St. Louis Medicaid Manager Fired After Reporting Racial Bias in Caseloads, Suit Says

A former regional manager for Missouri's Medicaid home-care assessment program has sued the state health department, alleging it saddled a mostly Black team of St. Louis assessors with the most dangerous and difficult caseloads, then fired her after she reported the pattern. Anjali Salik, who oversaw operations in St. Louis and St. Louis County, filed the lawsuit Wednesday claiming the department ran what her attorneys describe as a two-track system dividing assignments by race.

According to the lawsuit, as reported by the St. Louis Post-Dispatch, Black workers on Salik's team were routinely expected to take home visits in predominantly Black neighborhoods, while white colleagues could avoid those same calls. Salik says the disparity showed up in outcomes, not just assignments: one Black team member walked out of a home visit after discovering a dead body and a wounded child inside a residence, and another was held hostage during a police standoff while conducting an assessment. The suit alleges Black workers faced more adversity on the job as a direct result of how caseloads were divided.

A Manager Who Pushed Back

Salik says she tried to fix the imbalance starting in 2019, seeking more equitable workload distribution across her staff, according to the newspaper's account. Her lawsuit alleges her team also received less recognition from the department despite including one of the state's highest-producing assessors. Salik was fired, the suit claims, after she reported the alleged discrimination against herself and her team to superiors.

The lawsuit also details what Salik describes as a pattern of being passed over. She alleges the department denied her a promotion in 2018 in favor of a white applicant who had no experience in the division, and later passed her over again for a position at a statewide call center, a project the suit says Salik herself had proposed. In a separate promotion, the suit alleges a white woman was selected for the role despite having barely any supervisory experience.

The Agency's Response

The Missouri Department of Social Services' Division of Senior and Disability Services declined to comment on Salik's claims, per the Post-Dispatch report, and Salik's former supervisors did not respond to the paper's requests for comment. DSDS operates under the Missouri Department of Health and Senior Services and is responsible for conducting in-home functional assessments that determine whether Medicaid recipients qualify for nursing-facility-level care, according to the Missouri Department of Health and Senior Services. Assessors evaluate whether elderly and disabled residents need personal care, meal assistance, or respite services to remain safely in their homes.

Salik is represented by attorneys Sharon Leuga Jones and Nimrod Chapel, with Chapel also serving as president of the Missouri NAACP. Chapel has litigated similar cases against Missouri agencies before: in June 2025, he helped secure a $1.15 million St. Louis County jury verdict against Medicaid contractor Automated Health Systems Inc. over workplace discrimination and retaliation. He also represented the plaintiff in a case decided in May 2025, when the Missouri Court of Appeals Western District affirmed a Cole County default judgment and attorney fee award against the Missouri Department of Corrections over allegations of racial discrimination, harassment, and retaliation.

How the Law Works Against the State

Salik's claims fall under the Missouri Human Rights Act, which requires employees to file an administrative complaint with the Missouri Commission on Human Rights within 180 days of the alleged discrimination and to begin circuit court litigation within 90 days of receiving a right-to-sue notice, per legal filings referenced by FindLaw. The law applies to Missouri employers with six or more employees. Under Missouri Revised Statutes § 537.610, sovereign immunity generally caps tort liability against state entities, but claims alleging violations of civil rights statutes can bypass that ceiling, allowing juries to award compensatory and punitive damages beyond the standard limit, as Hoodline has previously reported.

The demographics of the region where Salik's team worked add context to the allegations. U.S. Census Bureau data shows Black residents make up roughly 42.3% of the population in the city of St. Louis, compared with 24.9% in surrounding St. Louis County, a disparity reflecting long-standing residential patterns across the two jurisdictions. Salik's case also lands amid a broader wave of scrutiny facing Missouri's social service system: the Eighth Circuit is currently reviewing a separate federal class-action, Holmes v. Bax, over call center dysfunction and delays affecting SNAP and Medicaid applicants statewide.

Retaliation claims like Salik's are also part of a larger national pattern. Nationally, retaliation accounted for 47.8% of the 42,301 discrimination charges filed with the U.S. Equal Employment Opportunity Commission in fiscal year 2024, making it the most common type of workplace claim in the country. Open questions remain about how state officials will formally respond to Salik's filing and whether the civil rights exception to Missouri's sovereign immunity cap will ultimately apply to any judgment in her favor.