In 2016, nearly half of beneficiaries in Arkansas’s Medicaid home and community based services (HCBS) program experienced unexpected and dramatic cuts to their care.
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Lifecycle Phase
There’s a lifecycle to the development of benefits technologies. Each case study notes the point at which advocates intervened, which should help you find case studies relevant to your situation. We don’t yet have case studies for some phases of the lifecycle. You can learn more about the lifecycle and each phase through our Lifecycle Framework.
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Benefits Program
Each case study describes the technology used to implement one or more benefits programs. Clicking multiple programs in this list will show you case studies that deal with all of them combined, like in integrated eligibility systems.
Case Study Library
The Case Study Library is a resource for advocates to learn about real examples of benefits cuts caused by benefits technology and what people have done about it. Each case study includes information about the policy context, the problems with the benefits technology, how advocates strategized around it, and the resolution or status of the issue. Each also includes contact information for the advocates involved, and any further readings or resources around the issue. We collected these case studies to show a range of public benefits technology problems and solutions, and to facilitate connections between advocates. We will continue to expand this Case Study Library as we learn about and develop more challenges to harmful benefits technology on the ground.
Arkansas Medicaid Home and Community Based Services Hours Cuts
Medicaid Arkansas Medicaid Home and Community Based Services Hours Cuts In 2016, nearly half of beneficiaries in Arkansas’s Medicaid home and community based services (HCBS) program experienced unexpected and dramatic cuts to their care. After hearing directly from beneficiaries, Legal Aid of Arkansas filed a federal lawsuit, which revealed that the state was using an algorithm called Resource Utilization Groups (RUGs) to determine people’s care needs. RUGs assigned insufficient hours of care to people at all levels of medical need. After the federal court determined the state had violated due process requirements, the state suspended care reductions for several months and revised its notices of adverse action. Further advocacy efforts revealed that, apart from providing insufficient levels of care, the algorithm did not account for certain medical conditions and other factors—a mistake that caused incorrect calculations for hundreds of people. A later state lawsuit invalidated the algorithm entirely on rulemaking grounds, and affected communities persuaded elected officials to abandon the algorithm. Advocates learned about the RUGs algorithm directly from people who lost hours of care, but only after the system had already been implemented. Because of this, the strategy involved litigation on their behalf—including an analysis of the algorithm obtained during discovery—and a media strategy centering self-advocates and beneficiaries. ## Issue Status The RUGs algorithm was invalidated by a state court and later rejected by elected officials. Litigation and representation in administrative hearings enabled some beneficiaries to retain previous care levels through the time RUGs was in effect. Starting in 2019, the state replaced the RUGs with a different system for assessments, eligibility, and care allocation. A healthcare-focused consulting firm, Optum, developed an assessment tool called ARIA (Arkansas Independent Assessment). The state uses that assessment to determine eligibility and to set an individual budget cap that limits the cost of services someone can receive—regardless of actual care needs. The state determines a person's care needs by using a time-task tool that outlines a set number of minutes for each care task. The new system has been designed for a different set of people, leaving over a quarter of those in Arkansas’s program determined wholly ineligible for care. Many of the people still eligible for services have their care limited by the budget caps and time-task tool. With so many people terminated or facing reductions in hours, the state again failed to protect people's rights to due process to fight the cuts. People lost benefits immediately even though the law requires the state to continue them while an appeal is ongoing. As a result, some people had to go without enough care or any care at all for several months. This led to people lying in their waste, missing medical appointments, skipping meals and baths, and suffering in other ways. Also, the state failed to explain the reason for the cuts so that people would know what they needed to prove to keep the care at the previous level. Several people sued the state again in federal court and, this time, they also sued the individual state Medicaid officials responsible for implementing the new system. They won the initial stage of the lawsuit and won the state's appeal to the Eighth Circuit Court of Appeal. Afterwards, they reached a settlement that forced the state to pay out nearly $500,000 and to make changes to the entire system. This way, the plaintiffs received money for their suffering and ensured that all program participants facing any cuts in the future will keep their benefits while they appeal and receive a detailed explanation of the reasons for the cuts so that they have a better chance to fight them. ## Links to More Information Federal lawsuit (available via [PACER](https://pacer.uscourts.gov/)): Jacobs v. Gillespie, 3:16-CV-119 (E.D. Ark.) State lawsuit (available via [Arkansas Court Connect](https://caseinfo.arcourts.gov/cconnect/PROD/public/ck_public_qry_main.cp_main_idx)): Ledgerwood et al. v. Arkansas Department of Human Services, 60CV-17-442 (Pulaski County Circuit Court) Appeal at Ark. Dep’t of Hum. Servs. v. Ledgerwood, 530 S.W.3d 336 (Ark. 2017) *Elder v. Gillespie*, Case No. 3:19-cv-155 (E.D. Ark.) [Complaint](https://arktimes.com/wp-content/uploads/2021/03/Elder-v-Gillespie-31-Consolidated-Complaint.pdf) *Elder v. Gillespie*, 54 F.4th 1055 (8th Cir. 2022) [Opinion](https://casetext.com/case/elder-v-gillespie-5) For trial documents (deposition transcripts, trial transcripts, verbal decisions by judges, etc.), please check with Kevin De Liban Formula For Care: Four-Part Series by Arkansas TV News Station KARK (2017) - [Part 1: Computer Program Determines Critical Care](https://www.kark.com/news/working-4-you-computer-program-determines-critical-care/) - [Part 2: Explaining the Formula for Care](https://www.kark.com/news/working-4-you-explaining-the-formula-for-care-claimed-to-cause-cuts-to-needy/) - [Part 3: Finding A Solution](https://www.kark.com/news/working-4-you-a-formula-for-care-finding-a-solution-2/) - [Part 