Marie Midday takes eight drugs a day. One retains her coronary heart price from spiking to keep away from a stroke. One prevents debilitating complications. One other ensures she doesn’t retain extra fluid.
Greater than a decade in the past, Midday mentioned, she was recognized with adult-onset Nonetheless’s illness, a uncommon sort of inflammatory arthritis that may trigger rashes, debilitating ache, and fevers. The illness upended her life.
She had been dwelling a typical suburban life in Michigan, shuttling her two children to actions like cheerleading, choir observe, and observe. She was energetic within the PTA. She managed a financial institution.
She went from that to crawling to the lavatory as a result of she was in a lot ache, “just crying all day long” from being so sick.
Midday, who’s disabled, mentioned she couldn’t work for eight years — a time marked by hospital stays that stretched for weeks.
“I honestly thought I was going to die,” Midday mentioned.
So it was a shock when Michigan denied her utility for Medicaid advantages final yr after she misplaced personal insurance coverage. Worse but, it got here all the way down to an IT error, in line with an legal professional who helped Midday overturn the denial.
“I can’t afford my medical care. I have to have insurance,” mentioned Midday, who has returned to working.
Deloitte, a multibillion-dollar international consulting agency, has operated Michigan’s Medicaid eligibility system beneath contracts value roughly $768 million since 2006, in line with contracts reviewed by KFF Well being Information. Nationwide, Deloitte dominates this necessary slice of presidency enterprise: Not less than 25 states have awarded the corporate contracts to construct or run laptop techniques that management entry to security internet advantages resembling Medicaid.
Michigan’s system has incorrectly directed folks with disabilities into skimpier advantages that cowl restricted care or has denied protection utterly, a KFF Well being Information investigation discovered. Comparable issues have been on the middle of a class-action go well with in Tennessee, courtroom paperwork present, and have occurred in Texas, in line with interviews and state data.
The KFF Well being Information investigations are based mostly on statements from state officers, allegations and declarations in courtroom paperwork, emails obtained by way of public data requests, state authorities data supplied to Medicaid enrollees and candidates, and interviews with attorneys and sufferers or their caregivers.
In an emailed assertion, Deloitte spokesperson Karen Walsh mentioned it discovered “no system anomalies causing routine denials of Medicaid for people with disabilities.”
“There are many reasons why someone may no longer be eligible for a benefit they once received or believe they deserve,” Walsh mentioned. “All 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.”
Lynn Sutfin, a spokesperson for Michigan’s Division of Well being and Human Providers, mentioned it “is not aware of any widespread or systemic issues” inside Bridges, Michigan’s eligibility system for Medicaid, SNAP, and different advantages, “related to disability‑based eligibility pathways.”
Since 2006, Deloitte’s contracts with the state have mentioned the corporate is chargeable for growth, implementation, upkeep, operations, and enhancements to the Michigan system.
Pc system issues foreshadow hassle as states put together to roll out essentially the most vital and sophisticated modifications to their Medicaid applications in years. These modifications, dictated by President Donald Trump’s landmark One Massive Stunning Invoice Act, have states dashing to replace their Medicaid laptop techniques.
Nationwide, roughly 15.5 million folks on Medicaid have a incapacity, in line with KFF.
“When these administrative systems get overloaded, everyone gets impacted,” mentioned Pamela Herd, a College of Michigan professor who researches bureaucratic obstacles to accessing authorities advantages. “The systems are going to be really, really strained.”
In Michigan, Midday was eligible for Medicaid by way of a program that gives protection to disabled adults who work. However the state’s laptop system didn’t register that she is disabled and mentioned she earned an excessive amount of to qualify, in line with paperwork reviewed by KFF Well being Information and interviews with Midday and Anastassia Kolosova, a incapacity rights legal professional who helped her.
With out Medicaid protection, Midday paid tons of of {dollars} out-of-pocket for prescriptions, after scrounging for low cost coupons. She takes a few of the medicine twice a day.
With out them, “I’m toast,” she mentioned. It was irritating “not knowing if my medicine’s going to be $50 or $500 this month, because it changes constantly.”
Midday mentioned her physician agreed to fewer visits to keep away from medical payments.
“It was kind of a nightmare,” Midday mentioned.
‘I Just Wanted To Give Up’
Medicaid, a security internet well being program collectively run by the federal authorities and states, covers roughly 67 million folks with low incomes or disabilities. State governments depend on firms like Deloitte to design and function laptop techniques that assess whether or not folks qualify for Medicaid or meals help by way of the Supplemental Vitamin Help Program, generally often called meals stamps.
