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Thursday, August 25, 2016

Federal Court Ruling Provides Immediate Relief to District of Columbia Medicaid Applicants and Beneficiaries

On July 12, 2016, the District Court entered an Order in the long-running Salazar v. District of Columbia class action case providing immediate relief to self-identified Medicaid applicants and beneficiaries who cannot access their benefits as a result of the District of Columbia government’s delays and errors in processing Medicaid eligibility applications and renewals. 

First, the District must grant provisional eligibility to all individuals who inform the government that more than 45 days have elapsed without a determination on their non-disability application for Medicaid benefits. The District must grant provisional eligibility to such individual applicants until it makes an eligibility determination on the application and provides them written notice of the decision.

Second, the District must provide continued eligibility to all Medicaid beneficiaries who inform the government that their Medicaid benefits are about to be terminated at renewal or recertification or have already been terminated, even though they did not receive advance notice that they needed to renew or they timely submitted all required forms and supporting documents. The District must continue these beneficiaries’ eligibility until it makes a determination on their renewal or recertification and provides them written notice of the decision. 

Individuals who believe they have one of these claims should contact plaintiffs’ counsel, Terris, Pravlik & Millian, LLP at (202) 682-0578 for free legal assistance, or the District government through the Medicaid customer service at line at (202) 727-5355, at any of its Service Centers, or at dpo.deputy@dc.gov.  

The July 2016 relief is a partial win for Medicaid applicants and beneficiaries, who first sought a preliminary injunction in December 2015.  They later sought, in February 2016, a modification of an existing consent decree seeking permanent relief for Medicaid applicants and beneficiaries without access to Medicaid benefits as a result of the District’s systemic failure timely and adequately to process applications and renewals.  In their papers, plaintiffs presented evidence of severe backlogs in the processing of thousands of applications and systemic delays and mishandling of paperwork at the time of renewal or recertification, arguing that the District was depriving these individuals of their constitutional and statutory rights. With the support of some of the major Medicaid advocacy and health organizations in the District, including the District of Columbia Legal Aid Society, Bread for the City, Whitman Walker Health, and Legal Counsel for the Elderly, plaintiffs presented dozens of examples of individuals who were denied health care and incurred out-of-pocket expenses through no fault of their own.

On April 4, 2016, the District Court granted in large part the relief sought by the plaintiff class, with some modifications, finding that “severe and technical and logistical problems in the processing of initial Medicaid applications and in the Medicaid benefits renewal process * * * have affected thousands of Medicaid beneficiaries and have deprived many District residents of necessary medical care to which they are entitled.”  However, shortly after the entry of the Court’s Order, the District of Columbia obtained a stay of the order and sought an appeal of it in the court of appeals.  The appeal of the April 4, 2016 Order is pending.

In the meantime, individuals who come forward with one of the claims described above can obtain immediate relief provided by the Court’s July 12, 2016 Order.  


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