Written by Andrew Patterson

Apr 04


Legal Aid Celebrates 10th Anniversary of Its Medicare Part D Project

Just over 10 years ago, the Medicare Part D prescription drug program went into effect. Shortly thereafter, Legal Aid and our non-profit and law firm partners went into action to help Medicare beneficiaries access this benefit. A decade later, this project is still helping hundreds of low-income individuals who are elderly or struggle with disabilities to access life-saving medications.

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Aug 12


Race, Pain Treatment, and Social Security Claims

A New York Times article from earlier this week sheds light on racial disparities in how pain is treated, finding that minorities, and particularly African Americans, frequently receive less effective treatment for acute and chronic pain than whites.  The article points to numerous factors contributing to the disparity, such as inadequately stocked pharmacies in predominately African-American neighborhoods, and less insurance coverage in African-American communities.  But it also specifically addresses the role that racial stereotypes play in causing the disparity in effective pain treatment.  One pain researcher from St. Louis University states that “we believe negative stereotypes impact clinical decision-making.”

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Apr 16


Social Security Halts Practice of Garnishing Tax Returns to Recover Parents’ Overpayments

On Monday, the Social Security Administration announced that it will no longer intercept tax returns to recover overpayments that are more than 10 years old. The decision was made following an article that was published last week in the Washington Post reporting that the Social Security Administration was garnishing individuals’ tax returns to recover alleged overpayments, in many instances belonging not to the individuals, but their parents.
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May 18


Government Programs for Children Make a Difference

Andrew Patterson - Staff Attorney, Public Benefits

Earlier this week, Slate published an important piece on the long-term impact of programs designed to benefit low-income children.  The article includes an analysis of data concluding that children who participate in programs such as WIC, Head Start, and other early-intervention programs experience a number of life benefits, including lower rates of teen births, drug use, and arrests for violent crimes.  At Legal Aid, every day we see the ways in which programs for families — particularly pregnant mothers and children — have real, tangible effects on the lives and life opportunities of the people they are designed to assist. As we continue to debate budget cuts at both the local and national level, we must remember that any serious conversation regarding the “affordability” programs that serve children and families must also take into account the long-term benefits they have on their participants, and on society at large.


Apr 27


Legal Aid Testifies about Local Medical Assistance Programs before D.C. Council Committee on Health

Andrew Patterson - Staff Attorney, Public Benefits

Last Thursday, April 19, Legal Aid testified before the D.C. Council Committee on Health about several important issues affecting enrollees in the District’s Medical Assistance programs. The last year has seen many changes to these programs – some of which offer an occasion for D.C. to update and modernize its health care processes, while others have, unfortunately, resulted in less access to care for vulnerable populations. The continued implementation of the new federal health care law, for example, provides an opportunity for the District to improve its eligibility determination and service delivery structures. However, the new policy of requiring face-to-face recertifications every six months for the Alliance program has led to a steep drop in the number of enrollees – many of whom likely still qualify for coverage. Legal Aid’s written testimony on these issue, and others, can be accessed here.

May 04


Proposed Change to D.C. Healthcare Alliance Would Erect High Barriers to Health Coverage


Andrew Patterson, Staff Attorney

Mayor Gray’s proposed budget includes a significant policy change in the D.C. Healthcare Alliance, a District-run health insurance program that covers low-income individuals who don’t qualify for Medicaid.  Currently, Alliance enrollees must recertify (demonstrate that they are still eligible for the program based on their residency and income) once per year by filling out and sending in a form. The Mayor is proposing that Alliance enrollees recertify twice a year by having a face-to-face interview with an Income Maintenance Administration employee.

Legal Aid is very concerned about what these changes would mean for our clients who rely on the Alliance for their health coverage.  Inadequate notification, concerns about taking time off work, and well-documented administrative problems at IMA could keep low-income District residents from getting the healthcare they need.  While we understand the budget pressures the District faces, this proposal would exacerbate problems with the existing recertification process rather than strengthen it, and would likely jeopardize health coverage for many eligible District residents. 

The budget hearing for the Department of Healthcare Finance, which administers the Alliance, took place on Thursday, April 16. Legal Aid submitted testimony raising our concerns about the proposed Alliance recertification process.  During the hearing, Chairman Catania expressed his concern with the burden this policy change would place on IMA.  We also urged the Council to avoid lowering Medicaid and Alliance provider reimbursement rates or cutting services available under these programs, issues that we have previously discussed on this blog. 

For a more detailed explanation of our position on the Alliance recertification process, read our full testimony.  To express your concerns about the proposed change to the Alliance, contact Councilmember David A. Catania, Chair of the Committee on Health, at (202) 724-7772 or

Dec 01


The District Sees Benefits from Health Care Reform

Andrew Patterson - Staff Attorney, Public Benefits

Amidst all the dismal budget developments for our client community, here is some wonderful news.  As a result of the health care reform law (“Affordable Care Act”) signed by President Obama in March 2010, more than 30,000 District residents will be enrolled in Medicaid as of December 1, 2010.  These individuals were previously enrolled in the DC Health Care Safety Net Alliance program whose benefit package is less comprehensive than the one under Medicaid.  This expansion will also save the District millions of dollars by substituting federal for local health dollars. 

