Medicaid Home-Based Care: 2019-2023

After we eliminated the use of the algorithmic system in effect through 2018, Arkansas started using a different system that, while less technically complex, still used algorithms. Where the old system cut hours, the new system determined that 30% of the people on the program were entirely ineligible for any care. When the state determined them ineligible, the cuts took effect immediately for many people. They didn’t have any chance to appeal the decision first, a right called “due process” that is guaranteed by the 14th Amendment of the US Constitution.

The thing is, the state knew this was illegal. We had told them so over 20 separate times. We asked them to fix the process so that people had the chance to appeal before any cuts took effect. They refused. So, we sued them.

This time, though, our lawsuit was different from most. When someone on Medicaid (or most other public benefits) sues a state, they can’t get any money for the benefits they wrongfully lost or the suffering they faced. The state has something called “sovereign immunity.” The only relief they can get is a change in the state’s practices. And, they can’t generally get any money from individual state officials acting illegally because of “qualified immunity,” which is the doctrine that protects abusive cops and other government officials from liability for official actions.

However, we sued the individual state officials and successfully broke through their “qualified immunity.” The state appealed that decision and lost. After that, the state decided to settle with our clients for almost $500,000 and an agreement to fix the appeals process, give people better notice of the reasons for any cuts, keep track of key statistics, and resolve other ongoing problems.