Smith, a former attorney for the National Health Law Program and now a lawyer for the plaintiffs in the Tennessee case. “They’re fraught with risk, they’re fraught with needing to have a lot of oversight.” In Georgia, Deloitte’s system has been criticized for not being adaptable or flexible, limiting the state’s ability to efficiently serve its customers and improve the customer and worker experience. In Pennsylvania, delays in eligibility determinations have left people hungry and sick, waiting for the benefits they are entitled to.
The National Health Law Program has filed a complaint with the Federal Trade Commission alleging ongoing errors and deceptive trade practices by Deloitte in its Medicaid eligibility systems. The organization claims that Deloitte’s systems have generated numerous errors, resulting in inaccurate eligibility determinations and loss of coverage for eligible individuals in many states. Deloitte denies these allegations, calling them “without merit.”
As states continue to navigate the process of disenrolling people who no longer qualify for Medicaid, advocates worry that many eligible individuals are losing coverage. A survey found that nearly 1 in 4 adults who were removed from Medicaid are now uninsured, suggesting that they should not have been dropped in the first place.
Despite the challenges and criticisms, Deloitte continues to hold lucrative contracts with numerous states for Medicaid eligibility systems. The company is looking ahead to the future of Medicaid in 2040, anticipating sweeping changes that will expand its business opportunities.
In the midst of these issues, Medicaid beneficiaries like DiJuana Davis in Tennessee are suffering the consequences of system errors. Davis lost her coverage due to missteps during the conversion process to a new eligibility system, leaving her uninsured for nearly two months. She experienced a serious complication during her pregnancy as a result of the delay in coverage restoration.
Overall, the KFF Health News investigation highlights the significant impact that system errors in Medicaid eligibility systems can have on America’s poorest residents. Delays, errors, and inefficiencies in these systems can result in real harm to individuals who rely on Medicaid for essential healthcare coverage.