Ruling allows lawsuit challenging opaque, algorithm-driven funding decisions to move forward
LINCOLN, NE — A Lancaster County District Court has overruled the State of Nebraska’s motion to partially dismiss a lawsuit challenging the Nebraska Department of Health and Human Services’ use of the interRAI assessment system to determine funding for people with intellectual and developmental disabilities. The ruling allows the challenged claims to proceed and lifts the stay previously imposed on the remaining claims.
Learn more about Bessey v. Nebraska Department of Health and Human Services
Legal Aid of Nebraska filed the lawsuit on behalf of Nicholas Bessey, joined by Nebraska Appleseed, the National Health Law Program, and TechTonic Justice. The case challenges the State’s use of interRAI to determine funding for Medicaid home- and community-based services.
In its October 29 order, the court rejected the State’s request to dismiss six of Nicholas’s claims, concluding that the case was not the unusual case in which the allegations reveal an “insuperable bar to relief.”
The ruling does not decide the ultimate merits of the lawsuit. It means Nicholas may continue pursuing his claims that the State’s assessment and funding process violates constitutional due process, the Nebraska Administrative Procedure Act, and the Developmental Disabilities Services Act.
“This ruling is an important step forward. Nicholas will now have the opportunity to pursue his claims about a process the State uses to make life-altering funding decisions,” said Mark Bestul, Senior Attorney with Legal Aid of Nebraska.
Nicholas is a Nebraskan with developmental disabilities who depends on Medicaid services to live safely in his community and remain close to friends and family. Although his condition had not improved, the State determined after an interRAI assessment that his annual individual budget should be reduced by approximately 35 percent.
The lawsuit alleges that the State failed to adequately explain how or why Nicholas’s funding was reduced. It further alleges that DHHS uses undisclosed criteria, scoring methods, and decision rules to translate interRAI assessment responses into funding levels, leaving individuals and families unable to verify or meaningfully challenge the determination.
People with developmental disabilities and their families rely on these services for the support necessary to remain in their homes and communities.
“People with developmental disabilities and their families rely on these services for the support necessary to remain in their homes and communities,” said Elizabeth Edwards, Senior Attorney with the National Health Law Program. “When the standards governing funding decisions are not disclosed, families may not know what information matters, how assessment responses affect funding, or what evidence is needed to challenge a reduction.”
“Using an algorithm does not relieve the State of its responsibility to make lawful, transparent, and explainable decisions,” said Robert McEwen, Legal Director with Nebraska Appleseed. “People should not have to guess how the State made its decision to reduce funding for the services they rely on. Fundamental fairness requires the State to provide a clear explanation of how the decision was made and a meaningful opportunity to challenge it.”
The lawsuit seeks clear notice explaining funding decisions, a meaningful opportunity to challenge those decisions, and an assessment process that complies with constitutional and Nebraska legal requirements. It asks the court to prevent the State from using the current interRAI process to determine funding levels unless and until lawful rules, procedures, and standards govern that process.
With the State’s partial motion to dismiss overruled, the case may now proceed toward resolution of Nicholas’s claims.
About Legal Aid of Nebraska
Legal Aid of Nebraska was established in 1963 and is the largest provider of direct and free civil legal services, providing free high-quality services to low-income Nebraskans in all 93 counties. Legal Aid’s mission is to stand with those facing justice alone – defending rights, confronting injustice, restoring hope, and opening doors to opportunity. Legal Aid has offices in Lincoln, Omaha, North Platte, Norfolk, Grand Island, and Scottsbluff.
About Nebraska Appleseed
Since 1996, Nebraska Appleseed has fought for justice and opportunity for all Nebraskans. We take a systemic approach to complex issues – such as child welfare, immigration policy, affordable health care and poverty – and we take our work wherever we can do the most good, whether that’s in the courthouse, at the Capitol, or in the community.
About the National Health Law Program
The National Health Law Program, founded in 1969, protects and advances health rights of low-income and underserved individuals and families. We advocate, educate and litigate at the federal and state levels to advance health and civil rights in the U.S. Our lawyers and policy experts fight every day for the rights of the tens of millions of people struggling to access affordable, quality health care coverage free from discrimination.
About TechTonic Justice
TechTonic Justice is a multidimensional, community-based effort to strengthen local justice movements and build long-term power among the people and communities that AI is leaving behind. By integrating litigation, organizing, community education, and narrative advocacy against harmful AI uses, TechTonic Justice supports low-income communities and their allies to secure the work, housing, schooling, benefits, and stability needed for a thriving life.
Media contact:
Media contact:
Sierra Salgado Pirigyi
Communications Director, Nebraska Appleseed
[email protected]
Cell: 402-612-0241
