said Noon, who has returned to working.<\/p>\n
Deloitte, a multibillion-dollar global consulting firm, has operated Michigan\u2019s Medicaid eligibility system under contracts worth roughly $768 million since 2006, according to contracts reviewed by KFF Health News. Nationwide, Deloitte dominates this important slice of government business: At least 25 states have awarded the company contracts to build or run computer systems that control access to safety net benefits such as Medicaid.<\/p>\n
Michigan\u2019s system has incorrectly directed people with disabilities into skimpier benefits that cover limited care or has denied coverage completely, a KFF Health News investigation found. Similar problems were at the center of a class-action suit in Tennessee<\/a>, court<\/a> documents show<\/a>, and have occurred in Texas, according to interviews and state records.<\/p>\n The KFF Health News investigations are based on statements from state officials, allegations and declarations in court documents, emails obtained through public records requests, state government information provided to Medicaid enrollees and applicants, and interviews with attorneys and patients or their caregivers.<\/p>\n In an emailed statement, Deloitte spokesperson Karen Walsh said it found \u201cno system anomalies causing routine denials of Medicaid for people with disabilities.\u201d<\/p>\n \u201cThere are many reasons why someone may no longer be eligible for a benefit they once received or believe they deserve,\u201d Walsh said. \u201cAll of the eligibility systems we support are owned by the states and built to their unique specifications. We will continue to work at the direction of our state clients.\u201d<\/p>\n Lynn Sutfin, a spokesperson for Michigan\u2019s Department of Health and Human Services, said it \u201cis not aware of any widespread or systemic issues\u201d within Bridges, Michigan\u2019s eligibility system for Medicaid, SNAP, and other benefits, \u201crelated to disability\u2011based eligibility pathways.\u201d\u00a0<\/p>\n Since 2006, Deloitte\u2019s contracts with the state have said the company is responsible for development, implementation, maintenance, operations, and enhancements to the Michigan system.<\/p>\n Computer system problems foreshadow trouble as states prepare to roll out the most significant and complicated changes to their Medicaid programs in years. Those changes, dictated by President Donald Trump\u2019s landmark One Big Beautiful Bill Act, have states rushing to update their Medicaid computer systems.<\/p>\n Nationwide, roughly 15.5 million people<\/a> on Medicaid have a disability, according to KFF.<\/p>\n \u201cWhen these administrative systems get overloaded, everyone gets impacted,\u201d said Pamela Herd, a University of Michigan professor who researches bureaucratic obstacles to accessing government benefits. \u201cThe systems are going to be really, really strained.\u201d\u00a0<\/p>\n In Michigan, Noon was eligible for Medicaid through a program that provides coverage to disabled adults who work. But the state\u2019s computer system didn\u2019t register that she is disabled and said she earned too much to qualify, according to documents reviewed by KFF Health News and interviews with Noon and Anastassia Kolosova, a disability rights attorney who helped her.<\/p>\n Without Medicaid coverage, Noon paid hundreds of dollars out-of-pocket for prescriptions, after scrounging for discount coupons. She takes some of the drugs twice a day.<\/p>\n Without them, \u201cI\u2019m toast,\u201d she said. It was stressful \u201cnot knowing if my medicine\u2019s going to be $50 or $500 this month, because it changes constantly.\u201d<\/p>\n Noon said her doctor agreed to fewer visits to avoid medical bills.<\/p>\n \u201cIt was kind of a nightmare,\u201d Noon said.<\/p>\n \u2018I Just Wanted To Give Up\u2019<\/strong><\/p>\n Medicaid, a safety net health program jointly run by the federal government and states, covers roughly 67 million<\/a> people with low incomes or disabilities. State governments rely on companies like Deloitte to design and operate computer systems that assess whether people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly known as food stamps.<\/p>\n That technology has a history of errors<\/a> that deprive eligible people of benefits, earlier KFF Health News investigations have<\/a> shown<\/a>. As reported previously, Kenneth Smith, a Deloitte executive who leads its national human services division, said Medicaid eligibility technology is state-owned and agencies \u201cdirect their operation\u201d and \u201cmake decisions about the policies and processes that they implement.