My money is on the technical people being perfectly competent but the business stakeholders fighting over turf and the systems architecture being what suffers.

My money is on the technical people being perfectly competent but the business stakeholders fighting over turf and the systems architecture being what suffers. This is already guaranteed given the number of moving parts involved, but with a government project requiring partnership with private business (the actual insurance companies .. or heck, even Medicaid), it has to be much, much worse than normal. I can just picture in my head a developer requesting an RESTful API for simple data interchange and the current owner of the legacy system they're asking about being 1) clueless, 2) hamstrung, or 3) actively impeding progress. Repeat this song and dance ad infinitum over the course of the project and you end up with a complex system designed to work in the specific use case of the conference room pilot prior to go-live ... but which will fail everything else.