TPM Files Motion to Prevent the District from Improperly Terminating Medicaid Recipients at Renewal and Making Applicants Wait More than 45 Days for Eligibility Determinations

On December 22, 2015, Terris, Pravlik & Millian, LLP, filed a motion for a preliminary injunction against the District of Columbia in the United States District Court for the District of Columbia on behalf of the Salazar plaintiff class.  The preliminary injunction seeks to ensure that no Medicaid applicant (non-disabled) waits longer than 45 days for a decision on an application for Medicaid benefits and that no Medicaid recipient’s coverage is improperly terminated as a result of the District’s inability to make correct and timely eligibility decisions at the time of renewal or recertification.  The District of Columbia has until January 15, 2016, to respond.

Class counsel filed the preliminary injunction after hearing increasing concerns from class members, medical providers, and Medicaid advocates about the technological and other problems causing excessive delays for Medicaid applicants and improper terminations for Medicaid recipients.  In addition, DC has announced that there will be no passive renewals for Medicaid for a period of time beginning on January 1, 2016. 

Plaintiffs presented documents produced by the District of Columbia in response to Freedom of Information Act (FOIA) requests which show that the District of Columbia is depriving thousands of Medicaid applicants of their right to have their applications processed within 45 days.  As of December 10, 2015, there was a backlog of approximately 4,500 Medicaid applicants who applied in DC Health Link, the District’s health insurance online exchange, who have been waiting more than 45 days for a decision, with an additional backlog of paper applications.  Plaintiffs show in their motion that the District of Columbia routinely loses or fails to process application paperwork, forcing applicants to resubmit paperwork and stand in line at service centers for hours.

At the time of renewal, the District of Columbia is also depriving Medicaid recipients of their right to receive Medicaid benefits until found to be ineligible and to receive advance notice and an opportunity for a hearing prior to termination of their benefits.  Technological problems caused by the District’s poorly functioning computer systems routinely cause improper termination of benefits at the time of renewal or recertification.  In addition, plaintiffs show that despite the District of Columbia’s efforts, ongoing systemic document processing problems cause benefits to lapse, leaving otherwise eligible families and children without access to needed healthcare and medications, with burdensome out-of-pocket expenses, or high medical bills.

The Salazar plaintiff class seeks to have the Court enter an injunction requiring all applicants to be added to the Medicaid rolls within 45 days of their application and requiring that no recipient be terminated at renewal until the District of Columbia can demonstrate to the Court, based on substantial evidence, that their technology and business processing systems for making timely eligibility determinations on applications and renewals, and providing adequate notice to Medicaid recipients and applicants of such decisions, are functioning as required to ensure and protect their rights under the United States Constitution and applicable federal law and regulations.

Plaintiffs’ motion is supported by FOIA documents provided by District of Columbia agencies, the testimony of class members, the Legal Aid Society of the District of Columbia, Whitman-Walker Health, Bread for the City, Legal Counsel for the Elderly, and the DC Fiscal Policy Institute.  The motion and supporting documentation are available through Dropbox at the following link: