NEWS & ANNOUNCEMENTS
Message Regarding COVID-19 Public Health Emergency
At Terris, Pravlik & Millian, LLP, we are working hard to continue serving our clients during the on-going COVID-19 pandemic. We are operating on our regular office schedule, but many of our lawyers are working from home. Our office is not open for clients to visit without an appointment.
If you are calling our Medicaid Hotline (202-682-0578), please leave a message with your name, the issue you are having, and your telephone number. One of our paralegals will contact you as soon as possible and within one business day. DC Medicaid beneficiaries whose coverage would have otherwise expired as of March 2020 or later will have their Medicaid benefits automatically extended during the COVID-19 federal public health emergency and they do not need to take any action to extend the benefits.
The District of Columbia has compiled information regarding the specific effects of the COVID-19 pandemic on Medicaid beneficiaries, which can be found here.
We wish everyone good health as we work together to combat this public health emergency and we will continue to help in any way we can. To contact us or schedule an appointment, simply give us a call at 202-682-2100 or send us a message here.
Notice to Plaintiff Class in D.L. v. District of Columbia
On February 27, 2020, plaintiffs’ counsel filed a request for an award of attorneys’ fees and expenses in D.L. v. District of Columbia, a class action related to special education services for preschool-aged children in the District of Columbia. The District of Columbia (the defendant) agreed to pay those fees and expenses and the matter has been submitted to the Court for its approval. Class members may file objections with the Court to the fee request on or before April 24, 2020. For additional detail, click here for a copy of the notice related to this motion. Click here for additional information regarding this case.
TPM Announces Nicholas Soares as Newest Partner
Terris, Pravlik & Millian, LLP is pleased to announce Attorney Nicholas F. Soares as its newest partner, effective January 1, 2020. As a partner, Nicholas will continue his work furthering the mission of TPM, to advocate for civil rights and the environment. Nicholas has been a part of the firm since 2012 and has concentrated his practice on environmental litigation, as well as on representing plaintiffs fighting employment discrimination.
Nicholas earned his Juris Doctorate, cum laude, from Georgetown University Law Center in 2012 and has been admitted to the bar in the District of Columbia, Virginia, and the District of Columbia U.S. District Court. While in law school, he served as a student attorney with Georgetown University’s Institute for Public Representation and interned with the Civil Rights Division of the United States Department of Justice. He also served as an editor for the American Criminal Law Review.
Longtime TPM partner Kathleen Millian notes that “Nick brings his keen insights and sense of humor to the work of the firm. We are very pleased that he will be joining us as a partner.” Along with Ms. Millian, all of Nicholas’s colleagues at TPM welcome his promotion and look forward to the contribution that his partnership will bring to the important civil rights and environmental work of TPM.
Notice to Plaintiff Subclasses in D.L. v. District of Columbia
Plaintiffs’ counsel filed a request for an award of attorneys’ fees and expenses in D.L. v. District of Columbia, a class action related to special education services for preschool-aged children in the District of Columbia. The District of Columbia (the defendant) agreed to pay those fees and expenses and the matter has been submitted to the Court for its approval. Subclass members may file objections with the Court to the fee request on or before February 10, 2020. For additional detail, click here for a copy of the notice related to this motion. Click here for additional information regarding this case.
TPM Medicaid Due Process Case Highlighted by National Health Law Program
Senior Attorney at the National Health Law Program, Wayne Turner, highlights Maldonado v. District of Columbia in a recent article about prescription denials entitled, “When Patients Leave the Pharmacy Empty Handed.” Maldonado v. District of Columbia is TPM’s putative class action case challenging the District of Columbia’s systemic failure to provide timely and adequate individualized written notice to persons whose prescriptions are denied Medicaid payment at the pharmacy. In his post, Turner speaks to the human cost of this failure to provide notice, noting that up to forty seven percent of prescriptions submitted by Medicaid beneficiaries are denied coverage on any given day—a statistic that is compounded by the fact that low-income people who rely on Medicaid to pay for their prescribed medications often “have no other means of obtaining potentially life-saving medication.”
