Calculated Need: Algorithms and the Fight for Medicaid Home Care
An in-depth report that examines how states use automated eligibility algorithms for home and community-based services (HCBS) under Medicaid and assesses their implications for access and fairness.
This resource analyzes five states’ use of “institutional level of care” algorithms to determine who qualifies for home-based care under Medicaid, finding that these tools often serve state budget priorities rather than individuals’ needs.
It highlights how the algorithms vary widely across states, conceal key criteria behind proprietary logic, and result in significant eligibility losses for people who previously received benefits. The report also includes practical advocacy tools and strategic recommendations for challenging algorithmic barriers and advancing universal access to home and community-based services.
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