From Health 201AI Med Risk

What happenedIn 2016 the Arkansas Department of Human Services began using a computerised assessment algorithm, instead of nurses' judgement, to set how many hours of in-home care people in its ARChoices Medicaid waiver programme received. Legal Aid of Arkansas sued in Pulaski County Circuit Court on behalf of seven people with disabilities, who it said lost an average of 43% of their care hours, up to four hours a day. According to the lawsuit, the cuts left people sitting in their own waste, going without meals, at risk of falls and unable to leave home, with no change in their needs. In Arkansas Department of Human Services v. Ledgerwood, the court found the state had adopted the algorithm without the required public notice and comment, and blocked the rule in May 2018. The state later stopped using the algorithm.

Failure modeAn opaque algorithm replaced clinical assessment in setting care hours. It cut services sharply without any change in patients' needs and without transparency or meaningful appeal.

What might have helpedPublishing the assessment method for public comment, as the court found the law required, and testing its outputs against nurses' assessments before rollout could have exposed the drastic cuts. Keeping a clinician able to override the allocation could have protected people whose needs hadn't changed.