4: Lawmakers Concerned About Changes](https://www.kark.com/news/working-4-you-formula-for-care-lawmakers-concerned-about-changes/) [What Happens When An Algorithm Cuts Your Healthcare](https://www.theverge.com/2018/3/21/17144260/healthcare-medicaid-algorithm-arkansas-cerebral-palsy) - The Verge (2018) [What Happened When A "Wildly Irrational" Algorithm Made Crucial Healthcare Decisions](https://www.theguardian.com/us-news/2021/jul/02/algorithm-crucial-healthcare-decisions) - The Guardian (2021) [The Automated Administrative State: A Crisis of Legitimacy](https://scholarlycommons.law.emory.edu/elj/vol70/iss4/1/) - Danielle Keats Citron and Ryan Calo (2021) [Disabled Arkansans obtain settlement and program improvements in lawsuit against DHS officials - *Arkansas Times*](https://arktimes.com/arkansas-blog/2023/08/07/disabled-arkansans-obtain-settlement-and-program-improvements-in-lawsuit-against-dhs-officials) (2023) ### Key Parties Involved & Contacts __Legal Aid of Arkansas__ Primary Advocate Contact: Kevin De Liban __Arkansas Department of Human Services__ __InterRAI__ Brant Fries __McKinsey and Company__ __Center for Information Management__ __Optum__ all operating all medicaidColorado Medicaid, SNAP, CHIP, and TANF Wrongful Denials
Medicaid; CHIP; SNAP; TANF Colorado Medicaid, SNAP, CHIP, and TANF Wrongful Denials In the late 90s, Colorado began a process to replace its multiple legacy benefits systems with one single system, called the Colorado Benefits Management System (CBMS). After a Request for Proposals (RFP) went out, the contract was awarded to Electronic Data Systems (EDS), and in 2004, the system went live—despite clearly not being finished. Because of all the unresolved problems in the system, case backlogs piled up and people were unable to get their benefits. According to one study, "hundreds of people complained that they were denied benefits unfairly, their applications weren‘t processed, or that they received contradictory letters about their eligibility. In addition, some individuals received benefits to which they were not entitled." After a few months, attorneys from the Colorado Center on Law and Policy sued the state, winning the creation of the Office of CBMS and an emergency call center. However, the system was never truly fixed, and in 2009, Deloitte was contracted to build a web portal that launched in 2010. The web portal also malfunctioned, but the heads of the Office of CBMS claimed the errors were caused by individual caseworkers and were not systematic. Despite the attention, problems persisted through the 2010s. Most issues were due to technical glitches in the system, relating to poor data quality, coding and logic errors, and lack of accountability for fixing issues that came up. For example, one person got over 70 contradictory automated notices from the system that didn’t have dates on them. These problems may have stemmed from the fact that EDS used code from an Arkansas project, even though the two states were trying to implement different policies and therefore needed different code. Additionally, the Deloitte contract’s fixed budget prevented new elements from being added even when they were deemed necessary during the development process. More recently, the state decided to try creating another integrated eligibility system. The Governor’s Office of Information Technology spent 2 years working with Deloitte to migrate the old system onto a Salesforce platform, which launched in 2019. Still called CBMS, the system has been far from perfect, and a 2020 audit "identified 67 \[of a sample of 100] notices with one or more problems with the accuracy, completeness, and/or understandability of the correspondence." A similar audit in October 2023 found at least one problem in 90% of the notices sampled, with many of the same problems continuing that were identified in 2016 and 2020. The 2023 audit cites that the "problems persist because the Department has not fully implemented the previously recommended changes to its monitoring functions, work processes, guidance to workers, and system design." ## Status of Issue The current (post-2019) CBMS is still not perfect. However, Colorado passed legislation (CO Rev Stat § 25.5-4-213 (2017)) in 2017, which requires an audit of state Medicaid correspondence in 2020 and again in 2023. Advocates like the Colorado Cross-Disability Coalition helped in getting this legislation passed. Throughout the past few years, people enrolled in these programs have continued to receive confusing or contradictory notices, as well as information in non-preferred languages. ### Links to More Information (old system) "[Colorado Benefits Management System (C): Seven Years of Failure](https://aisel.aisnet.org/cgi/viewcontent.cgi?article=3612&context=cais)" (old system) [Press release - NCLEJ and Colleagues Achieve Settlements to Secure Colorado’s Timely Processing of Medicaid, SNAP, CHIP, and TANF Applications](https://nclej.org/news/nclej-and-colleagues-achieve-settlements-to-secure-colorados-timely-processing-of-medicaid-snap-chip-and-tanf-applications) [Colorado's new benefits management system has glitches](https://statescoop.com/colorados-new-benefits-management-system-has-glitches/) - StateScoop [Colorado is almost done migrating its huge benefits management system](https://statescoop.com/colorado-is-almost-done-migrating-its-huge-benefits-management-system/) - StateScoop [Audit legislation](https://law.justia.com/codes/colorado/2017/title-25.5/colorado-medical-assistance-act/article-4/part-2/section-25.5-4-213/) - CO Rev Stat § 25.5-4-213 (2017) [Medicaid Client Correspondence Performance Audit, 2020](https://leg.colorado.gov/sites/default/files/documents/audits/1936p_medicaid_client_correspondence_-_september_2020.pdf) [Two-thirds of audited state Medicaid notices contained errors](https://coloradonewsline.com/2020/09/25/two-thirds-of-audited-state-medicaid-notices-contained-errors/) - Colorado Newsline [Colorado Audit Finds Inaccuracies, Unclear Information in Medicaid Letters to Members - *The Denver Gazette*](https://denvergazette.com/news/state-auditors-office-medicaid-audit-innacuracies-unclear-information/article_9e944fcc-6c59-11ee-a0f1-9f9d7a206300.html) (2023) [Medicaid Correspondence Performance Audit](https://leg.colorado.gov/sites/default/files/documents/audits/2261p_medicaid_correspondence.pdf) (2023) ### Key Parties Involved & Contact (for 2019 system) __Colorado Cross-Disability Coalition__ __Colorado Center on Law and Policy__ __Sjoberg Evashenk Consulting (2020 audit)__ __Deloitte Consulting__ __Colorado Department of Health Care Policy and Financing__ all operating all medicaid chip snap tanfIn the late 90s, Colorado began a process to replace its multiple legacy benefits systems with one single system, called the Colorado Benefits Management System (CBMS).
