Executive Summary
J.R. is a young child who requires nursing services and appealed a significant reduction in her Medicaid nursing services that was based on the results of a secret scoring tool and care guidelines. The notice provided to J.R. reducing their services only provided the end result of the tool and some general information about their condition, but did not explain the criteria used to determine how many hours J.R. needed. The criteria used and how J.R. was assessed were not explained, nor were the criteria or guidelines made available to J.R. for the appeal. J.R. appealed the final agency decision to uphold the reduction in services, claiming, among other issues, problems with due process and Medicaid EPSDT. NHeLP’s amicus brief in support of J.R.’s request to reverse the final agency decision provides the court information on how transparency helps address bias and errors in health care automated decision-making systems (ADS), the prevalence of inequities and errors in such systems, and the well-established due process rights that require transparency in the use of ADS. E60
