Low-income District residents will have an easier time getting and keeping their health care coverage, thanks to a recent federal court ruling requiring the District to change how it handles Medicaid applications and renewals.
The District has faced a number of problems administering its Medicaid program. DC residents often face long waits at social service centers – many line up as early as 4 a.m. to get in – and lost paperwork is a common problem. In addition, changes to the District’s IT system with the implementation of the Affordable Care Act have caused technological problems and backlogs in Medicaid application processing. This has created challenges to get on Medicaid and to maintain eligibility (which has to be renewed annually). According to one Court document: “These problems have affected thousands of Medicaid beneficiaries and have deprived many District residents of necessary medical care to which they are entitled.”
In December 2015, the law firm of Terris, Pravlik & Millian, LLP sought to address these systemic problems by filing motions as part of the long-running Salazar v. District of Columbia case. Judge Gladys Kessler ruled in April 2016 that the District had failed to comply with federal law requiring timely processing of Medicaid applications and renewals, causing thousands of Medicaid beneficiaries to face delays in obtaining coverage and improper termination of coverage. Judge Kessler stressed that these violations had an impact on “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.”
In July, Judge Kessler ordered two crucial safeguards be implemented immediately to protect Medicaid beneficiaries. First, the District must grant provisional eligibility to Medicaid applicants who inform the government that their applications have not been acted upon within the 45-day deadline. Second, the District must extend Medicaid coverage to residents who inform the government that they are facing termination at renewal despite having received no advance notice of the need to renew or having already submitted their renewal form. These actions seek to ensure that low-income residents will not go without needed medical care while they await decisions on their applications or renewals.
DCFPI and Legal Aid will be working with Medicaid advocates to publicize this decision and ensure that low-income residents and their families can benefit from this relief and access the medical care they depend on. Those who would like to help or would like to refer individuals who are having trouble applying for or renewing their Medicaid coverage can contact Chelsea Sharon at csharon@legalaiddc.org.
