Legal Aid Helps Secure Broad Relief for Medicaid Beneficiaries
Public Benefits
Public Benefits Law Unit
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Legal Aid’s client community scored a major victory Monday when a federal judge took steps to remedy the District government’s systemic failure to timely process Medicaid applications and renewals. Ruling on motions filed in December 2015 by the law firm Terris, Pravlik & Millian, LLP in the long-running case of Salazar v. District of Columbia, Judge Gladys Kessler ordered the District to take sweeping steps to protect Medicaid beneficiaries.

Legal Aid played a key role in the litigation. In her opinion, after recounting nearly a dozen client examples gathered by Legal Aid and other organizations, Judge Kessler emphasized that: “Lest the reader be getting exhausted reading all these numbers and examples, s/he must constantly keep in mind that these are real people—poor and sick people and their children—who are being denied the health care and the dignity of receiving health care to which they are entitled by law” (our emphasis).

The motions filed by Terris, Pravlik & Millian, LLP sought to address the inability of thousands of Medicaid beneficiaries to access needed health coverage due to the District’s systemic problems in processing Medicaid applications and renewals. The District has admitted that, over the course of 2015, several thousands of Medicaid applications had been pending in the District’s electronic eligibility system beyond the 45-day deadline imposed by federal regulations—some likely for nine months or longer. Additionally, throughout 2015, thousands of Medicaid recipients lost coverage each month at renewal, many due to the District’s failure to timely and accurately process renewal paperwork.

These application and renewal processing problems are attributable to both technological problems and 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 as early as 4 or 5 a.m. and wait for several hours to submit their application or renewal paperwork, only to face improper termination or denial of their benefits when the District loses or fails to process the paperwork they have submitted.

In support of these motions, Legal Aid worked with class counsel and other Medicaid advocates (including Bread for the City, Whitman-Walker Health and Legal Counsel for the Elderly) to analyze thousands of documents obtained from the relevant District agencies under the Freedom of Information Act and submitted declarations documenting the struggles of individual clients who were unable to obtain benefits until Legal Aid became involved in their case. This work follows prior efforts to document systemic Medicaid problems and advocate for policy changes, including a service center monitoring project that interviewed hundreds of consumers waiting in line at service centers and culminated in testimony before the D.C. Council’s Committee on Health and Human Services presented in conjunction with the D.C. Fiscal Policy Institute.

Judge Kessler relied heavily on the evidence provided by Legal Aid and other legal services providers, citing to the Service Center monitoring project and underscoring that “[i]ndividual examples [of affected beneficiaries] provided by several of the District of Columbia’s most reliable and experienced legal aid and public health organizations . . . convey the severity of the problem.” Judge Kessler also found the stories of Legal Aid clients to be “particularly enlightening” in showing that “the issues of long Service Center wait times, paperwork loss, and processing delays have not been remedied.” In particular, Judge Kessler highlighted the case of a mother of two whose children remained without health insurance for nearly four months after she first submitted an application, as well as the case of a mother of seven who had been unable to seek crucial medical care for a serious health condition for several months due to the District’s failure to timely and accurately process her family’s renewal form.

Finding that these improper terminations and denials stemmed from “systemic issue[s] plaguing the Medicaid system” rather than stray, anomalous errors, Judge Kessler ordered broad injunctive relief to protect Medicaid beneficiaries. Specifically, Judge Kessler ordered the District government to: (1) provisionally approve all Medicaid applications pending beyond the regulatory processing deadline of 45 days to account for the District’s delays in application processing; (2) extend coverage to Medicaid beneficiaries for an additional 90 days at renewal to account for the District’s systemic delays in processing renewal paperwork; and (3) keep these remedies in place until the District can “demonstrate to the Court, based on substantial evidence, that their technology and administrative processing systems . . . are functioning as required to ensure and protect the rights of Medicaid recipients and applicants” under federal law.

Legal Aid is hopeful that this relief will improve the ability of individuals and families to obtain necessary medical care and medications and to access the health coverage to which they are entitled under the law.

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