Medicaid's new work requirements run on computer systems built by private contractors. This is the money trail: who holds the contracts, what the work costs, and what these companies' systems have done before.
Ledger checked October 21, 2026. Every figure is labeled by what kind of number it is — a contract value, a vendor's estimate, or money actually spent — and cited. Unlike figures are never added together.
Starting January 1, 2027, most states must check whether millions of Medicaid enrollees worked, studied, or volunteered 80 hours a month. States are not building the checking machines themselves. They are paying a small set of companies — Deloitte above all — to rewire the eligibility systems that decide who keeps health coverage. A year-long Senate investigation found those same companies' systems have a track record of errors that wrongfully strip coverage — and that not one of the five biggest vendors would show the Senate its contracts.
The ledger
The vendors
The Senate report (October 20, 2026)
Senators Ron Wyden, Elizabeth Warren, and Raphael Warnock released a 41-page interim report after a year investigating Maximus, Gainwell, General Dynamics Information Technology, Conduent, and Deloitte. Its findings: errors in these companies' systems wrongfully strip health coverage from eligible Americans; none of the five provided historical data on how many people their systems referred to states as ineligible; none provided meaningful detail on how they test their systems for accuracy; and no vendor provided its contracts — so no one could verify whether the contracts even penalize errors. The report's words: “Administrative errors in this line of work are not like errors in other fields. There are life-and-death consequences for sick Americans who seek care only to find that their Medicaid coverage has been terminated.” It recommends CMS set mandatory contractor standards, minimum financial penalties when system errors wrongly drop enrollees, quarterly public error-rate disclosure, and public release of the contracts. In August 2026, CMS said it intends to develop standards for Medicaid systems.
How to read these numbers
These are state contracts, not federal awards. States buy eligibility systems with Medicaid funds — the federal government pays 90% of systems development and 75% of operations — so the individual vendor contracts generally do not appear as discrete awards on USASpending. The paper trail is state procurement records, state budget documents, and the estimates vendors gave states, much of it assembled by KFF Health News. Where a figure comes from a state document obtained by reporters, we say so. Where we could not verify a number, the state simply is not in the ledger yet.
What is missing: for most of the 43 implementing jurisdictions, the community-engagement-specific contract values are not public as of October 21, 2026 — states extended existing vendors quickly, and, as the Senate found, the contracts themselves are not public. This ledger starts with the states where figures are documented and will grow as records surface. If you have a contract or a figure with a source, send it to Strait Research via the contact on straitresearch.org.
