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Medicaid Home-Based Care: 2016-2018 — TechTonic Justice [1]
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Date: 2025-02
Medicaid is the U.S.’s only health insurance program for low-income people. All states offer some sort of home-based care that allows people who are disabled or elderly to have a caregiver come to their home to help with needed care tasks like getting out of bed, bathing, cooking, cleaning, and going to medical appointments. Staying at home is better for people’s dignity and, on the whole, is cheaper for the state than paying for a nursing home.
In 2016, Arkansas changed the way it decided how many hours of care people would get. Instead of using a nurse’s professional judgment—the standard for decades—the state switched to an algorithm. The results were devastating. People with conditions like cerebral palsy, quadriplegia, and multiple sclerosis faced cuts ranging from 20-50%, leaving them with so little care that they were forced to lie in their own waste, get bed sores from not being turned, miss medical appointments, and be totally shut in. Approximately 4,000 of the 8,000 people on the program faced cuts.
In response, we—myself, my team at Legal Aid of Arkansas, my clients, and the wider client community—fought back with an intensive campaign that incorporated various types of advocacy. We filed lawsuits in federal and state court and won. We educated the public about the absurd algorithm and the irrational outcomes. We activated the communities of disabled and elderly people hurt by the algorithm. And, we provided information to journalists wanting to report on the story.
In the end, WE WON. The algorithm was thrown out by a court. And, the Arkansas legislature told the state to get rid of this algorithmic system to determine Medicaid home-based care.
Highlights of Different Types of Advocacy
Lawsuits/Litigation
We had a successful three-day trial in federal court that led to systemwide improvement in the information that recipients received so that they could better challenge their cuts. We also won in state court, with this oral argument at Arkansas Supreme Court resulting in a unanimous victory (here’s the link to the full argument).
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[1] Url:
https://www.techtonicjustice.org/victories/medicaid-home-based-care-2016-2018
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