Social Security Administration Supplemental Security Income Terminations
SSI Social Security Administration Supplemental Security Income Terminations For many years, the Social Security Administration (SSA) has incorrectly assessed people getting Supplemental Security Income (SSI), who qualify for the program depending on their finances. The [asset limits](https://www.americanprogress.org/article/deadly-poverty-trap-asset-limits-time-coronavirus/) for SSI are notably strict, and prevent disabled and elderly people from saving money and building financial security—people must have less than $2,000 in “[countable resources](https://www.ssa.gov/ssi/spotlights/spot-resources.htm)” (or $3,000 for a couple). The technology used by the SSA to check assets caused additional issues: When the first day of the month fell on a weekend or holiday, the system would deposit money early, but would fail to consider that deposit’s timing when doing an asset check. The early deposit then counted towards someone’s assets and the system terminated benefits if the total amount went over the limit. Sometimes the system would retract deposits. This happened to thousands of people, most of whom did not understand that the termination was in error so they could appeal it. New York Legal Assistance Group (NYLAG) sued the SSA in 2018 and settled two years later, forcing SSA to fix the system and prevent automatic terminations. ## Status of Issue Advocates from NYLAG filed a class-action lawsuit, *Ershteyn v. Berryhill*, based on SSA’s violation of Social Security law and due process and equal protection. SSA’s practice of wrongfully denying benefits to recipients of Supplemental Security Income resulted mainly from flaws in its computer system. A critical issue during the settlement was how to fix the computer system and how long it would take. NYLAG contacted Upturn for assistance in reviewing technical documents about the system. With Upturn’s assistance, NYLAG was able to secure a settlement that required the fix to be implemented on a significantly shorter timeline. The fix prevents caseworkers from moving forward with a case termination if they have not properly accounted for early deposits. ### Links to More Information [NYLAG’s Complaint](https://nylag.org/wp-content/uploads/2019/08/Ershteyn-Complaint_2018.11.21-Amended-Complaint-FINAL-FILE-STAMPED.pdf) [NYLAG press release: SSI Recipients’ Benefits No Longer Wrongfully Terminated](https://www.nylag.org/ssi-recipients-benefits-no-longer-wrongfully-terminated/) [NYLAG press release: NYLAG Sues To Stop Widespread Social Security Mistake That Harms Recipients](https://nylag.org/nylag-sues-to-stop-widespread-social-security-mistake-that-harms-recipients/) ### Key Parties Involved & Contact __NYLAG__ Primary Advocate Contacts: Elizabeth Jois, Michelle Spadafore, Danielle Tarantolo __Social Security Administration__ __Upturn__ all operating all ssiFor many years, the Social Security Administration (SSA) has incorrectly assessed people getting Supplemental Security Income (SSI), who qualify for the program depending on their finances.
Idaho Medicaid Home and Community Based Services Care Cuts
Medicaid Idaho Medicaid Home and Community Based Services Care Cuts The Idaho Medicaid agency adopted a new formula for assessing individual budgets available to people with intellectual and developmental disabilities through their home and community based services (HCBS) waiver program. When the formula went live, many people noticed large cuts in their budgets, elevating the issue to advocates. After a class-action lawsuit, K.W. v. Armstrong, led to the discovery of the assessment formula and its origins, the formula was deemed arbitrary and unconstitutional. Initially, the state claimed that the formula they use to determine Medicaid assistance was a “trade secret,” but the court quickly ordered the state to disclose it on due process grounds. Additionally, advocates found during litigation that the formula was developed using faulty data and had fundamental statistical flaws—making its decisions effectively arbitrary. ## Status of Issue *K.W. v. Armstrong* was settled in 2016, after the algorithm had already affected about 6,000 people. The settlement guaranteed that people whose budgets were cut would continue to get their original budgets, at least until the implementation of a new “fair” system. The court ordered the state to audit the new system and make the determination logic public. The settlement agreement also required the state to collaborate with people using Medicaid services in developing the new system. However, new challenges emerged in trying to design a “better” algorithm for determining individuals’ Medicaid budgets—a hallmark of what we see as “Measurement” issues in our Making Sense of Technology Problems Framework—and the state has been slow to complete this part of the settlement. Advocates found that the decision-making algorithm had positive and negative effects on different people, and that transparency of the system could only help so much. In a post-settlement dispute in 2023, the parties disagreed over the limited dissemination of the Supports Intensity Scale - Adult’s Version (SIS-A) User’s Manual, which is a document that was available for purchase on the SIS-A creator’s website. The SIS-A is part of the new resource allocation model and budget tool the state was planning to use for calculating HCBS budgets. The state argued SIS-A tool was proprietary information of its creator, AAIDD, and the user’s manual could not be released as part of the resource allocation process. The court agreed with the plaintiffs that due process required that the manual, either in whole or part, may be required to be released to individuals during the resource allocation process. ### Links to More Information [ACLU of Idaho Case Tracking Page](https://www.acluidaho.org/en/cases/kw-v-armstrong) [ACLU's *K.W. v Armstrong* press release](https://www.aclu.org/press-releases/federal-court-rules-against-idaho-department-health-and-welfare-medicaid-class-action) [ACLU’s Blog Post on K.W.](https://www.aclu.org/blog/privacy-technology/pitfalls-artificial-intelligence-decisionmaking-highlighted-idaho-aclu-case) [*K.W. v. Armstrong* settlement