\u201d<\/p>\n \u201cThey\u2019re not Deloitte systems,\u201d he said, noting Deloitte is one player among many who together administer Medicaid benefits.<\/p>\n States are under immense pressure to update their eligibility systems on a tight schedule to adhere to requirements in the Republicans\u2019 sweeping 2025 tax and spending law. Companies including Deloitte, Accenture, and Optum are being paid millions in taxpayer funds<\/a> to make the changes, which are projected to strip Medicaid from roughly 7.5 million people and SNAP from 2.4 million people by 2034.<\/p>\n Many coverage restrictions in the new federal law don\u2019t apply to seniors, children, or people who are disabled, such as Noon. Nonetheless, the law\u2019s demands on state agencies and the computer systems they oversee will disrupt benefits, advocates for Medicaid enrollees and other healthcare experts said in interviews.<\/p>\n The same systems also need to correctly classify why someone is eligible for Medicaid \u2014 and therefore which rules and restrictions apply.<\/p>\n The law\u2019s SNAP restrictions began to take effect in 2025, and major Medicaid provisions begin later this year, generally after the midterm elections.<\/p>\n Kolosova is a supervising attorney with Disability Rights Michigan, a legal advocacy organization for people with disabilities. She said she has been unable to get a meeting with Michigan officials to understand the underlying problem that deprived Noon of health coverage.<\/p>\n State records show Deloitte has held contracts for at least 14 years for Bridges, Michigan\u2019s eligibility system for Medicaid, SNAP, and other benefits. In its attempts to secure more business, the company often cites its nationwide footprint in Medicaid operations.<\/p>\n \u201cDeloitte understands Bridges,\u201d and its history in Michigan makes the company \u201cthe ideal vendor,\u201d the firm said in its bid documents<\/a>. Given Deloitte\u2019s work on similar systems in 31 other states, the firm said<\/a>, \u201cMichigan benefits from our technical expertise drawn from across the nation.\u201d<\/p>\n But advocates who work with people with disabilities say Michigan\u2019s computer system has failed<\/a> to recognize when certain adults should receive Medicaid benefits. <\/p>\n Problems aren\u2019t unique to the Great Lakes State. Medicaid beneficiaries who brought a class-action lawsuit<\/a> against Tennessee in 2020 said the state\u2019s Deloitte-built system \u201cdoes not reliably test for eligibility\u201d for several categories of people with disabilities. The firm\u2019s contract in Tennessee<\/a> is worth $1.12 billion over a decade.<\/p>\n A federal judge in 2024 sided with the Medicaid beneficiaries<\/a>, ruling that Tennessee violated federal law and the U.S. Constitution. The lawsuit does not name Deloitte as a defendant.<\/p>\n In Michigan, a 2010 report<\/a> from the state\u2019s Office of the Auditor General said government agencies \u201cdid not provide effective project administration\u201d and failed to ensure that the state could \u201cindependently maintain and operate Bridges\u201d because \u201cthe contractor did not transfer knowledge and skills\u201d to state officials, according to the audit.<\/p>\n The auditor\u2019s report said that, as a result, Deloitte\u2019s original contract \u2014 valued at roughly $70 million \u2014 ballooned by $50 million over the initial cost, a 71% increase. State records show Michigan would go on to add millions more, bumping the cost of Deloitte\u2019s initial contract to $124.1 million.<\/p>\n The audit said maintaining the contract would result \u201cin significant additional costs.\u201d<\/p>\n Sutfin said that \u201cthe state is now fully capable of operating and maintaining Bridges independently.\u201d<\/p>\n Deloitte\u2019s latest contract<\/a> in Michigan \u2014 worth $197.4 million \u2014 is set to expire in 2030.<\/p>\n Noon applied for Medicaid in August, she and Kolosova said. In September, the Michigan Department of Health and Human Services sent a notice denying her coverage, citing incorrect income information and stating she wasn\u2019t disabled, according to Kolosova and state documents reviewed by KFF Health News.<\/p>\n Noon said that when she called the state for help, state workers \u201cdidn\u2019t know anything about\u201d the Medicaid program she had applied to, Freedom to Work.<\/p>\n \u201cI can\u2019t tell you how many times I just wanted to give up,\u201d she said.