Upturn

Calculated Need: Algorithms and the Fight for Medicaid Home Care Upturn advances equity and justice in the design, governance, and use of technology.

⚠️New from our Benefits Tech Advocacy Hub (BTAH) partners at @upturn.org: Calculated Need, exposes how states are outsourcing critical Medicaid Home and Community-Based Services (HCBS) to opaque, profit-driven algorithms.

Read it here: www.upturn.org/work/calcula...

Calculated Need: Algorithms and the Fight for Medicaid Home Care Upturn advances equity and justice in the design, governance, and use of technology.

8/ We hope our report can support the important harm reduction work advocates are already doing in fighting automated determinations. We also believe in building towards the bigger fight for a system of universal care, which is the only way everyone can get the care they need.

Calculated Need: Algorithms and the Fight for Medicaid Home Care Upturn advances equity and justice in the design, governance, and use of technology.

7/ Based on our work with advocates, we developed an "advocacy tools" section of our report to help those seeking to access, analyze, and understand the algorithms used in their state, and to ask broader political questions in relation to these tools.

Missouri Medicaid Home and Community Based Services Eligibility Issues The Benefits Tech Advocacy Hub brings together legal and technical expertise to fight for access to public benefits and to make sure technology does not limit that access.

6/ In Missouri, the only state in our report that publicly released its eligibility algorithm, we worked with Legal Services of Eastern Missouri to assess an earlier version of the algorithm back in 2019, which led to important fixes that reduced the algorithm’s harms. www.btah.org/case-study/m...

An outline of the District of Columbia labeled "State: DC Council; Department of Health Care Finance" and "Vendors: interRAI; FEI Systems."

5/ Separately, when DC redesigned its eligibility process, the DC agency cited the constraints of its vendor's assessment tools as a way to dismiss advocates’ concerns about new eligibility rules, showing how the influence of vendors can undercut due process. www.upturn.org/work/calcula...

An outline of the state of Nebraska labeled "State: Nebraska Department of Health and Human Services" and "Vendors: Optumas; interRAI."

4/ Meeting minutes from Nebraska, obtained through public records, pull back the curtain on how the state agency and vendors jointly designed its home care eligibility algorithm. The minutes even stated that “the idea of… eligibility being clear cut is a myth.” www.upturn.org/work/calcula...

Calculated Need: Algorithms and the Fight for Medicaid Home Care Upturn advances equity and justice in the design, governance, and use of technology.

3/ There’s no escaping the fact that these automated Medicaid eligibility determinations are arbitrary and subjective: based on our analysis, someone who is eligible for home care in Mississippi and Nebraska could be *ineligible* in Missouri, New Jersey, and DC.

Calculated Need: Algorithms and the Fight for Medicaid Home Care Upturn advances equity and justice in the design, governance, and use of technology.

2/ Our report offers an in-depth analysis of five states’ eligibility algorithms, case studies on how states work with vendors to develop their algorithms, and historical research on the emergence of the federally mandated eligibility standard for Medicaid home care.

Cover of Upturn's new report titled "Calculated Need: Algorithms and the Fight for Medicaid Home Care. A Comparison of Five States' Eligibility Algorithms." The authors are Miriam Osman, Emily Paul, and Emma Weil. Published in October 2025.

1/ NEW: Read our new report, “Calculated Need: Algorithms and the Fight for Medicaid Home Care.” We show how automated eligibility determinations are political tools that draw a subjective line between who is deserving and undeserving of getting care in their home. www.upturn.org/work/calcula...

Upturn Seeks an Executive Director Upturn advances equity and justice in the design, governance, and use of technology.

The search for Upturn’s next Executive Director starts today!

We're seeking candidates with 10+ years of experience and a commitment to advancing equity & justice, who can guide Upturn’s long-term political vision and continue to grow the institution. Apply by Nov 24: www.upturn.org/join/executi...

Upturn Announces Executive Director Transition After nearly 15 years of leading Upturn, Harlan Yu plans to step down from his role as Executive Director in June 2026.

Our longtime Executive Director @harlanyu.bsky.social announced today his plans to depart Upturn in 2026.

Over 15 years, we’ve built a strong, principled & impactful organization fighting for racial, economic & social justice through a tech lens. We’re excited for Harlan and will miss him dearly!

Upturn Seeks a Director of Operations Upturn advances equity and justice in the design, governance, and use of technology.

@upturn.org is hiring a Director of Operations! This position is ideal for a senior leader with experience managing the full suite of functions necessary to support the operations and infrastructure of a nonprofit organization.

Applications due 2/28/25.

www.upturn.org/join/directo...