discussion (2023)](https://casetext.com/case/kw-v-armstrong-10) Richard Eppink: “[Why an Advocatocracy over Automated Decisionmaking Is a Bad Idea](https://drive.google.com/file/d/1xdJiJShMG7FRvYmBJlr79jPl4-jVyIcB/view)” AI Now Institute's Litigating Algorithms 2019 US Report - [Session 1: You Won! Now What?](https://ainowinstitute.org/wp-content/uploads/2023/04/litigatingalgorithms-2019-us.pdf) National Health Law Program - [Demanding Ascertainable Standards: Medicaid as a Case Study](https://healthlaw.org/resource/demanding-ascertainable-standards-medicaid-as-a-case-study/) ### Key Parties Involved & Contact __ACLU of Idaho__ Primary Advocate Contact: Richard Eppink __Piotrowski Durand, PLLC__ __Idaho Department of Health and Welfare__ __Idaho Attorney General’s office__ all operating all medicaidThe Idaho Medicaid agency adopted a new formula for assessing individual budgets available to people with intellectual and developmental disabilities through their home and community based services (HCBS) waiver program.
Michigan Unemployment Insurance False Fraud Determinations
Unemployment Michigan Unemployment Insurance False Fraud Determinations The Michigan Unemployment Insurance Agency rolled out the Michigan Integrated Data Automated System (MiDAS) in 2013, which was built by contractor Fast Enterprises starting in 2011 for $47 million. During its first two years in use, the system falsely accused 40,000 residents of fraud (a 5-fold increase from expected numbers). A corresponding spike in appeals alarmed advocates. It turned out that the system would flag any data discrepancies as fraud, no matter how trivial, and required followup from the applicant to clarify within 10 days. MiDAS also took the average of an applicant’s entire income instead of looking at individual paychecks, which led to discrepancies between reported and system-determined income—and more false fraud flagging. Even worse, people filing disputes had to fill out an extremely misleading questionnaire, which was pre-filled with responses that would flag the applicant for fraud. Applicants would receive notices only on the unemployment portal (instead of in the mail), which they had no reason to check if they were no longer receiving benefits. Applicants accused of fraud had their tax refunds seized and wages garnished by the state, all in disproportionately high amounts compared to what they were accused of actually owing. The Michigan Auditor General reviewed 22,000 MiDAS fraud determinations in 2016 and determined that 93% did not actually involve fraud. Because applicants were not given a real chance to fight fraud determinations, many suffered severe consequences, like having to file for bankruptcy or tarnished credit ratings. In 2015, advocates filed a class-action lawsuit, Bauserman v. Unemployment Insurance Agency, which was initially dismissed by a lower court because plaintiffs waited too long to file. In 2019, the Michigan Supreme Court decided that a state constitutional claim for damages could move forward. And in the 2017 federal court case Cahoo v. SAS Analytics Inc., other advocates sued the state agency, the state agency’s contractor, and several individual agency officials. ## Status of Issue In a 2017 settlement under *Zynda, et. al. v. Zimmer et. al*., Michigan’s Unemployment agency agreed to stop using MiDAS’s automated functions without human review. The settlement also made the agency reverse and refund certain fraud determinations. The Michigan Legislature also passed a set of bills in 2017 which lessen fraud penalties and prevent certain consequences if administrative errors caused the fraud allegations. Many claimants are still working on getting refunds and damages paid back to them. In October 2022, the parties [settled](https://www.freep.com/story/news/local/michigan/2022/10/20/michiganunemployment-false-fraud-lawsuit/69577567007/) *Bauserman v. Unemployment Insurance Agency* for $20 million. In July of 2022, the Michigan Supreme Court ruled that more than 3,000 Michiganders wrongfully accused of fraud by auto-determinations from 2013-2015 could seek financial relief—holding that plaintiffs can recover monetary damages for their constitutional-tort claim where the agency intercepted their state and federal tax refunds, garnished their wages, and forced them to repay unemployment benefits that they had lawfully received. The state Court of Claims issued a [final order](https://www.bridgemi.com/michigan-government/michiganders-falsely-accused-jobless-fraud-share-20m-settlement) in January 2024, ending nine years of litigation; lawsuit class members received settlement checks in early 2024. And in 2023, the Sixth Circuit Court of Appeals reversed the lower court’s decision in *Cahoo v. SAS Analytics* that had denied qualified immunity to the agency officials named in the suit. The appeals court cited the extensive discovery that had occurred and concluded that discovery changed the nature of the case to one about collection of paid benefits. Although the court acknowledged the multitude of problems with the MiDAS program, it found that the remaining claims were about an internal fraud red flag, which did not deprive benefits at that point without additional process, notice, and opportunities for appeal. The Sixth Circuit also ruled the agency officials do have qualified immunity because of the lack of evidence showing the connection between the officials and defects with pre-deprivation processes. A dissenting opinion said there were questions of fact about the protections that individuals were afforded as well as the role of state officials in the decision-making, and would not have reversed the District Court’s decisions to deny qualified immunity and set the case for jury trial. ### Links to More Information [2017 Bills: Gov. Rick Snyder signs bipartisan bills modernizing Unemployment Insurance Agency system](https://www.michigan.gov/formergovernors/0,4584,7-212-96477_90815_57657-456134--,00.html) - Michigan.gov [Michigan may pay victims of unemployment benefits blunder](https://www.dailypress.net/news/local-news/2017/12/michigan-may-pay-victims-of-unemployment-benefits-blunder/) - Daily Press [States' Automated Systems Are Trapping Citizens in Bureaucratic Nightmares With Their Lives on the Line](https://time.com/5840609/algorithm-unemployment/) - TIME Magazine [Thousands of unemployed in Michigan wrongly accused of fraud can seek cash from state](https://www.freep.com/story/news/local/michigan/2022/07/26/unemployed-wrongly-accused-fraud-can-seek-cash-state/10157193002/) - Detroit Free Press [*Cahoo v. SAS Analytics Inc.