Nicholas Bessey has a developmental disability and relies on Nebraska Medicaid’s home-and-community-based services to keep living in his own community instead of an institution. His medical condition, according to his legal filing, had not changed. But in early 2026 the state’s new computerized assessment system cut his individualized care budget by 35 percent anyway. On May 8, 2026, Legal Aid of Nebraska, Nebraska Appleseed, the National Health Law Program, and TechTonic Justice sued the Nebraska Department of Health and Human Services on his behalf, arguing the state can’t hide a benefits cut behind a black-box algorithm.
What interRAI is and why Nebraska adopted it
The system at the center of the suit, called interRAI, is an assessment tool states use to score how much care a Medicaid recipient with a disability needs and translate that score into a dollar budget. States have increasingly turned to standardized algorithmic assessments like it to manage Medicaid home-care spending, pitched as a way to apply consistent, defensible criteria across thousands of cases rather than leaving budget decisions to inconsistent caseworker judgment. Nebraska rolled out its version as part of a broader push to modernize how it determines level-of-care and spending caps for people with intellectual and developmental disabilities.
What the lawsuit actually alleges
The complaint doesn’t argue that no cuts are ever justified — it argues Nebraska broke its own legal obligations in how it made them. Specifically, the suit says DHHS failed to explain why Bessey’s funding was cut when his condition stayed the same, relied on criteria and scoring logic it never adequately disclosed, bypassed the formal rulemaking process required before changing how benefits are calculated, and gave recipients no meaningful way to challenge a decision they couldn’t fully see the basis for. “A Medicaid agency cannot evade their responsibilities through the use of an algorithm,” said Elizabeth Edwards of the National Health Law Program, summarizing the suit’s core argument in a single line.
This isn’t Nebraska’s problem alone
Similar algorithmic assessment systems have already triggered major service cuts for disabled Medicaid recipients in Arkansas and Washington, D.C., both of which faced their own legal challenges after recipients saw unexplained reductions in home-care hours. The pattern across states is consistent enough that disability-rights attorneys describe it as a playbook: adopt a standardized algorithm, see aggregate costs drop, and leave individual recipients to figure out — often without success — why their specific benefits changed. TechTonic Justice, one of the groups backing Bessey’s case, has made a broader practice of tracking these algorithmic benefits tools across states, arguing that the technology has quietly become one of the most consequential and least scrutinized forms of government decision-making affecting disabled and low-income Americans today.
The case for algorithmic assessment, and why advocates aren’t buying it
State Medicaid agencies defend tools like interRAI as a genuine improvement over the alternative: ad hoc caseworker decisions that can be inconsistent, slower, and just as opaque in practice, if for different reasons. Standardized scoring, in theory, should make budgets more predictable and harder to challenge on grounds of bias or favoritism. Disability advocates counter that an opaque algorithm doesn’t fix opacity, it just moves it — trading a caseworker’s unexplained judgment call for a vendor’s proprietary scoring formula that the state itself may not fully understand or be able to defend when a recipient asks why their number changed.
Why due process is the legal hook, not just fairness
The lawsuit leans on due process law rather than disability-rights law alone, because federal and state due process protections generally require that before the government takes away a benefit someone is already receiving, it has to give a specific, individualized reason and a real chance to contest it. An algorithm that outputs a score without an accompanying explanation a human can evaluate and rebut is, in this legal theory, functionally the same as no explanation at all — regardless of how sophisticated the scoring model is underneath. Courts have historically been receptive to exactly this argument in earlier algorithmic-benefits cases, including the Arkansas Medicaid litigation, where a federal judge found the state’s assessment tool violated due process rights in part because recipients couldn’t get a meaningful explanation of why their hours had been cut, a precedent Bessey’s attorneys are likely to lean on directly.
What’s next
The case is now in Nebraska’s court system, and its outcome will likely influence how other states structure or defend similar algorithmic assessment tools, given the direct parallel to the Arkansas and D.C. cases. Expect disability-rights groups in other states to watch the ruling closely as a potential template, and expect state Medicaid agencies nationally to start building more explicit appeal and explanation mechanisms into algorithmic systems preemptively, rather than risk the same due-process argument landing in their own courts.
Photo: truthseeker08 / PIXABAY via Pixabay
