Fairness in Automated Decision-Making Systems

Algorithms and other automated decision-making systems (ADS) are omnipresent features of Medicaid. ADS make decisions about eligibility and services that greatly impact whether people get the services they need and for which they are eligible. Enrollees often do not understand ADS has made the decision or how, which may violate fundamental constitutional protections. From NHeLP’s decades-long experience working to stop harm from ADS in Medicaid, we know that ADS are rarely, if ever, going to be perfect. Not only because humans are involved at every level of ADS design, programming, and policies, but also because Medicaid enrollees are a diverse population and health care has endemic institutional biases that are frequently embedded in the ADS. NHeLP advocates for effective safety nets around ADS to ensure that when they fail a person can identify that a system was used, what the error was, and remedy that error so they may receive their needed benefits. For more details, see our Principles for Fairer, More Responsive ADS, blog series about ADS in Medicaid, and our other resources.