United States of America · Little Rock · See the United States of America profile
Evidence: Observational / pre–post Top 74% 47/100 · Ask Evidence Copilot about this practice
Arkansas replaced individualized nurse assessments of home-care hours with an algorithm (RUGs, then Optum's ARIA); federal and state courts found due-process violations after cuts left some recipients with barely half their prior hours.
In 2016, the Arkansas Department of Human Services introduced RUGs, an interRAI-based algorithm, to set weekly home-care hours for Medicaid beneficiaries with disabilities, replacing individualized nurse assessments.
The stated aim was a standardised, algorithmic method for allocating home- and community-based-services hours in place of case-by-case nursing judgement.
Nearly half of beneficiaries saw their hours cut under RUGs; courts in Jacobs v. Gillespie and Ledgerwood v. Arkansas DHS found the algorithm violated due process by giving no meaningful explanation for cuts, leading DHS to retire RUGs and adopt Optum's ARIA system in 2019.
Under RUGs, one widely reported recipient's hours fell from 56 to 32 a week despite no change in her condition; under ARIA, over a quarter of assessed individuals became ineligible and the overall weekly hours cap fell from 56 to 46.
A further suit, Elder v. Gillespie, again found due-process problems with ARIA; a 2022 settlement including nearly $500,000 in payments required DHS to give written reasons for cuts and continue benefits during appeals, though advocates report arbitrary-seeming cuts have persisted since.
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