Turner explains how health law advocates, including TPM attorney Stephanie Madison and Sheldon Toubman of the New Haven Legal Assistance Association, are taking this issue beyond District lines and advocating for individualized notice on the national level. He notes that the National Council for Prescription Drug Programs was persuaded “to establish a Point of Sale Patient Specific Denial Notice Task Group” by Madison and Toubman who traveled to San Antonio to make their case for individualized notice standards. Along with organizations like the National Health Law Program, TPM continues to fight for the due process rights of Medicaid beneficiaries in the District of Columbia and beyond. Read Wayne Turner’s full article here.
TPM Wins Leave to File a Second Amended Complaint in Medicaid Due Process Notice Case
On April 4, 2019, the United States District Court for the District of Columbia granted plaintiffs, represented by Terris, Pravlik & Millian, LLP and the National Health Law Program, leave to file a Second Amended Complaint over the opposition of the defendant the District of Columbia in Maldonado v. District of Columbia, D.D.C., Civ. No. 10-1511.
The case was brought in 2010 by plaintiffs, a class of Medicaid beneficiaries seeking due process notice when their requests for coverage for prescription medications are denied. Plaintiffs first amended their complaint in 2013, after their standing to bring suit had been recognized by the Court of Appeals for the District of Columbia Circuit.
There have been significant rulings by the district court and the Court of Appeals since 2013. In 2015, the Court of Appeals held that plaintiffs had a protected property interest under the Fifth Amendment of the Constitution in any prescribed medication “not completely excluded from coverage” by Medicaid. In March 2017, the district court found that plaintiffs stated a claim that the District’s current Medicaid prescription medication claims processing system violates the Fifth Amendment’s Due Process Clause by not providing individualized written notice at the point-of-sale to persons denied Medicaid coverage for their prescriptions as written. In plaintiffs’ Second Amended Complaint, plaintiffs add a class representative, supplement the descriptions of recent prescription denial experiences by the class representatives, refine the definition of the plaintiff class, and ensure consistency with the rulings of the district court and the Court of Appeals since 2013.
On May 31, 2019, the District of Columbia filed a partial motion to dismiss plaintiffs’ Second Amended Complaint – its fourth motion to dismiss in the case. On June 28, 2019, plaintiffs opposed the motion to dismiss and filed a cross-motion for partial summary judgment. The parties are currently completing the briefing on the motions.
D.C. Circuit Rejects USAO-ALM Attorneys’ Fees Matrix in DL v. District of Columbia
DL v. District of Columbia is a class action seeking to remedy the District of Columbia’s failure to provide and timely provide special education services to preschoolers with disabilities. After years of litigation, in 2016, the District Court found the District of Columbia liable and ordered sweeping injunctive relief, which the Court of Appeals subsequently affirmed. Plaintiffs’ counsel are working to ensure that the District of Columbia makes the improvements needed to comply with the injunction and appropriately serve the District’s children.
The parties to this case have also been involved in a lengthy dispute regarding the amount of attorneys’ fees that must be paid by the District of Columbia to plaintiffs’ counsel for their work to effectuate this change. The District argued that plaintiffs’ fee award should be based on hourly rates from the USAO-ALM Matrix, which is a new matrix of attorneys’ hourly rates developed by the United States Attorney’s Office for the District of Columbia. That matrix provides hourly rates that are substantially below market rates for complex federal litigation in the District of Columbia.
In the most recent development in that dispute, on May 21, 2019, the Court of Appeals for the District of Columbia Circuit rejected the USAO-ALM Matrix because it is “based on data for all types of lawyers—not just those who litigate complex federal cases—from the entire metropolitan area—not just the District of Columbia.” The Court explained that “[t]he USAO’s matrix is helpful only if it canvasses the relevant type of lawyer, which it does not.” It also stated that the USAO-ALM Matrix is based on data for the wrong geographic area, explaining that its geographic area “stretches well beyond the District to cover thousands of square miles over three states, from rural Madison County, Virginia, to the eastern shore of Maryland, back to the foothills of Jefferson County, West Virginia.”