<\/p>\n For some people with disabilities, Medicaid is supposed to count only half their earnings when assessing whether they should receive benefits. That didn\u2019t happen. Kolosova said she thinks Michigan\u2019s eligibility system didn\u2019t identify Noon as disabled, even though the state \u201calready had all the information they needed\u201d to show she was.<\/p>\n By failing to recognize her disability, the state used the wrong income formula and said Noon earned too much to qualify for Medicaid, she added. Deloitte and Michigan declined to respond to a detailed list of questions about Noon\u2019s experience.<\/p>\n Kolosova said Disability Rights Michigan has seen a growing number of calls from people about Freedom to Work benefit denials. \u201cMaybe two or three a month,\u201d she said.<\/p>\n \u201cThere\u2019s something wrong with the system if they\u2019re relying on individual caseworkers to catch this,\u201d Kolosova said. \u201cThe system needs to work.\u201d<\/p>\n Enrolled in the Wrong Coverage<\/strong><\/p>\n Noon\u2019s experience isn\u2019t the first time in recent years that people with disabilities have been denied benefits by Deloitte-run eligibility systems.<\/p>\n In Texas in 2023, Lilly Livingston, who has Down syndrome and is now 22, was abruptly cut off from Medicaid benefits, according to Livingston\u2019s mother, Marie. She has undergone numerous surgeries to reconstruct her severely misaligned jaw, which caused sleep apnea and impaired her speech and chewing ability. She relied on an array of Medicaid services, including speech and occupational therapy.<\/p>\n When Livingston lost benefits, she was wrongly enrolled in Healthy Texas Women, a limited program that provides breast and cervical cancer screenings and family planning services.<\/p>\n \u201cTrying to fix that was a nightmare,\u201d Marie Livingston said.<\/p>\n Terry Anstee, an attorney with Disability Rights Texas, intervened.<\/p>\n In a September 2023 email with the subject line \u201cURGENT,\u201d Anstee begged a Texas Medicaid eligibility worker for help.<\/p>\n Some unknown \u201cerror\u201d had occurred and stripped Livingston of her benefits, Anstee said in an email he sent to a state Medicaid staffer. \u201cLilly has had 2 major surgeries, and her recovery is contingent on Medicaid.\u201d<\/p>\n It was clear that Livingston qualified for Medicaid through multiple paths, Anstee said: \u201cIt never made any sense.\u201d <\/p>\n Deloitte declined to respond to a detailed list of questions about Livingston\u2019s case. Jennifer Ruffcorn, a spokesperson for Texas Health and Human Services, confirmed that Livingston was erroneously enrolled in Healthy Texas Women. However, Ruffcorn said, Livingston did not experience a lapse in Medicaid coverage in 2023.<\/p>\n Anstee disputed the state\u2019s characterization: \u201cA glance in the system by a Texas HHS press officer or other staff 3 years after the fact may not tell the full story or show the issues that Ms. Livingston endured in August and September 2023. Ms. Livingston experienced lapses in coverage.\u201d<\/p>\n The problem Livingston encountered in Texas was also reported in Michigan.<\/p>\n In 2024, mental health services advocates in Michigan raised red flags about a similar error: People with disabilities were being enrolled in a limited Medicaid program covering sexual health and family planning services. Plan First covers only services such as birth control<\/a> and treatment for sexually transmitted infections. It doesn\u2019t provide the comprehensive coverage that people with disabilities require.<\/p>\n But some enrollees were \u201cbeing automatically enrolled in Plan First,\u201d Malcolm Kletke, a lobbyist representing the Community Mental Health Association of Michigan and other mental health providers, wrote to a Michigan health official, according to emails obtained by KFF Health News through a public records request.<\/p>\n These enrollees had \u201clong received Medicaid due to their disability,\u201d and getting enrolled in the wrong plan meant losing access to \u201cservices essential to their recovery and quality of life,\u201d Kletke wrote in September 2024 to Amy Epkey, a senior deputy director of the Michigan Department of Health and Human Services.<\/p>\n In fact, the state\u2019s own records show that Medicaid enrollment for those with disabilities did decline.<\/p>\n![\"Newsletter](\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\"){kind=icon}
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