*, No. 18-1296 (6th Cir. 2019)](https://law.justia.com/cases/federal/appellate-courts/ca6/18-1296/18-1296-2019-01-03.html) and [No. 21-2672 (6th Cir. 2023)](https://law.justia.com/cases/federal/appellate-courts/ca6/21-2672/21-2672-2023-06-15.html) [*Bauserman v. Unemployment Insurance Agency*](https://law.justia.com/cases/michigan/supreme-court/2019/156389.html) [Michiganders falsely accused of jobless fraud to share in $20M settlement - Bridge Michigan, January 30, 2024](https://www.bridgemi.com/michigan-government/michiganders-falsely-accused-jobless-fraud-share-20m-settlement) [*Zynda, et. al. v. Zimmer et. al.* settlement](https://www.bwlawonline.com/wp-content/uploads/2017/02/Zynda-ORD-2017-02-02-Robo-Fraud-Settlement-and-Dismissal.pdf) AI Now Institute - Litigating Algorithms 2019 US Report [Session 3: Public Benefits and Collateral Consequences](https://ainowinstitute.org/litigatingalgorithms-2019-us.pdf) Undark - [Government’s Use of Algorithm Serves Up False Fraud Charges](https://undark.org/2020/06/01/michigan-unemployment-fraud-algorithm/) ### Key Parties Involved & Contact __Pitt McGehee Palmers & Rivers__ Primary Advocate Contact: Jennifer Lord __Sugar Law Center for Economic & Social Justice__ Primary Advocate Contact: Tony Paris __Michigan Unemployment Insurance Agency__ __SAS Analytics__ all operating all unemploymentThe Michigan Unemployment Insurance Agency rolled out the Michigan Integrated Data Automated System (MiDAS) in 2013, which was built by contractor Fast Enterprises starting in 2011 for $47 million.
Michigan Supplemental Nutrition Assistance Program Terminations
SNAP Michigan Supplemental Nutrition Assistance Program Terminations In 2013, Michigan implemented a data-matching system to enforce federal Supplemental Nutrition Assistance Program (SNAP) regulations ([CFR 273.11(n)](https://www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-C/part-273/subpart-D/section-273.11)) which ban people fleeing from a felony prosecution from accessing SNAP benefits. The system compared the names of people enrolled in or applying to SNAP with a database of outstanding felony warrants. The latter database was maintained by the Michigan State Police in the Law Enforcement Information Network (LEIN). The matching program was part of austerity measures pushed by Republican Governor Rick Snyder and a Republican-controlled legislature. The enforcement of the felony arrest warrant rule was already primed to have a disparate impact on Black residents, regardless of any technical issues—as [racism](https://www.sentencingproject.org/publications/un-report-on-racial-disparities/) in the criminal legal system makes Black people much more likely to be stopped and arrested than white people. After the system was rolled out, over 19,000 people were automatically cut off from food assistance that they had been receiving, which was about $150-$200 a month. Some of these people were victims of identity theft, or their relatives had used their name during interactions with police. They received vague notices of these automated terminations, like, “You or a member of your group is not eligible for assistance due to a criminal justice disqualification.” Many of these people had developmental disabilities and needed full-time caretaking services. Even those that appealed through the state's regular appeal process did not have their benefits reinstated, as the computer system automatically cut them off again—probably because their name was still in the law enforcement database. One woman (whose name had been used on fraudulent checks) traveled to a city she had never visited to turn herself into the police. She spent 8 hours in jail to clear the false arrest charges, and only afterwards regained her food assistance benefits of $200 a month. Advocates intervened through a class-action lawsuit titled *Barry v. Lyon* in 2013 and a subsequent case, *Unan v. Lyon*, in 2015. One of the plaintiffs of the former case, Donitha Copeland, was a member of the Westside Mothers non-profit, which advocates for recipients of public benefits and also participated in the lawsuit. Additionally, Freedom of Information Act Requests later revealed the state’s media campaign plan to use the felony data-matching system to demonize people with outstanding warrants who rely on social safety net programs. ## Status of Issue According to the Detroit Free Press, "In 2015, U.S. District Judge Judith Levy struck down the state's database, concluding it wrongfully denied plaintiffs of their right to food aid because they were neither actively fleeing or avoiding prosecution for a felony." After the case, courts required that anyone whose benefits had been wrongly terminated was paid $3,120, or, if they opted out, whatever sum their missed benefits actually totaled. ### Links to More Information [Sixth Circuit opinion in *Barry v Lyon*](https://www.aclumich.org/sites/default/files/Barry%20v.%20Lyon%206th%20Circuit%20opinion_0.pdf) [Sixth Circuit opinion in *Unan v Lyon*](https://casetext.com/case/unan-v-lyon-3) [Detroit Free Press - Court: Michigan stiffed deserving people out of food aid ](https://www.freep.com/story/news/local/michigan/2016/08/26/court-michigan-food-stamps-crime/89425014/) AI Now Institute - Litigating Algorithms 2019 US Report - [Session 3: Public Benefits and Collateral Consequences](https://ainowinstitute.org/litigatingalgorithms-2019-us.pdf) ### Key Parties Involved & Contact __Center for Civil Justice__ __American Civil Liberties Union of Michigan__ __Michigan Dept. of Health and Human Services__ __Westside Mothers__ all operating all snapIn 2013, Michigan implemented a data-matching system to enforce federal Supplemental Nutrition Assistance Program (SNAP) regulations (CFR 273.11(n)) which ban people fleeing from a felony prosecution from accessing SNAP benefits.
