Medicaid Requirement Could Test States' Technology

The Medicaid work requirement in President Trump's tax cut and spending bill now in the hands of Senate Republicans would not only put millions of Americans at risk of losing coverage, it will make dozens of states build software systems quickly to enforce the regulation. States with outdated technology will have to hustle to get expensive and complex systems in place, the New York Times reports, in an effort whose fallout could echo the bungled online launch of the Affordable Care Act enrollment portal in 2013. State officials and technology experts said the state systems could be set up for major failures. "That's how Healthcare.gov happens," said a former top Biden administration official.

Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, thinks the systems will be ready in time. "We are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements," he said. Former state Medicaid officials have doubts. The states already would be making due with less federal money. Among the possibilities, experts say, are that the site won't load for applicants—who would have to prove they meet the work requirement— or wrongly tells them they're not eligible. The crush on call centers and staff members could increase. And people with coverage could have it dropped.

Among the winners will be technology companies that develop the systems, per the Times. "This is going to be a huge payday for government contractors," said Luke Farrell, who worked for the United States Digital Service during the Biden administration helping states fix their Medicaid technology systems. "They get to build something once and then sell it 25 times."