Legal Aid lawyers provided compelling evidence of the District’s failure to properly administer its Medicaid program in support of a recent motion for a preliminary injunction filed by Terris, Pravlik & Millian, LLP in Salazar v. District of Columbia. The lawsuit, which has a complicated procedural history dating back to 1993, seeks to enforce the rights of Medicaid recipients and applicants in the District.

The preliminary injunction motion seeks to address the District’s failure to timely and accurately process Medicaid applications and renewals, leaving thousands of households without needed Medicaid coverage. According to the District’s own data, more than 4,000 applications have been pending in the District’s electronic eligibility system beyond the 45-day deadline imposed by federal regulations-- some for nine months or longer. Additionally, many Medicaid recipients have lost Medicaid coverage due to the District’s failure to timely process their renewal paperwork.

These application and renewal processing problems are attributable in large part to technological problems plaguing the administration of the District’s Medicaid program, problems that have recently garnered the attention of local media. In addition, there are systemic problems with document management and customer service at the District’s service centers, where individuals come to apply for and renew their Medicaid benefits. At the service centers, Legal Aid clients (and thousands of others across the District) regularly line up around 4 a.m. and wait for several hours to submit their paperwork but still face improper termination or denial of their benefits due to the District’s inability to retain and process the documents they have submitted.

The result is that low-income children and adults who are eligible for Medicaid benefits are unable to obtain coverage for necessary medical services and medications. For example:

• One Legal Aid client went in person to a service center in January 2015 to renew her family’s Medicaid benefits. The agency representative told her to place the renewal paperwork in the service center dropbox and then told her she was “all set.” However, at the end of February, her family’s Medicaid benefits were terminated. As a result, the client had to miss a specialist appointment for a chronic medical condition. After Legal Aid reached out to the agency, the family’s Medicaid coverage was restored.
• Another client came to Legal Aid after her family’s Medicaid benefits were terminated without notice.  Beginning in March 2015, she went to a service center on three different occasions to try to get the issue resolved and reported that she had to spend nearly the entire day at the service center before going to work at night.  Despite her efforts, her children’s Medicaid benefits remained inactive, and they were unable to access medical or dental care.  After Legal Aid reached out to the agency in June, the family’s Medicaid benefits were restored the next day.
• Another client went in person to a service center in December 2014 to renew her family’s Medicaid benefits, but her children’s Medicaid coverage was nonetheless terminated.  She visited the service center three times to try to correct the problem but had no success.  Each time, she had to take time off work due to the long lines and wait several hours to be seen.  Finally, in May 2015, Legal Aid reached out to the District, and the family’s coverage was restored.  In the time she went without coverage, however, her son missed crucial medical appointments for a chronic kidney condition, and she had to pay out-of-pocket for his medications.

Through the motion for preliminary injunction, counsel for the Salazar class at Terris, Pravlik and Millian are asking Judge Gladys Kessler to require the District to provisionally approve all Medicaid applications pending over 45 days, until a final determination can be made, and to continue the eligibility of all Medicaid recipients due to be renewed or recertified until the District can show that its agencies can process applications and renewals in compliance with federal and District laws.

In support of the motion, Legal Aid attorneys Jennifer Mezey and Chelsea Sharon worked with class counsel and other Medicaid advocates to analyze thousands of documents obtained from the relevant District agencies under the Freedom of Information Act and document the struggles of many individual clients who were unable to obtain benefits until Legal Aid or other legal services advocates became involved in their case.  This work follows prior efforts to document problems and advocate for policy changes, including co-authoring with the DC Fiscal Policy Institute (DCFPI) a comprehensive report on the dysfunction at the District’s service centers and a project to interview hundreds of consumers waiting in line at service centers, which culminated in testimony before the D.C. Council’s Committee on Health and Human Services presented in conjunction with DCFPI.

The District’s response to the motion for a preliminary injunction is due today, and a ruling will likely not be issued until the spring.  In the meantime, Legal Aid will continue to advocate for individual clients seeking access to Medicaid benefits and push for systemic improvements in the District’s administration of its Medicaid program.