Missouri Medicaid Home and Community Based Services Eligibility Issues
Medicaid Missouri Medicaid Home and Community Based Services Eligibility Issues In 2018, the Missouri Department of Health and Senior Services (DHSS) proposed a new algorithm for determining qualification for home and community based services (HCBS). The state put this Nursing Facility Level of Care (NF LOC) algorithm up for public comment, which used variables from the InterRAI assessment system. Testing by legal aid organizations, home and community based services providers, and outside researchers at Upturn, showed that the algorithm could disqualify as many as 66% of currently eligible people. The algorithm also contained some basic syntax errors that might have led to unintended results. The state published subsequent versions of the algorithm which decreased the percentage of beneficiaries who would likely be found ineligible, but all versions failed to capture many people's needs. Unlike many other cases, this algorithm was made publicly available for comment by the state, and no litigation has happened yet. Many legal aid and home health care organizations have worked together to understand the implications of the algorithm. So far, many problems have been identified in rounds of public comment, especially about which variables from patients’ assessments are included in the algorithm and how they are considered. For example, the algorithm considered people’s mobility issues with getting in and out of bed, but not with getting up and down stairs. ## Status of Issue Opposition to the proposed algorithm is ongoing. The state has been preparing to implement the most recent version of the algorithm, pending federal approval and the announcement of written regulations to accompany the LOC algorithm. In June 2021, Missouri [decided to postpone](https://health.mo.gov/seniors/hcbs/info-docs/info-06-21-04.pdf) full implementation of the new LOC algorithm due to federal funding obligations to not make certain HCBS changes. Until April 2024, the eligible group will be the combined group of everyone currently eligible under the pre-algorithm criteria and everyone who is newly eligible under the LOC algorithm criteria. The [state plans to transition](https://health.mo.gov/seniors/hcbs/loc-transformation.php) to using only the LOC algorithm criteria on April 1, 2024. ### Links to More Information [Missouri DHSS LOC Transformation Project Website](https://health.mo.gov/seniors/hcbs/loc-transformation.php) [LOC Algorithm v2.3](https://health.mo.gov/seniors/hcbs/pdf/loc-algorithm2-3.pdf) [LOC Determination Guide](https://health.mo.gov/seniors/hcbs/pdf/loc-determination-guide2-3.pdf) [Mercer Report](https://drive.google.com/file/d/15jm4-Cd7ZPgRmDkn6dglfujW0xai79bA/view?usp=sharing) [Postponement announcement, June 2021](https://health.mo.gov/seniors/hcbs/info-docs/info-06-21-04.pdf) ### Key Parties Involved & Contact __Legal Services of Eastern Missouri__ Primary Advocate Contact: Jamie Rodriguez __HCBS providers__ __Upturn__ __Missouri Department of Health and Senior Services__ __Go Long Consulting__ __Mercer Consulting__ __InterRAI__ all building all medicaidIn 2018, the Missouri Department of Health and Senior Services (DHSS) proposed a new algorithm for determining qualification for home and community based services (HCBS).
