Feasibility-Guided Fair Adaptive Offline Reinforcement Learning for Medicaid Care Management

Abstract

We introduce Feasibility-Guided Fair Adaptive Reinforcement Learning (FG-FARL), an offline RL procedure that calibrates per-group safety thresholds to reduce harm while equalizing a chosen fairness target (coverage or harm) across protected subgroups. Using de-identified longitudinal trajectories from a Medicaid population health management program, we evaluate FG-FARL against behavior cloning (BC) and HACO (Hybrid Adaptive Conformal Offline RL; a global conformal safety baseline). We report off-policy value estimates with bootstrap 95% confidence intervals and subgroup disparity analyses with p-values. FG-FARL achieves comparable value to baselines while improving fairness metrics, demonstrating a practical path to safer and more equitable decision support.