Archive for June, 2021

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June 14, 2021
Preventing Harm from Automated Decision-Making Systems in Medicaid
Elizabeth Edwards Automated Decision-Making, Delivery System Reform, Disability, Eligibility & Enrollment, Uncategorized
Algorithms and other automated decision-making systems (ADS) are omnipresent features of today’s Medicaid systems. While there are some advantages to automated decisions, the idea that such decisions are free from bias or error is false. Humans are behind the design, programming, and ultimate decisions on what to do with…
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June 11, 2021
L.S. by and through Ron S. v. Delia, Eastern District of North Carolina and Fourth Circuit Court of Appeals
Litigation Team Cases
This class action was filed on behalf of a class of North Carolinians with intellectual and developmental disabilities who received letters from their regional managed care organization, Piedmont Behavioral Health (known as PBH and later Cardinal Innovations Healthcare), informing them that, based on their Supports Intensity Scale (SIS) assessment,…
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June 11, 2021
Cyrus ex rel. McSweeney v. Nusbaum, Southern District of West Virginia
Litigation Team Cases
In 2004, a class of recipients of West Virginia’s Medicaid HCBS waiver program for older adults and people with disabilities was granted a preliminary injunction that restored HCBS benefits that had been terminated the year before and required the state to provide adequate notice that explained the reasons for…
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June 11, 2021
Salazar v. District of Columbia, D.C. District Court, D.C. Circuit
Litigation Team Cases
This class action was originally brought in 1996 on behalf of children and adults who had applied for Medicaid, with claims including that the Medicaid agency failed to: issue decisions and provide coverage within 45 days of a submitted application, provide advance notice of termination of benefits; provide or…
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June 11, 2021
Demanding Ascertainable Standards: Medicaid as a Case Study
Jane Perkins Issue Brief, Article
State Medicaid agencies and their contractors are increasingly relying on preset guidelines or assessment tools or both to make coverage decisions. Problems arise when the use of these tools results in program enrollees and advocates being refused access to the standards and procedures that govern the operation of the…
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June 11, 2021
AMICUS:Washtenaw County Community Mental Health v. Wiesner, State of Michigan Court of Appeals
Litigation Team Cases
NHeLP submitted two amicus briefs in this case in support of a Medicaid beneficiary who won his Medicaid Fair Hearing, entitling him to certain home and community based services and supports. Rather than complying with the hearing decision and providing him the services to which he was entitled, his…
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Archive for June, 2021

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Preventing Harm from Automated Decision-Making Systems in Medicaid

L.S. by and through Ron S. v. Delia, Eastern District of North Carolina and Fourth Circuit Court of Appeals

Cyrus ex rel. McSweeney v. Nusbaum, Southern District of West Virginia

Salazar v. District of Columbia, D.C. District Court, D.C. Circuit

Demanding Ascertainable Standards: Medicaid as a Case Study

AMICUS:Washtenaw County Community Mental Health v. Wiesner, State of Michigan Court of Appeals