North Carolina Medicaid Home and Community Based Services Care Cuts
Medicaid North Carolina Medicaid Home and Community Based Services Care Cuts In 2011, a North Carolina regional managed care organization (which contracts with the state to provide services for programs in Medicaid) called Piedmont Behavioral Health (PBH) sent out alarming notices to people with intellectual and developmental disabilities (IDD) in the home and community based services (HCBS) waiver program of Medicaid. The notices stated that individuals’ HCBS waiver services would soon need to fit within a budget determined by their Supports Intensity Scale (SIS) score. The SIS is an assessment tool generally used for people with IDD, but this announcement was specific to PBH. The new budget would reduce services for many people, but they were told they could not appeal it. The change also occurred in the middle of the plan year, whereas services usually only changed once a year if needs remained the same. Advocates and beneficiaries filed a class action lawsuit challenging the lack of due process around the use of the SIS. The due process issues were that the SIS budget summary mailed to participants did not include explanations of the scoring system, the meaning of the score, or the score’s effect on services. Another due process issue was that people were unable to appeal their budget assignment. The case also challenged the lack of availability of the exceptions process, called “intensive review.” The class action was certified and a preliminary injunction was granted in L.S. by and through *Ron S. v. Delia*. The defendant, PBH, appealed and the decision was upheld in *K.C. ex rel. Africa H. v. Shipman*, 716 F.3d 107 (4th Cir. 2013). The case was subsequently settled under the title *L.S. et al. v. Wos et al*. After the decision in L.S., North Carolina’s Department of Health and Human Services (DHHS) began using the SIS statewide. In the state court case Biggs v. Cohen, plaintiffs identified various ways by which the use of the SIS in North Carolina violated the L.S. settlement agreement. North Carolina DHHS subsequently [issued guidance](https://files.nc.gov/ncdhhs/Joint-Communication-Bulletin--J297--LME-MCO-LS-V-Wos-Instruction--002-.pdf) for the regional managed care organizations on how the SIS should and should not be used, and stated that an exceptions process must be available. ## Status of Issue The case is settled, and includes guidance saying the SIS cannot be the sole method used for determining someone’s support needs. ### Links to More Information [*LS v. Wos* Instruction from NC DHHS regarding use of the Supports Intensity Score](https://files.nc.gov/ncdhhs/Joint-Communication-Bulletin--J297--LME-MCO-LS-V-Wos-Instruction--002-.pdf) [*L.S. v. Delia* decision](https://healthlaw.org/resource/north-carolina-home-and-community-based-services-case-l-s-et-al-v-delia-e/) [NHeLP press release after 4th circuit decision](https://healthlaw.org/news/medicaid-class-action-nc/) ### Key Parties Involved & Contact __National Health Law Program (NHeLP)__ Primary Advocate Contact: Elizabeth Edwards __Charlotte Center for Legal Advocacy__ Primary Advocate Contact: Doug Sea __Disability Rights NC__ __[Cardinal Innovations Healthcare](https://www.cardinalinnovations.org/) (previously Piedmont Behavioral Health or PBH)__ __NC DHHS__ __AAIDD's SIS tool__ all operating all medicaidIn 2011, a North Carolina regional managed care organization called Piedmont Behavioral Health sent out alarming notices to people with intellectual and developmental disabilities in the home and community based services waiver program of Medicaid.
Tennessee Medicaid Terminations
Medicaid Tennessee Medicaid Terminations In March 2019, Tennessee launched the TennCare Eligibility Determination System (TEDS), which was designed to streamline enrollment and redeterminations for Tennessee’s Medicaid program. The system’s launch was delayed for many years and plagued by technical setbacks. After its launch, many people’s Medicaid coverage was terminated. The reasons for these cuts are not completely understood, but are likely due to systemic defects—such as issues with interface design, inter-system communication, and underspecified notices to individuals. Advocates also said the redetermination process did not fully meet the accessibility needs of people with disabilities. Instead, it terminated people’s benefits or put them at risk of termination, even though reasonable accommodations should have existed. In 2020, the Tennessee Justice Center and partners filed a class-action lawsuit against the state, *A.M.C. v. Smith*. ## Status of Issue Litigation against the state is ongoing. The class-action lawsuit represents 35 adults and children across the state, and claims that “TennCare’s system for reevaluating eligibility is defective and fails to provide the notice and opportunity for hearing required by the Medicaid Act and the Constitution” and “TennCare’s eligibility redetermination process discriminates against people with disabilities.” A five day bench trial was held in November 2023 with post-trial briefing to be completed in early 2024. ### Links to More Information [NHeLP lawsuit press release](https://healthlaw.org/resource/a-m-c-v-smith-middle-district-of-tennessee/) with [complaint](https://healthlaw.org/wp-content/uploads/2020/05/0001-Complaint-3-19-20-Corrected-filing-date.pdf) [TennCare website](https://tenncareconnect.tn.gov/services/homepage) [At least 220,000 Tennessee kids faced loss of health insurance due to lacking paperwork](https://www.tennessean.com/story/news/investigations/2019/07/14/tenncare-coverkids-medicaid-children-application-insurance-denied/1387769001/) - The Tennessean [*A.M.C. v. Smith* Recent Filing Explainer](https://healthlaw.org/resource/recent-filing-in-lawsuit-describes-medicaid-unwinding-harms-in-tennessee/) (Aug. 2023) ### Key Parties Involved & Contact __National Health Law Program (NHeLP)__ Primary Advocate Contact: Elizabeth Edwards __Tennessee Justice Center__ Primary Advocate Contact: Brant Harrell __National Center for Law and Economic Justice__ __Selendy Gay Elsberg, PLLC__ __Tennessee’s Division of TennCare__ __Maximus__ __Deloitte__ all operating all medicaidIn March 2019, Tennessee launched the TennCare Eligibility Determination System (TEDS), which was designed to streamline enrollment and redeterminations for Tennessee’s Medicaid program.
Wisconsin Medicaid Home and Community Based Services Terminations
Medicaid Wisconsin Medicaid Home and Community Based Services Terminations In January 2017, Wisconsin began using an automated system to determine if someone fit the regulatory definition of having an intellectual or developmental disability (IDD). The IDD designation is used for eligibility in two of the state’s Medicaid home and community based services (HCBS) programs for adults. Prior to 2017, human screeners manually determined IDD designations for individuals. But the automated system’s logic was different from the federally mandated eligibility requirements for determining IDD designation. Shortly after implementation, many people with disabilities received notices terminating them from the programs. Almost all of the terminations were because the person no longer met the “federal definition” of IDD, even though the combination of their limitations and diagnosis did in fact qualify them under the federal regulatory definition. Over 100 people appealed their terminations. All of those represented by counsel won, as did almost all of those who appealed without counsel. In all cases where the administrative law judge compared the computerized determination with the person's individual characteristics and the actual federal regulatory definition of IDD, the decision was that the computer was wrong. Advocates from Disability Rights Wisconsin worked with the state to ultimately fix the automated system, but the fix was not fully implemented until July 2019. Until then, individuals who had won their hearings were sometimes terminated by the computer system again and the system continued to deny or terminate eligibility for others. However, the state was manually reviewing cases prior to the fix to the computer logic and corrected the computer eligibility errors. ## Status of Issue The logic issue with how the system was operationalizing the eligibility requirements was resolved fully in July 2019 through cooperation with the state and individual appeal ### Links to More Information None public ### Key Parties Involved & Contact __Disability Rights Wisconsin__ Primary Advocate Contacts: Mitch Hagopian, Melanie Cairns __National Health Law Program (NHeLP)__ Primary Advocate Contact: Elizabeth Edwards __Wisconsin Department of Health Services__ all operating all medicaidIn January 2017, Wisconsin began using an automated system to determine if someone fit the regulatory definition of having an intellectual or developmental disability (IDD).
