Private Contractors Profit as Medicaid Coverage Shrinks Under New Rules

The report identifies five key contractors—Maximus, Gainwell, General Dynamics Information Technology, Conduent, and Deloitte—currently managing state enrollment systems. Despite receiving millions in taxpayer funds to facilitate the transition to federal mandates, these firms refused to disclose data regarding how many individuals their systems have flagged as ineligible. The new rules require certain recipients to document at least 80 hours of work or qualifying activity per month to maintain coverage, a threshold that could result in over 10 million people losing benefits by 2028.

Senate Democrats, led by Sen. Ron Wyden and Sen. Elizabeth Warren, argue that the reliance on these for-profit entities creates a perverse incentive structure. Preliminary data from Nebraska, one of the few states already testing these mandates, suggests that bureaucratic friction rather than actual ineligibility drives the majority of coverage losses. While contractors deny that their internal policies prioritize removals, lawmakers emphasize that the rushed, automated nature of these systems poses a severe risk to those with critical medical needs.