Legal Aid of Arkansas filed suit today in Pulaski County Circuit Court to stop the state Department of Human Services from using a computer algorithm to determine Medicaid benefits for people with severe disabilities.
The seven plaintiffs in the suit are low-income individuals with disabilities including cerebral palsy, quadriplegia, multiple sclerosis and other debilitating illnesses whose Medicaid ARChoices benefits were cut by an average of 43 percent when the algorithm was applied, a news release from Legal Aid said. “With such large cuts, the plaintiffs have had to sit in their own waste, go without meals, risk falls, and stay shut in. If the cuts are upheld, nursing homes will be in their futures,” Legal Aid said.
DHS has used what Legal Aid calls a “secret” algorithm since Jan. 1, 2016, rather than the discretion of a trained nurse to determine benefits. Legal Aid alleges in the suit that DHS did not seek public input or oversight into the algorithm, a violation of the Administrative Procedures Act; if it prevails, DHS will have to submit the algorithm, called RUGs, for public vetting.
Plaintiffs in the case are Bradley Ledgerwood, Louella Jones, Peggy Sanders, Marcus Strope, Winnie Winston, Dana Wolfe and Michael Yarra.
Ledgerwood was a plaintiff, along with Ethel Jacobs, in an earlier Legal Aid suit against DHS. U.S. District Judge D. Price Marshall ruled in November that DHS did not provide ARChoices participants adequate notice about changes in the way hours of care were determined.
UPDATE: Amy Webb, spokeswoman for DHS, sent the following statement to me this morning:
We have not been served with the lawsuit and we do not generally comment on pending litigation. However, I can explain, in general, why we are using the system we are using today. The system we used previously was subjective, which meant that a person with a disability in Texarkana may not get the same level of services as a person with the same disability and needs in Jonesboro. We wanted to take the subjectivity out of the system so that decisions about level of care were objective, consistent, based on science and based on real data from real Arkansans. That’s what the RUG level system does.
I have asked her to provide a comparison of ARChoices benefits before and after the implementation of RUG.