Idaho Medicaid disability Resource Allocation Model
The Resource Allocation Model was used by Idaho's Department of Health and Welfare (IDHW) to determine Medicaid in-home care and service budgets for developmentally and intellectually disabled people.
The model hit the headlines in 2012 when Idaho’s branch of the American Civil Liberties Union filed a class-action lawsuit when it became clear that the algorithm had severely cut funding for thousands of people who had qualified for the state's Developmental Disability Waiver ('DD Waiver'), without explanation. The state acknowledged this was a result of a new formula, but would not release details claiming it was a protected 'trade secret.'
The court determined the formula was 'unconstitutionally arbitrary,' forcing the Medicaid programme to reconfigure its system so that the patients received the proper dollar value services, and restore the dollar value services the patients previously received.
As part of the 2016 legal settlement (pdf), Idaho's Department of Health and Welfare agreed to work with the Human Services Research Institute ('HSRI') to develop a new resource allocation model by January 2020. Idaho subsequently asked for an extension to 2024 so that it could work with adults with developmental disabilities and their families to develop the new model.
As noted in George Washington University's ETI AI Litigation Database, the settlement provided that the public would have the right to inspect and copy the data 'about the IDHW’s budget setting methodologies, models, and tools,' and DD Waiver programme participants would have the right to inspect past, present, and future information, with redactions involved only when necessary to protect personal information.
Operator: Idaho Department of Health and Welfare
Developer: Idaho Department of Health and Welfare
Sector: Govt - health; Govt - welfare
Purpose: Assess care resource requirements
Technology: Resource allocation algorithm
Issue: Accuracy/reliability; Fairness
Transparency: Governance; Black box; Complaints/appeals
Published: March 2023