This decision should result in the ultimate award of attorneys’ fees in this case at market rates for complex federal litigation in the District of Columbia. Congress used fee-shifting provisions in civil rights and other laws to improve access to justice for those that cannot afford counsel. This decision furthers that purpose because it takes plaintiffs’ counsel one step closer to being compensated at market rates.
A copy of the decision is here. More information about this case is here. Please contact Todd Gluckman at 202-204-8482 or tgluckman@tpmlaw.com if you have any questions.
Funds Are Available under the Salazar Class Action for Projects to Benefit Children on DC Medicaid
Approximately $1.2 million is available in the Salazar Penalty Escrow Account Fund to be granted to court-approved projects that will improve the health of Medicaid eligible children and their families in the District of Columbia.
The Salazar Penalty Escrow Account Fund was set up by the United States District Court for the District of Columbia in 2010 with funds deposited by the District of Columbia to pay penalties assessed against it by the Court in Salazar v. District of Columbia, Civil Action No. 93-452. The funds must be used solely for the benefit of the Salazar plaintiff class, which includes Medicaid eligible children in the District of Columbia. The court order establishing the fund is available here. As of April 2018, the fund contains $1,295,279.45. The distribution of the funds is subject to court approval.
In the past, the Salazar Penalty Escrow Account Fund has been used for a project to encourage higher rates of blood lead testing by purchasing point-of-care blood lead testing equipment for pediatric practices and to pay for a report by the National Academy for State Health Policy (NASHP) concerning the potential use of national quality child health measures and electronic reporting to track and improve the delivery of health services to Medicaid-enrolled children in the District of Columbia.
For further information, please contact plaintiffs’ attorney, Zenia Sanchez Fuentes, at zsanchez@tpmlaw.com or at 202-204-8484.
TPM Wins Summary Judgment Ruling That Environmental Groups Have Constitutional Standing to Sue NL Industries for Contaminating River Sediments
On March 27, 2018, the United States District Court for the District of New Jersey issued a decision in Raritan Baykeeper v. NL Industries granting summary judgment to environmental groups Raritan Baykeeper and Edison Wetlands Association on the issue of constitutional standing. The district court held that these groups have standing to sue NL Industries under the Resource Conservation and Recovery Act (RCRA), 42 U.S.C. 6972(a)(1)(B), for contaminating the sediments of the Raritan River with heavy metals such as arsenic, copper, lead, nickel, and zinc. The district court’s decision came after a five-day evidentiary hearing in May 2017 in which plaintiff members testified about their environmental and recreational interests in the river and their concerns that contamination would diminish these interests. Click here to read the decision.
For almost a half-century, NL operated a titanium dioxide production plant in Sayreville, New Jersey, on a peninsula bordering the Raritan River. NL’s discharges from the site, during the plant’s operation and after its closure, caused high levels of metals to accumulate in the sediments of the river adjacent to the site. These metals may cause an imminent and substantial endangerment to human health and the environment. Raritan Baykeeper and Edison Wetlands Association filed this case in August 2009, in order to compel NL to clean up the sediment contamination that it caused.
The land portion of the former NL site is currently undergoing remediation for a redevelopment project called Riverton. Although the redeveloper intends to build a marina offshore in the Raritan River, as of now, there is no plan to clean up the sediments. With the district court’s ruling that plaintiffs have standing under RCRA, Raritan Baykeeper and Edison Wetlands Association can now seek a trial on the merits to compel a cleanup of the river sediments.
TPM has a long history of fighting to ensure that citizen-plaintiffs have access to the federal courts and has established many landmark decisions on the issue of standing, including the Supreme Court case Friends of the Earth v. Laidlaw and the court of appeals cases Friends of the Earth, Inc. v. Gaston Copper Recycling Corp., ICO v. Honeywell, Inc., and Public Interest Research Group of New Jersey v. Powell Duffryn Terminals Inc. TPM is pleased that the district court followed these cases in reaching its decision.
