Yesterday, the Legal Aid Society of the District of Columbia and the DC Fiscal Policy Institute (DCFPI) issued a new, comprehensive report on the barriers in D.C. to the accessibility of major safety net benefits. Entitled, “Closing the Gap Between Policy and Reality: Preventing Wrongful Denials and Terminations of Public Benefits in the District of Columbia,” the report tells the stories of low-income individuals and families who were unable to apply for or lost critical benefits due to the problems they encountered at Economic Security Administration (ESA) Service Centers. This report builds on longstanding advocacy by Legal Aid and our partner organizations to ensure that the District’s longstanding commitment to progressive public benefits eligibility policies are not thwarted by access barriers. In “Closing the Gap,” Legal Aid and DCFPI build on our previous advocacy efforts (here, here, and here, for example) on behalf of persons living in poverty generally, and specifically, to discuss the opportunities that the Affordable Care Act provides to remedy these problems in the long run, while acknowledging that, in the short run, posing multiple challenges to benefit service delivery. Among the stories contained in the report are those of:
Mr. Kaplan (name changed to preserve anonymity), who went for several months without Medicaid because ESA could not locate his application. Mr. Kaplan is an elderly individual who works full-time to support himself. In late 2013, Mr. Kaplan filed an online application for Medicaid. After receiving a notice that additional information was necessary, he went to the Taylor Street Service Center in January 2014. He waited in line for several hours to provide the necessary documents, and, upon doing so, was given a date-stamped receipt. In February 2014, he went back to Taylor Street to check on the status of his application and was assured that it was being processed. Still having heard nothing about his application some time later, Mr. Kaplan went to the H Street Service Center to again check on the status of his application. This time, however, he was told that ESA had no record of his application. Mr. Kaplan then called DC Health Link to see what he could do. He was told that he would need to file a new application. This application was finally approved in April 2014, several months after he first attempted to apply for health coverage.
Ms. Lewis (name changed to preserve anonymity), whose family remains without health insurance due to lost paperwork. Ms. Lewis is a mother of two who attempted to apply for health insurance for her children online through the DC Health Link website in February 2014. When the system would not permit her to scan the required documents, Ms. Lewis reports that she then sent these documents through email and fax several times, but several weeks passed and she received no response on the application. While waiting for the application to be processed, Ms. Lewis’s son was injured and required emergency medical attention. When she got to the emergency room, she was told that she would be billed for any treatment because she had no Medicaid coverage. Because she could not afford these costs, she left the emergency room without her son being treated for his injury. Ms. Lewis spoke with an advocate who contacted ESA and learned that Ms. Lewis’s application had been denied for failure to provide required information. Apparently, none of Ms. Lewis’s many prior faxes or emails had been successful. Ms. Lewis now must reapply for health insurance all over again, and her children remain uninsured.
In “Closing the Gap” we acknowledge the good intentions and hard work of agency officials but document how inadequate staffing, insufficient space, technological glitches, inadequate policy dissemination and communications efforts from the agencies tasked by the District of Columbia to implement the ACA – Health Benefits Exchange Authority (Exchange), the Economic Security Administration (ESA) of the District Department of Human Services and the District Department of Health Care Finance (DHCF) have lead to access barriers for our clients and other low-income individuals and families throughout the District. These barriers include:
• Long wait times at service centers;
• Inaccurate or incomplete information provided by agency staff coupled with a lack of widely available policies and procedures;
• Violation of the “No Wrong Door” principle; and
• Lost application and recertification documents.
Legal Aid and DCFPI have discussed the concerns raised in the report with ESA, DHCF and the Exchange staff, and representatives from the agencies indicated to us that they are working to address them. But more must be done. The report offers the following recommendations to add to and support the District’s efforts:
• Engage in (and release the results of) short-term and long-term planning through ongoing agency and advocate communications;
• Continue to improve technology as one piece of a comprehensive strategy for increasing efficient customer service;
• Hire more staff at all levels and divisions; deploy and train these staff more effectively; and hold staff accountable for providing quality, accurate service to consumers;
• Expand the space at service centers and find ways to conduct business outside of service centers;
• Promulgate and disseminate rules, policies and procedures through the development and implementation of a communications strategy;
• Improve and formalize procedures for handling mail, faxes and drop boxes, including the provision of receipts and other confirmation;
• Eliminate the in-person recertification requirements for the SNAP and Alliance programs; and
• Make services language accessible as required by the Language Access Act of 2004.
We look forward to working with the District on these short term and long term solutions to these access barriers for the sake of Mr. Kaplan, Ms. Lewis and her children, and all of those featured in “Closing the Gap.”