The Affordable Care Act required that states expand Medicaid access to childless adults with income at or below 133% of the federal poverty level, or about $1,200.00 per month, by FY 2014.  The District has enacted this expansion earlier than any other state except Connecticut.  Additionally, the District has also expanded Medicaid coverage to childless adults between 134% and 200% of the poverty level through a special waiver from the federal government. 

Prior to health reform, the District Medicaid program covered mainly families with children and adults with disabilities.  Although the District is one of the few jurisdictions that provides coverage to childless adults through the Alliance program, the coverage is not as expansive as that of Medicaid.  For instance, substance abuse and mental health services – crucial services for many living in poverty – are covered under Medicaid but excluded from coverage under the Alliance.  Additionally, the Alliance funded entirely with local money, unlike Medicaid in which seventy cents of every dollar spent comes from the federal government. 

Legal Aid applauds the District for swiftly moving to expand access to Medicaid and for carrying out the transition in a way that created minimal disruption in receipt of benefits.  While other states are suing the federal government and otherwise fighting implementation of this landmark legislation, the District is using it to provide a better package of health benefits to low-income residents at a lower cost.

May 10


Proposed Health Care Finance budget protects access to important services, but cuts others that will be necessary as health reform is implemented.

During this difficult budget year, Legal Aid is pleased that the Department of Health Care Finance has proposed a budget that does not place enrollment caps on the city's Medicaid and Alliance programs, and that continues to fund important optional Medicaid services, especially mental health and substance abuse services for adults.  These are policies that other states have implemented and we commend DC for maintaining its commitment to providing access to health care.  Moreover, the passage of the Patient Protection and Affordable Care Act, a.k.a. health reform, means that the District of Columbia will save money by increasing access to Medicaid (funded jointly by the District and federal governments) for individuals who are currently receiving Alliance benefits that are funded entirely by the District. 

With Medicaid covering more residents, however, the District will also need more Medicaid providers.  Yet the Mayor’s proposed budget reduces reimbursement rates to Medicaid providers, which will make it more difficult to recruit additional providers to the city’s Medicaid network.  The Mayor also proposed reduced funding for language access services, services that will be important as more immigrants who lawfully reside in the U.S. are transitioned to Medicaid and DC Healthy Families.  Legal Aid delivered this testimony at the Committee on Health’s budget hearing for the Department of Health Care Finance, and urged the council to raise revenue to restore these cuts, and others, to the District’s safety net. 

Jan 19


Washington Post Article Reveals Barriers to Those Seeking to Access the District’s Assistance Programs

Staff Attorney, Public Benefits

Staff Attorney, Public Benefits

Today’s Washington Post includes an important article on the barriers many low-income residents face to accessing our city’s safety-net programs.  The story reveals what residents who participate in these programs already know, which is that Income Maintenance Administration (IMA) service centers – where residents apply for Food Stamps, Medical Assistance, and other assistance programs – are under-staffed, over-whelmed, and unable to meet the increased demand for services.

As noted in the article, the Mayor closed two IMA services centers last year in an effort to save money.  This has increased the burden on the remaining service centers at a time when the number of District residents who need assistance has risen dramatically.  For example, the number of people enrolled in the District’s Food Stamp program has increased 22% since 2007.  The article also notes that the administration pledged to fully staff the remaining service centers, but has so far failed to honor that pledge.  The result is that residents – many of whom are elderly, pregnant, or disabled – must often wait for entire days for the assistance they need to apply or recertify.  At the end of the day, many are turned away without being helped and are told to come back.

Many Legal Aid clients tell a similar story.  Legal Aid assists clients who have been denied or terminated from Food Stamps, Medical Assistance and/or TANF – not because they do not qualify – but because of problems with the application and recertification process.  Notices are not mailed or received, application/recertification papers are lost, and recipients are unable to communicate with case-workers.  Those without the assistance of an attorney or case manager undoubtedly face a more difficult process of gaining access to the benefits they need and deserve.

Reducing IMA’s capacity to serve its clients is yet another way that the Mayor’s efforts to close budget gaps have disproportionately burdened our city’s low-income residents.  Rather than making it more difficult for those in need to access the District’s safety-net program, the Mayor should focus on policies that reduce barriers to assistance.  A major step towards reducing these barriers would be for the Mayor to fulfill his administration’s pledge to the city’s low-income residents by adequately staffing all IMA service centers.

Nov 18


Oh, The Plans They-Are-A-Changin’

Staff Attorney

Staff Attorney

Medicare Part D “Open Season” Begins – Challenges Remain as Many Recipients Face Possibility of Increased Costs and Less Coverage in 2010.