That know-how has a historical past of errors that deprive eligible folks of advantages, earlier KFF Well being Information investigations have proven. As reported beforehand, Kenneth Smith, a Deloitte govt who leads its nationwide human companies division, mentioned Medicaid eligibility know-how is state-owned and companies “direct their operation” and “make decisions about the policies and processes that they implement.”
“They’re not Deloitte systems,” he mentioned, noting Deloitte is one participant amongst many who collectively administer Medicaid advantages.
States are beneath immense stress to replace their eligibility techniques on a decent schedule to stick to necessities within the Republicans’ sweeping 2025 tax and spending legislation. Firms together with Deloitte, Accenture, and Optum are being paid tens of millions in taxpayer funds to make the modifications, that are projected to strip Medicaid from roughly 7.5 million folks and SNAP from 2.4 million folks by 2034.
Many protection restrictions within the new federal legislation don’t apply to seniors, kids, or people who find themselves disabled, resembling Midday. Nonetheless, the legislation’s calls for on state companies and the pc techniques they oversee will disrupt advantages, advocates for Medicaid enrollees and different healthcare specialists mentioned in interviews.
The identical techniques additionally must appropriately classify why somebody is eligible for Medicaid — and due to this fact which guidelines and restrictions apply.
The legislation’s SNAP restrictions started to take impact in 2025, and main Medicaid provisions start later this yr, usually after the midterm elections.
Kolosova is a supervising legal professional with Incapacity Rights Michigan, a authorized advocacy group for folks with disabilities. She mentioned she has been unable to get a gathering with Michigan officers to know the underlying drawback that disadvantaged Midday of well being protection.
State data present Deloitte has held contracts for no less than 14 years for Bridges, Michigan’s eligibility system for Medicaid, SNAP, and different advantages. In its makes an attempt to safe extra enterprise, the corporate typically cites its nationwide footprint in Medicaid operations.
“Deloitte understands Bridges,” and its historical past in Michigan makes the corporate “the ideal vendor,” the agency mentioned in its bid paperwork. Given Deloitte’s work on related techniques in 31 different states, the agency mentioned, “Michigan benefits from our technical expertise drawn from across the nation.”
However advocates who work with folks with disabilities say Michigan’s laptop system has failed to acknowledge when sure adults ought to obtain Medicaid advantages.
Issues aren’t distinctive to the Nice Lakes State. Medicaid beneficiaries who introduced a class-action lawsuit in opposition to Tennessee in 2020 mentioned the state’s Deloitte-built system “does not reliably test for eligibility” for a number of classes of individuals with disabilities. The agency’s contract in Tennessee is value $1.12 billion over a decade.
A federal decide in 2024 sided with the Medicaid beneficiaries, ruling that Tennessee violated federal legislation and the U.S. Structure. The lawsuit doesn’t title Deloitte as a defendant.
In Michigan, a 2010 report from the state’s Workplace of the Auditor Normal mentioned authorities companies “did not provide effective project administration” and failed to make sure that the state might “independently maintain and operate Bridges” as a result of “the contractor did not transfer knowledge and skills” to state officers, in line with the audit.
The auditor’s report mentioned that, in consequence, Deloitte’s authentic contract — valued at roughly $70 million — ballooned by $50 million over the preliminary value, a 71% enhance. State data present Michigan would go on so as to add tens of millions extra, bumping the price of Deloitte’s preliminary contract to $124.1 million.
The audit mentioned sustaining the contract would outcome “in significant additional costs.”
Sutfin mentioned that “the state is now fully capable of operating and maintaining Bridges independently.”
Deloitte’s newest contract in Michigan — value $197.4 million — is ready to run out in 2030.
Midday utilized for Medicaid in August, she and Kolosova mentioned. In September, the Michigan Division of Well being and Human Providers despatched a discover denying her protection, citing incorrect revenue data and stating she wasn’t disabled, in line with Kolosova and state paperwork reviewed by KFF Well being Information.
Midday mentioned that when she known as the state for assist, state staff “didn’t know anything about” the Medicaid program she had utilized to, Freedom to Work.
“I can’t tell you how many times I just wanted to give up,” she mentioned.
For some folks with disabilities, Medicaid is meant to depend solely half their earnings when assessing whether or not they need to obtain advantages. That didn’t occur. Kolosova mentioned she thinks Michigan’s eligibility system didn’t establish Midday as disabled, despite the fact that the state “already had all the information they needed” to indicate she was.
By failing to acknowledge her incapacity, the state used the improper revenue formulation and mentioned Midday earned an excessive amount of to qualify for Medicaid, she added. Deloitte and Michigan declined to answer an in depth checklist of questions on Midday’s expertise.
