How AI Algorithms Are Quietly Cutting Off Medicaid Home Care for Millions
Automation is playing an increasing role in deciding who gets access to vital healthcare services in the US. Medicaid’s home and community-based services (HCBS) support over five million Americans, yet cost-cutting algorithms now shape eligibility with little public scrutiny. Critics argue these systems reduce care access while making it harder to challenge unfair decisions.
The issue has gained urgency as the Trump administration pushes AI-driven prior authorisation for Medicare in some states—a plan facing widespread opposition from doctors, patients, and lawmakers.
The shift toward automated healthcare decisions began with state-level efforts to control Medicaid spending. The Centers for Medicare & Medicaid Services (CMS) approved automated eligibility checks for home care, allowing states to use algorithms to limit services. These tools often operate behind closed doors, with vendors citing proprietary rights to block scrutiny of how decisions are made.
Individuals can appeal denied claims, but the process is time-consuming and does nothing to change the underlying algorithms. Even successful appeals leave the same flawed systems in place for the next person. Policy proposals have focused on requiring human review or increasing transparency, yet these fixes fail to address the broader problem: automation depoliticises healthcare access, making it harder to mobilise for systemic change.
Experts warn that 'fairer' automation is not the answer. Instead, they argue for building coalitions to challenge these systems collectively. By organising against automated cuts to home care, advocates can push for a universal healthcare model—one that includes guaranteed home care for all who need it.
The push for AI in Medicare prior authorisation highlights the growing reliance on automation in public healthcare. Without collective action, these systems will continue to restrict access while avoiding public accountability. Advocates stress that real change requires organising—not just for better algorithms, but for a universal system that ensures care as a right.
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