This past Sunday, November 15th, marked the first day of the Medicare Part D “open season,” the time when Medicare enrollees attempt to navigate the maze of prescription drug plans to find the one that will best meets their needs in 2010.  For the fourth year, Legal Aid in partnership with the Whitman Walker Clinic Legal Program, will host free walk-in clinics and conduct extensive outreach among our current and former clients, as well as the greater DC community, to assist enrollees with the selection process.  These clinics are staffed by our lawyers as well as generous volunteers from area law firms.  Since the fall of 2005, Legal Aid staff and pro bono volunteers have helped hundreds of low-income Medicare beneficiaries avoid health crises by ensuring that they are in appropriate prescription drug plans. 

Medicare Part D is a dizzying array of private drug plans – each of which has its own drug formulary (list of covered medications), monthly premium, and set of restrictions.  Low-income Medicare beneficiaries in the District – those with income below 300 percent of poverty (or about $2,700 per month for a household of one in 2009) – can receive the Low-Income Subsidy to pay most of their portion of the drug costs.  Beneficiaries who receive this subsidy have limited co-pays for their drugs, and many do not have to pay a monthly premium.  But the number of plans that do not charge a premium for low-income beneficiaries continues to shrink.  As recently as 2007, for example, low-income enrollees could choose from over twenty five zero-premium drug plans in the District.  For 2010, that number has dropped to eleven.  As such, it has become increasingly difficult for low-income Medicare enrollees in the District to find a zero-premium plan that meets their prescription drug needs.

Moreover, most of the various drug plans change their formularies, add or eliminate restrictions, and vary their premiums on an annual basis.  These changes go into effect each January, and can take enrollees by surprise.  For instance, some low-income enrollees learn that their plan has begun to charge a monthly premium only when they start receiving bills in January.  Others learn that one of their medications is no longer covered when they go to their pharmacy and are told they must pay full price.  Still other enrollees find that, although a medication is still covered, their plan has imposed a new restriction on the drug, such as a quantity limit or prior authorization.  Such barriers can delay enrollees’ access to critically important medication.

The story of two Legal Aid clients, Mr. and Mrs. S, illustrates why an individualized analysis is important for every enrollee.  When Mr. and Mrs. S came to Legal Aid, they were covered by drug plans that did not adequately meet their medical needs.  Both clients needed several medications that were not covered by their plans, and so were forced to pay out of pocket.  Furthermore, even though they qualified for the Low-Income Subsidy, neither client was enrolled in the program.  This meant they were being charged a monthly premium, and were responsible for higher co-pays for their drugs.  Legal Aid was able to help Mr. and Mrs. S enroll in the Low-Income Subsidy.  Legal Aid also helped them each identify a zero-premium drug plan that covered all their medications with no restrictions.  As a result, Mr. and Mrs. S no longer pay a monthly premium for their drug coverage, and pay only limited co-payments for their medications.

However, the story of another Legal Aid client, Ms. D, illustrates how the dwindling number of zero-premium plans can greatly reduce options for low-income enrollees.  When Ms. D came to one of Legal Aid’s walk-in clinics last year, we discovered that every zero-premium plan in the District applied significant restrictions to many of her medications.  Only one drug plan did cover all of Ms. D’s medications without any restrictions, a plan that included a monthly premium of more than $40.00.  Despite Legal Aid’s efforts to help Ms. D avoid these restrictions, it became clear that all of the zero-premium plans would greatly restrict her access to important medications.  Ms. D, therefore was forced to choose between an affordable plan that did not best meet her medical needs, or a plan that would further strain her already limited income.  Ultimately, because she did not want lose access to important medications, Ms. D chose to pay the high monthly premium.  Because this plan’s premium is likely to rise even more next year, Ms. D will likely face another difficult decision in the coming weeks. 

Medicare Part D, along with the Low-Income Subsidy, helps many seniors and people with disabilities access drugs that would otherwise be prohibitively expensive.  But another reality of Part D is that many Medicare enrollees need a great deal of assistance to identify and enroll in the most appropriate drug plan.  As the health care debate continues to rage at the national level, Medicare Part D illustrates how a complex and confusing program can often prevent those most in need of fully realizing the program’s benefits. 

So if you or someone you know is a low-income Medicare beneficiary with income below $2,700 per month for a household of one, please come to one our free walk-in clinics.  The remaining dates, times and locations are listed below.  If those dates and times don’t work, please call 202-628-1161 to get a phone or in-person appointment for help.



Date & Time

Advocates for Justice & Education

The “Big Chair” Building:

2041 Martin Luther King Jr. Ave. SE, Office #400

Friday December 4 from 9:00a to 12:00p 

Bread for the City

Northwest Office

1525 Seventh St., NW

Tuesday December 8

from 5:00p to 8:00p 

The Legal Aid Society

Main Office

1331 H St. NW, Suite 350

Near Metro Center

Weds. December 9

From 9:00a to 12:00p

Bread for the City

Southeast Office

1640 Good Hope Road, SE 

Tuesday December 15

from 9:30a to 1:00p