To read a press release issued by Raritan Baykeeper on April 2, 2018, click here.
To read local news coverage of the decision published on April 5, 2018, click here.
TPM to Participate in Symposium on Environmental Law at Georgetown University Law Center
Kathy Millian will speak on a panel about the future of environmental law at the 30th Anniversary Symposium sponsored by the Georgetown Environmental Law Review entitled “From Exxon to Paris: An Examination of Environmental Law Over the Past 30 Years.” The symposium will be held at the law school on Friday, April 13. Ms. Millian litigated Interfaith Community Organization v. Honeywell, an important citizen suit enforcing RCRA and resulting in a comprehensive clean-up of a site and the nearby river sediments contaminated by hexavalent chromium.
Lynn Cunningham Retires as Of Counsel to TPM
After more than 40 years of practicing law and 22 years as of counsel with Terris, Pravlik & Millian, LLP, our good friend and colleague Lynn Cunningham has announced that he is retiring from the practice of law. We will miss him and wish him luck in his future endeavors.
Lynn’s legal career is a testament to his life-long commitment to advocate for the public interest. Over his 40-year legal career, Lynn has represented the neediest people in Washington DC and elsewhere to gain access to health care, housing, and welfare through impact litigation in the federal and local courts. Lynn is also an Episcopal priest who was the Rector of St. Thomas Episcopal Church in Dubois, Wyoming from 2005 to 2011.
Lynn graduated from Cornell University in 1966 and Union Theological Seminary in 1969. After graduating from Columbia University Law School in 1972, Lynn began his legal career with the New York firm of Lovejoy, Wasson, Lundgren & Ashton. In 1975, Lynn moved to Washington DC, where he joined the law offices of Florence Wagman Roisman, which served as the Washington Branch Office of the National Housing Law Project. There, he worked on complex class actions, including a successful nationwide class action lawsuit against the U.S. Department of Housing and Urban Development (HUD) to release $60 million in impounded multifamily housing subsidy funds, an action against HUD to prevent the demolition of a low-income housing project in the District of Columbia, and an action against the U.S. Secretary of Labor to provide employment goals and timetables for women in the skilled construction trades.
In 1977, Lynn joined the nonprofit law firm Neighborhood Legal Services Program, where he worked in the Law Reform Unit and became the managing attorney of the unit in 1980. At Neighborhood Legal Services, Lynn practiced as lead counsel or co-counsel in major litigation in the District of Columbia in the areas of landlord-tenant, low-income housing, consumer protection, homelessness, and public benefits, resulting in substantial relief for the plaintiffs in those cases.
In 1993, Lynn joined Terris, Pravlik & Millian, LLP, in bringing a successful class action lawsuit, Salazar v. District of Columbia, challenging the District of Columbia’s operation of its Medicaid program on behalf of Medicaid recipients and applicants to enforce their statutory and Constitutional rights. In 1996, Lynn joined Terris, Pravlik & Millian, LLP, as of counsel. For the past 20 years, Lynn has been providing strategic advice as co-counsel in Salazar, as the firm continues to monitor and enforce the District of Columbia’s compliance with a consent decree in that case. His knowledge of class reform litigation in the District of Columbia has been invaluable to the firm.
In 1996, Lynn became a professor of clinical law at the George Washington University Law School, where he co-led the Public Justice Advocacy Clinic teaching students to vigorously advocate for the most disadvantaged members of society. During his tenure as professor at George Washington University Law School, he acted as lead counsel or co-counsel in class action lawsuits on behalf homeowners who lost their homes as a result of the failure of their mortgage lenders to maintain proper licenses for making mortgage loans in the District of Columbia, school children with disabilities challenging the failure of the D.C. Public Schools to maintain emergency evacuation plans, and prisoners in the D.C. jail who were illegally strip searched and detained beyond their release dates in violation of their Constitutional rights. He retired as Professor Emeritus of Clinical Law in 2005. From 2005 to 2017, Lynn continued practicing as a solo practitioner in complex federal litigation under the Constitution or federal statutes on behalf of incarcerated and low-income people.
Lynn has published many articles on affordable housing and poverty issues, most notably updating the Neighborhood Legal Services Program Landlord and Tenant Manual, a widely used reference manual on landlord-tenant law. In recognition of his contributions to the public interest, Lynn has been awarded the Legal Aid Society of DC Servant of Justice Award, the Stuart Stiller Award, and the Jerrold Scoutt Prize.
TPM Wins Affirmance in Federal Appeals Court that District of Columbia Underserves Preschoolers with Disabilities
D.L. v. District of Columbia is a class action brought by the firm seeking to remedy the District of Columbia’s failure to provide and timely provide special education services to preschoolers with disabilities in violation of the Individuals with Disabilities Education Act (IDEA) and other laws.
On Friday, June 23, 2017, the court of appeals, in a unanimous decision, affirmed the lower court decision in all respects. The lower court found that the District of Columbia violates the rights of preschoolers with disabilities by failing to provide and timely provide services required by the IDEA and District law. The lower court issued an injunction requiring numerous corrective actions to prevent further violations.
U.S. District Court Judge Royce C. Lamberth, who has presided over the case since 2005, described the case as follows: “This case concerns the District of Columbia’s obligations, under both federal and local law, to provide special education to some of our most vulnerable citizens at a very early and critical stage in their lives. In the first few years of a child’s life, there exists a narrow window of opportunity in which special education, tailored to the child’s particular needs, can work a miracle. ‘[S]omewhere in the neighborhood of 75 to 80 percent’ of the disabled children who are found in the community and served by quality early intervention programs will go on to kindergarten alongside every other ordinary five-year-old—without needing further supplemental special education. * * * So that’s what’s at stake here.”
The court of appeals rejected all arguments made by the District in its appeal of Judge Lamberth’s ruling. Addressing the District’s argument that the IDEA precludes comprehensive injunctions and allows only for relief on an individual child basis, the court of appeals stated that “the District’s argument would eviscerate the very purpose of IDEA.” Congress enacted the IDEA in response to the “pervasive and tragic” failure to serve all children with disabilities. In exchange for federal funding, the IDEA imposes on states, including the District, the obligation of identifying and evaluating all preschoolers with disabilities. The court of appeals found that although the District had “enthusiastically accepted millions of dollars in IDEA funding,” it was now proposing to shift back to parents the burden of determining whether a child was eligible for special education services. The court of appeals stated: “Given the purpose of IDEA, we cannot imagine a more preposterous argument.”
Plaintiffs and their counsel are very pleased with the ruling. This decision will have a positive and lasting impact on children with disabilities in the District. We hope and expect that the District will now focus its full attention and resources on complying with the injunction and bringing about the improvements needed to ensure that special education services are timely delivered to all preschoolers with disabilities.
This decision was featured in the Washington Post on June 23, 2017.
Click here for the decision.
TPM Wins Ruling that Plaintiffs Have Stated a Claim that Due Process Requires Individualized Written Notice When Prescribed Drugs Denied Medicaid Coverage at Pharmacy
On March 26, 2017, the United States District Court for the District of Columbia issued a decision in N.B. v. District of Columbia in favor of plaintiffs represented by Terris, Pravlik & Millian, LLP, and the National Health Law Program. Plaintiffs allege that the District of Columbia has systematically failed to provide Medicaid recipients with due process when a prescribed medication is denied Medicaid coverage at the pharmacy. Defendants, the District of Columbia and the Department of Health Care Finance, had filed a renewed motion to dismiss on a second remand from the United States Court of Appeals for the District of Columbia Circuit (“the D.C. Circuit”). The district court partially denied defendants’ renewed motion to dismiss, finding that plaintiffs have stated a claim that the District’s current system violates the Fifth Amendment’s Due Process Clause by not providing individualized written notice to Medicaid recipients.
Plaintiffs filed their complaint on September 7, 2010. On August 8, 2011, the district court granted defendants’ first motion to dismiss on the ground that plaintiffs lacked standing. On June 8, 2012, the D.C. Circuit reversed the district court’s decision and remanded the case for further proceedings. In March 2014, the district court granted defendants’ second motion to dismiss because, inter alia, it determined that the plaintiffs lacked a protected property interest (i.e., a legitimate claim of entitlement to the prescribed medication) and therefore had no protections under the Due Process Clause.
In July 2015, the D.C. Circuit reversed in part, holding that under the U.S. Constitution plaintiffs have a protected property interest in Medicaid coverage of any prescribed medication not completely excluded from coverage under Medicaid. The D.C. Circuit cited the “mandatory, non-discretionary terms” used in the District’s Medicaid regulations (29 D.C.M.R. 2700, et seq.). The D.C. Circuit remanded the case to the district court.
On March 23, 2016, defendants filed a third motion to dismiss, arguing, inter alia, that plaintiffs failed to state a Due Process Clause claim because the District’s current Medicaid pharmacy program provides sufficient notice to Medicaid recipients. Defendants argued, inter alia, that Medicaid recipients who are denied prescription drug coverage could learn the reason for the denial by asking the pharmacist or calling District officials. Plaintiffs contended that the system’s reliance on affirmative inquiry was inadequate to protect the due process rights of Medicaid recipients under the Constitution.
The district court agreed with the plaintiffs. The court found that requiring Medicaid recipients to ask the pharmacist or call District officials to learn the reason for the prescription denial “is constitutionally insufficient, and thus, the fact that a Medicaid plaintiff could conduct such an inquiry is irrelevant to the constitutional analysis” (emphasis in original). The district court concluded that plaintiffs have stated a claim under the Due Process Clause of the Fifth Amendment and that the District’s current practice “simply cannot constitute adequate notice. * * * [I have] concluded that defendants have failed to provide adequate initial written notice that reasonably apprises plaintiffs of the reasons for the prescription denial.” The case now proceeds to discovery and a determination on class certification.
Click here for the decision.
We Mourn the Passing of Founding Partner Bruce J. Terris
Bruce J. Terris, the founding partner of Terris, Pravlik & Millian, LLP, died at his home on February 3, 2017. He was 83. After a career with the Solicitor General’s Office in the United States Department of Justice, Bruce began his own public interest law firm in 1970. He was a hero of the environmental movement, representing environmental groups from Friends of the Earth, to Sierra Club, to the Hackensack Riverkeeper, among many others. Bruce’s path-breaking work established important precedents in environmental law, including the standard for environmental standing in the Supreme Court’s decision in Friends of the Earth v. Laidlaw Environmental Services, Inc. (TOC), 528 U.S. 167 (2000). Bruce was also a leading litigator in civil rights cases, representing individuals and groups in class actions to enforce the Constitution and federal laws including Title VII, the Individuals with Disabilities in Education Act (IDEA), the Medicaid Act, and the Fair Housing Act. Bruce was admired by colleagues and opponents alike for his passionate belief in his cause, his brilliant oral advocacy skills, and his persuasive brief-writing. Bruce believed in fairness and justice. He dedicated his career to representing those who could not otherwise afford a lawyer to take on the powerful, be it the government or a large corporation. We will miss his optimism, his wit, his wise counsel, his kindness, and his generous advice and mentoring of the lawyers at our firm. The firm will continue to practice public interest law and, as was Bruce’s wish, will continue to be known as Terris, Pravlik & Millian, LLP.
For more about Bruce's legal career, click here.
Memorial contributions in honor of Bruce may be made to the World Wildlife Fund, the Sierra Club Foundation, or the Waterkeeper Alliance.
Notice to Plaintiff Subclasses in D.L. v. District of Columbia
Plaintiffs’ counsel filed a motion for an award of litigation costs, including attorneys’ fees and related expenses, in DL v. District of Columbia, a class action related to special education services for preschool-aged children in the District of Columbia. Defendants are scheduled to file an opposition to that motion. In addition, subclass members may file objections to that motion. For additional detail, click here for a copy of the notice related to this motion. Click here for additional information regarding this case.
District of Columbia Responds to FOIA Request Concerning the Implementation of Federal Court Order Providing Relief to Medicaid Applicants and Beneficiaries
On July 12, 2016, the U.S. 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’s delays and errors in processing eligibility applications and renewals. More information about the July 12, 2016, Order and how to obtain relief under it is provided in our August 25 and September 28 posts.
On September 27, 2016, Terris, Pravlik & Millian, LLP, class counsel for the Salazar v. District of Columbia plaintiff class of Medicaid applicants and beneficiaries, submitted a request under the District of Columbia’s Freedom of Information Act (FOIA) for policies, procedures, and training materials developed by the District of Columbia to implement the relief in the Order entered by the U.S. District Court on July 12, 2016.
In its FOIA Response, the District provided 68 pages of documents detailing how it processes requests for provisional Medicaid, in the case of applications, and for extended Medicaid, in the case of renewals, under the July 12 Order. The District also provided sample notices for applicants and beneficiaries who submit a claim for relief under the July 12 Order.
If you or someone you represent is a non-disabled applicant who has been waiting longer than 45 days for a Medicaid eligibility determination and have submitted a claim seeking relief under the Court’s July 12 Order, be sure to request a notice from the District of Columbia informing you whether the relief has been granted.
If you or someone you represent is a Medicaid beneficiary of any kind, including a QMB, EPD-HCBS, IDD, and Long-Term Care Nursing Home beneficiary, and whose benefits are about to be terminated at renewal or recertification or have already been terminated, even though you did not receive advance notice of the need to renew or you timely submitted all required forms and supporting documents, and have submitted a claim seeking relief under the Court’s July 12 Order, be sure to request a notice from the District of Columbia informing you whether the relief has been granted.
If you disagree with District’s determination, please call Terris, Pravlik & Millian, LLP at 202-682-0578 for free legal help or email us at medicaidhelp@tpmlaw.com.
Terris, Pravlik & Millian, LLP Will Provide Free Legal Help for Delayed Medicaid Applications or Problems with Medicaid Renewals
If you or a client is waiting more than 45 days for a decision on a District of Columbia Medicaid application or has lost or is threatened with the loss of Medicaid coverage at renewal (also known as recertification), either without notice or after having turned in all required forms, call Terris, Pravlik & Millian, LLP at 202-682-0578 for free legal help or a referral. You may also email us at medicaidhelp@tpmlaw.com.
Terris, Pravlik & Millian, LLP, class counsel for the Salazar v. District of Columbia plaintiff class of Medicaid applicants and beneficiaries, provides free legal help for many problems involving Medicaid applications and renewals. We provided more information about a July 12, 2016, Order providing relief to Medicaid applicants and beneficiaries here.
The District of Columbia Medicaid agency has forms to be submitted if you wish to submit a claim for relief concerning a Medicaid application or renewal without a lawyer. Fill out a renewal or application claim form and submit it to dpo.deputy@dc.gov, at any Department of Human Services (DHS) service center* or make a claim by telephone at the Medicaid customer service line: (202) 727-5355. Keep a record of what you submit. If you have any problems, please call us for help: 202-682-0578.
Information for DHS service centers is as follows:
Anacostia
2100 Martin Luther King Avenue, SE
(202) 645-4614 (phone)
(202) 727-3527 (fax)
Congress Heights
4001 South Capitol Street, SW
(202) 645-4525 (phone)
(202) 645-4524 (fax)
Fort Davis
3851 Alabama Avenue, SE
(202) 645-4500 (phone)
(202) 645-6205 (fax)
H Street
645 H Street, NE
(202) 698-4350 (phone)
(202) 724-8964 (fax)
Taylor Street
1207 Taylor Street, NW
(202) 576-8000 (phone)
(202) 576-8740 (fax)
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.