State Integrated Eligibility Services

Deloitte is proud to support state Health and Human Services agencies and the people they serve.

Throughout the U.S., health and human services agencies trust the Deloitte professionals who live this mission because they know first-hand the quality of our work, our record of innovative digital service delivery, and our deep understanding of their programs.

Over the past four decades, Deloitte has worked at the direction of dozens of states to help them implement, maintain and enhance their eligibility and enrollment systems to comply with their specific policies, rules and processes. We have also worked with our clients to make it easier for their constituents to access the benefits for which they are eligible.

The depth and breadth of our capabilities and experience – and the extraordinary impact we deliver for our clients – differentiates us from other vendors and makes us the go-to organization for states’ mission-critical, technology-enabled transformation projects.

Setting the Record Straight: Deloitte’s response to KFF Health News’ coverage of state eligibility systems
(Letter to the Editor, November 4, 2024)

In March 2024, in good faith and with respect for KFF Health News, Deloitte’s health and human services practice leader provided a 90-minute interview with two reporters for a story they said was about “problems with Deloitte’s eligibility systems across the country.

We agreed to the interview because we had heard from several of our state clients that they, too, had been contacted by KFF Health News, and the questions being raised showed a misunderstanding of integrated eligibility systems, the technology that sustains them, and the complexity of the health and human services programs they support.

We also wanted to clarify that eligibility systems are owned by the states, not Deloitte; they are uniquely built for each state (in some cases, by other vendors decades ago); and we work at the direction of our state clients to maintain and enhance these systems to comply with state-specific policies, rules and processes, and evolving federal regulations.

Unfortunately, the interview did not appear to be seeking facts, but rather confirmation of a false premise. The reporters repeatedly said they did not want to “blindside” us with their allegations, yet they disregarded any facts we offered that contradicted them – including statistics published by KFF.

Indeed, the stories that subsequently ran misrepresented the information presented in source material, ignored the shared responsibilities in a large technology project, and relied on innuendo and supposition, rather than facts.

Many of the issues KFF Health News reported as “widespread” are, in fact, isolated to specific situations or involve sensitive data that cannot be refuted by Deloitte due to client confidentiality obligations. That said, there are many reasons why someone may lose coverage or no longer be eligible for a benefit they once received.

Every “issue” a constituent faces is not the result of a system “error,” and challenges with individual cases in individual systems are not due to some fundamental problem in the way Deloitte supports state Medicaid programs.

The state clients interviewed confirmed this. In a telling example, one said there were no system issues impacting people in their state with intellectual and developmental disabilities, yet KFF Health News reported an advocate’s opinion as fact.

On the issue of contract changes, Deloitte rejected the claim that our state clients send us a “change request…when a fix is needed.” We said that was inaccurate and explained that when there are policy or rule changes – or a global pandemic – that require modifications to a state’s technology, change orders are not only necessary, but appropriate under our contracts.

They do not represent errors in a system that need to be fixed.

Several of our state clients verified this:

• One told KFF Health News that system changes were made to align with changing federal and state policies, as well as to meet evolving business needs, improve functionality, and comply with new federal requirements related to the COVID-19 pandemic.
• Another client said that a change request was designed to address a limitation of the system rather than technical issues.

Throughout the unwinding of the COVID-19 Public Health Emergency – as technologies evolved and policies changed – Deloitte worked closely with states to minimize the challenges for those going through the Medicaid redetermination process. The innovations and human-centered design processes we helped our clients implement enhanced the digital experience for their constituents and made it easier for caseworkers, staff, and community partners to support the 34 million people in their care.

When the Centers for Medicare and Medicaid Services (CMS) clarified ex parte guidance and our state clients requested system changes based on that guidance, Deloitte supported rapid system turnaround. We also demonstrated our ability to quickly help states implement new federal e14 authorities and options such as iterative text, e-mail, and notice campaigns to keep constituents, providers and other stakeholders informed.

The impact of our work is evidenced by the following statistics from KFF and Georgetown University:

• Deloitte supports 3 of the 5 states with the lowest Medicaid disenrollment rates.
• Deloitte supports 5 of the 10 states with the highest ex parte rates.
• Deloitte supports 8 of the 12 states with the biggest gains in ex parte rates.
• Deloitte supports the state with the lowest administrative closure rate.

Our HHS clients understand that large system implementations are challenging due to the complexity of the programs they support, and that all IT systems require ongoing maintenance, periodic enhancements and upgrades to software and hardware, and database management.

That is why so many states continue to select Deloitte to help them maintain their mission-critical HHS systems, and why industry analysts like Forrester and Gartner consistently rank Deloitte as a leader in system integration and business transformation.