$400 Million Algorithmic System Illegally Denied Thousands of Medicaid Benefits

An anonymous reader quotes a report from Gizmodo: Thousands of Tennesseans were illegally denied Medicaid and other benefits due to programming and data errors in an algorithmic system the state uses to determine eligibility for low-income residents and people with disabilities, a U.S. District Court judge ruled this week. The TennCare Connect system -- built by Deloitte and other contractors for more than $400 million -- is supposed to analyze income and health information to automatically determine eligibility for benefits program applicants. But in practice, the system often doesn't load the appropriate data, assigns beneficiaries to the wrong households, and makes incorrect eligibility determinations, according to the decision (PDF) from Middle District of Tennessee Judge Waverly Crenshaw Jr.

'When an enrollee is entitled to state-administered Medicaid, it should not require luck, perseverance, and zealous lawyering for him or her to receive that healthcare coverage,' Crenshaw wrote in his opinion. The decision was a result of a class action lawsuit filed in 2020 on behalf of 35 adults and children who were denied benefits. ]Crenshaw found that TennCare Connect did not consider whether applicants were eligible for all available programs before it terminated their coverage. Deloitte was a major beneficiary of the nationwide modernization effort, winning contracts to build automated eligibility systems in more than 20 states, including Tennessee and Texas. Advocacy groups have asked (PDF) the Federal Trade Commission to investigate Deloitte's practices in Texas, where they say thousands of residents are similarly being inappropriately denied life-saving benefits by the company's faulty systems.

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