Kolosova mentioned Incapacity Rights Michigan has seen a rising variety of calls from folks about Freedom to Work profit denials. “Maybe two or three a month,” she mentioned.
“There’s something wrong with the system if they’re relying on individual caseworkers to catch this,” Kolosova mentioned. “The system needs to work.”
Enrolled within the Improper Protection
Midday’s expertise isn’t the primary time in recent times that folks with disabilities have been denied advantages by Deloitte-run eligibility techniques.
In Texas in 2023, Lilly Livingston, who has Down syndrome and is now 22, was abruptly lower off from Medicaid advantages, in line with Livingston’s mom, Marie. She has undergone quite a few surgical procedures to reconstruct her severely misaligned jaw, which induced sleep apnea and impaired her speech and chewing capability. She relied on an array of Medicaid companies, together with speech and occupational remedy.
When Livingston misplaced advantages, she was wrongly enrolled in Wholesome Texas Girls, a restricted program that gives breast and cervical most cancers screenings and household planning companies.
“Trying to fix that was a nightmare,” Marie Livingston mentioned.
Terry Anstee, an legal professional with Incapacity Rights Texas, intervened.
In a September 2023 e mail with the topic line “URGENT,” Anstee begged a Texas Medicaid eligibility employee for assist.
Some unknown “error” had occurred and stripped Livingston of her advantages, Anstee mentioned in an e mail he despatched to a state Medicaid staffer. “Lilly has had 2 major surgeries, and her recovery is contingent on Medicaid.”
It was clear that Livingston certified for Medicaid by way of a number of paths, Anstee mentioned: “It never made any sense.”
Deloitte declined to answer an in depth checklist of questions on Livingston’s case. Jennifer Ruffcorn, a spokesperson for Texas Well being and Human Providers, confirmed that Livingston was erroneously enrolled in Wholesome Texas Girls. Nonetheless, Ruffcorn mentioned, Livingston didn’t expertise a lapse in Medicaid protection in 2023.
Anstee disputed the state’s characterization: “A 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.”
The issue Livingston encountered in Texas was additionally reported in Michigan.
In 2024, psychological well being companies advocates in Michigan raised crimson flags a few related error: Folks with disabilities have been being enrolled in a restricted Medicaid program protecting sexual well being and household planning companies. Plan First covers solely companies resembling contraception and remedy for sexually transmitted infections. It doesn’t present the excellent protection that folks with disabilities require.
However some enrollees have been “being automatically enrolled in Plan First,” Malcolm Kletke, a lobbyist representing the Neighborhood Psychological Well being Affiliation of Michigan and different psychological well being suppliers, wrote to a Michigan well being official, in line with emails obtained by KFF Well being Information by way of a public data request.
These enrollees had “long received Medicaid due to their disability,” and getting enrolled within the improper plan meant dropping entry to “services essential to their recovery and quality of life,” Kletke wrote in September 2024 to Amy Epkey, a senior deputy director of the Michigan Division of Well being and Human Providers.
In actual fact, the state’s personal data present that Medicaid enrollment for these with disabilities did decline.
Over roughly 4 years, enrollment within the Medicaid class that features folks with disabilities fell by 10% within the state, in line with the Michigan Home Fiscal Company, which supplies nonpartisan evaluation to lawmakers. The drop was uncommon given folks usually depart this system due to dying or having recovered from a brief incapacity, and it’s unlikely these numbers would balloon, mentioned Robert Sheehan, who was the psychological well being affiliation’s CEO on the time.
Sutfin mentioned the state examined the decline in enrollment and located “several contributing factors, including post‑covid renewal patterns, changes in beneficiary circumstances and movement to other coverage categories.”
After inquiries from KFF Well being Information, the Michigan well being division acknowledged in April that it had made modifications to “address concerns raised by advocates.”
Michigan’s laptop system now prevents approval of Plan First advantages till all different protection choices are evaluated, Sutfin advised KFF Well being Information. Sutfin mentioned the modifications have been carried out however “not to correct system errors.”
Sutfin mentioned the state submitted a change request to Deloitte to deal with this drawback. The repair was carried out in January 2025.
Till offered with Kletke’s e mail, the state had denied there have been issues associated to Plan First.
Even after the state addressed that challenge, different issues continued.
Midday’s protection denial discover arrived in September. She fought with the state for months to reverse its determination, “paying cash for all of the medicines through these appeals over and over and over again.”
It was solely in January that she was permitted.
“I literally cried,” Midday mentioned. “It was a really big deal.”