Florida Unemployment Insurance False Fraud Determinations
Unemployment Florida Unemployment Insurance False Fraud Determinations In 2013, Florida released a new unemployment benefits website called CONNECT, built by Deloitte. Applicants immediately experienced issues causing unemployment benefits to be delayed or incorrectly denied. CONNECT created significant hurdles for people claiming benefits and included an aggressive system for flagging application errors called the Fraud Initiative Rating and Rules Engine (FIRRE). For example, FIRRE would flag cases where it detected trivial discrepancies on an application—like if someone’s name on the application was not exactly as it appeared on their driver's license, or an apartment number was formatted differently. FIRRE would also flag when multiple people filed claims from the same computer, which disproportionately impacts Black, Latinx, and other people of color who are less likely to have a personal computer or broadband at home than white people. Inconsistencies found by data matches would lock an applicant's account, requiring intervention by a small group of higher level employees. Claimants had limited time to respond to requests for verification to resolve inconsistencies: 48 hours after an initial phone call and 7 days to respond to the subsequent letter. The hurdles to getting benefits extended beyond the computers, as claims representatives were instructed to hang up on people who offered inconsistent information. The wait times for reaching a claims representative were extensive, and an 8-hour hold time was common during the height of the COVID-related unemployment crisis. At the same time, the system failed to tell the applicant if they entered certain disqualifying information, so people were accidentally approved for benefits they later had to pay back. In 2019, Florida’s Auditor General released a [report](https://flauditor.gov/pages/pdf_files/2019-183.pdf) on CONNECT and FIRRE. The audit confirmed that many people were not given notice and subsequently had their cases locked, with no caseworker training on how to fix these situations. Since Florida's launch of CONNECT, claims flagged as “fraudulent” increased more than 600%. By 2015, Florida's percentage of unemployed people receiving jobless benefits was the worst in the nation, at under 12%, and has [stayed the second worst since then](https://www.nytimes.com/2020/04/23/us/florida-coronavirus-unemployment.html?jr=on). In one report, the system's fraud detection program identified 70,000 fraudulent claims for 2014, even though there are usually only 60,000-90,000 unique Florida unemployment benefit claims in a given year. Many Flordians claim that the system was “designed to fail” considering the government’s lack of action on the system despite multiple audits and reports concerning its failure. ## Status of Issue After 2019, Florida officials put forth a plan to replace, or at least overhaul, the system. According to the Florida Department of Commerce, the two-year modernization project was completed in July 2023 with about $92.4 million in funding granted by the Florida Legislature, and $8.4 million from the US Department of Labor specifically for promoting access. The Department further stated in October 2023 that “continuous modernization projects” would be scheduled over the next three years. Their focus included “expanded fraud protection” in addition to usual concerns of efficiency and functionality. The estimated costs breakdown for fraud detection programs, including a “Digital ID Verification Solution,” was $3.4 million. ### Links to More Information [Presentation on the FIRRE System](https://uidl.naswa.org/bitstream/handle/20.500.11941/308_2016_FL_FIRRE_pdf/2016_FL_FIRRE.pdf?sequence=1&isAllowed=y) [2019 Florida Auditor General’s report](https://flauditor.gov/pages/pdf_files/2019-183.pdf) [Florida took an aggressive approach to unemployment fraud. Was it worth it?](https://www.tampabay.com/news/florida-politics/2021/03/21/florida-took-an-aggressive-approach-to-unemployment-fraud-was-it-worth-it/) - Tampa Bay Times [More evidence that Florida’s unemployment system was designed to fail - Editorial](https://www.tampabay.com/opinion/2021/03/23/more-evidence-that-floridas-unemployment-system-was-designed-to-fail-editorial/) - Tampa Bay Times [Florida’s unemployment fix could cost $244 million](https://www.tampabay.com/news/florida-politics/2021/03/01/floridas-unemployment-fix-could-cost-244-million/) - Tampa Bay Times 2021 ISF Report - [Florida Department of Economic Opportunity Improved Delivery of Reemployment Assistance Benefits – Final Report](http://floridajobs.org/docs/default-source/communicationsfiles/2021-improved-delivery-of-reemployment-assistance-benefits-final-report-and-cost-benefit-analysis.pdf) [Florida Commerce Reemployment Assistance Modernization website](https://www.floridajobs.org/office-directory/division-of-workforce-services/initiatives/reemployment-assistance-modernization) (2023 system) ### Key Parties Involved & Contact __Florida Policy Institute__ Primary Advocate Contact: Cindy Huddleston __State of Florida Auditor General__ __Florida Department of Economic Opportunity__ __Deloitte Consulting__ all operating all unemploymentIn 2013, Florida released a new unemployment benefits website called CONNECT, built by Deloitte. Applicants immediately experienced issues causing unemployment benefits to be delayed or incorrectly denied.