AI-Driven Risk Stratification Models for Medicaid: Algorithms, Bias, and Validation Challenges

AI risk stratification models can play a significant role in creating patient risk scores, allowing Medicaid managers to project care delivery costs and allocate resources more efficiently. However, these models can be biased and opaque, hampering their effectiveness in risk stratification. This document explores algorithms that can be deployed in Medicaid risk stratification and their vulnerabilities.