Frequently Asked Questions About the Salazar Settlement Agreement

1. What Is the Salazar Case and Why Is There a Settlement?

The Salazar case is a long-running federal court class action case about the District of Columbia’s failure to comply with Medicaid law. The main part of the lawsuit that remains open relates to the District of Columbia’s failure to meet its obligation to comply with various aspects of the Medicaid statute, and especially to arrange and provide for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services—to children and young adults up to age 21. EPSDT is a robust Medicaid benefit that includes well-child visits, developmental screenings, dental care, mental health services, therapies, and medically necessary treatments. For more than 25 years, the District’s Medicaid program has been subject to court supervision under a consent decree to ensure that the District met its obligations to the Plaintiff class under the Medicaid statute. During that time, the District was required to report to the Court and follow detailed court orders. The Settlement Agreement, that the Court has preliminarily approved, is designed to:

·       Set out new, specific commitments the District must meet;

·       Use remaining escrow funds to benefit children and families;

·       Improve transparency and accountability in the DC Medicaid EPSDT program; and

·       End court oversight after a two-year period if the District meets its obligations.

The last part of the Salazar lawsuit that is covered by the Settlement Agreement is the District’s duty to reimburse Medicaid beneficiaries when they have to pay out-of-pocket for medical expenses that Medicaid should have covered. That duty will be in a District of Columbia regulation.

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2. How Long Does the Settlement Agreement Last?

The Settlement Agreement lasts two years, ending on October 31, 2027.

During those two years, the federal court keeps jurisdiction to enforce the settlement if the District does not follow it.

After the Settlement Agreement expires, the original court orders will be vacated, and the case will be dismissed, unless there are unresolved enforcement issues.

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3. What Changes Affect Children and Families Directly?

A. Updated Health Check (Well‑Child) Standards

The District must keep DC Medicaid’s HealthCheck Periodicity Schedule up to date so that it reflects current medical guidance. The Periodicity Schedule guides what services children should receive during well-child visits. This includes:

·       Fluoride varnish for young children at recommended intervals;

·       Required blood lead testing at different ages;

·       Ongoing review of needed changes based on federal or District law.

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B. Better Oversight of Provider Access

The Settlement Agreement strengthens oversight of whether children can actually get appointments. The District must:

·       Monitor audits by managed care plans about access to pediatric providers;

·       Review whether children can get timely routine and urgent care;

·       Require corrective action plans if plans fall below required access levels.

·       This is meant to address long‑standing concerns about long wait times and limited provider availability.

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4. New Tools to Help Families Choose and Understand Managed Care Plans

A. Child‑Health Focused Report Card

Starting in 2026, DC will publish a yearly Child‑Health Focused Report Card comparing Medicaid managed care plans on child‑specific measures, such as:

·       Timely pediatric appointments;

·       Dental preventive care;

·       Lead screening;

·       Well‑child visits;

·       Care for children with chronic conditions.

Families will receive this report card during open enrollment, and it will be posted online. The goal is to help families make informed choices.

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B. Managed Care Performance Dashboard

The District must also create a public performance dashboard showing data from each managed care plan about:

·       Child‑health quality measures;

·       Screening rates;

·       Timely prior authorization decisions;

·       How often grievances are resolved on time.

This information must be displayed in a way that is easier for parents to understand and compare between plans, and if possible, to national levels.

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5. Giving Families a Voice Through a Child‑Health Subcommittee

The District must create a child‑health focused subcommittee within its Medicaid advisory structure known as the Medicaid Advisory Committee. Key features include:

·       At least six meetings per year;

·       Medicaid leaders attend regularly;

·       Beneficiary feedback must be meaningfully considered;

·       Meeting notes must be posted publicly;

·       Stipends for participation by parents and caregivers.

$10,000 from escrow funds will be used to provide $75 stipends per meeting for Medicaid beneficiaries who participate.

These stipends continue through June 30, 2028, or until funds are used.

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6. How Else Will Escrow Funds Be Used?

About $735,000 remains in the Salazar Escrow Fund. These funds must be used to benefit class members and improve child health services.

A. Child Health Experts ($200,000)

·       Two nationally recognized experts will help the District:

·       Review child health data and best practices;

·       Focus on prevention and services for children with special health care needs;

·       Gather input from families, providers, and plans;

·       Issue public reports with recommendations.

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B. Participant‑Directed Services Study ($100,000)

A study will examine whether DC could allow families more control over certain home health services for medically fragile children, including:

·       Models used in other states;

·       Budget and staffing considerations;

·       Options and limits around family caregivers.

·       The final report will be public, but the District is not required to implement its recommendations.

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C. Grants to Child‑Serving Organizations (about $338,000)

Grants will be awarded to organizations serving DC Medicaid‑eligible children for projects such as:

·       Helping families access health care;

·       Workforce support for pediatric and mental health providers;

·       Parent education and advocacy;

·       Support during Medicaid eligibility changes.

·       If funds remain, additional grant rounds will occur.

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7. Reimbursement for Out‑of‑Pocket Medical Expenses

One of the most important changes for families is reimbursement. If a family paid out of pocket for a Medicaid-covered service, supply, or equipment—because Medicaid or the managed care plan did not cover it at the time—the District must now have clearer rules for repayment. Key changes include:

·       Families have one full year (instead of six months) to request reimbursement.

·       The District will issue clear regulations explaining how to apply.

·       Medicaid managed care plans must notify families about this right.

·       Forms will be available in English and other required languages.

·       The District will also track whether managed care plans decide and pay these requests on time and publish summary results each year.

The final regulation is available here.

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8. What Oversight and Enforcement of the Settlement Agreement Exists?

The District must submit five compliance reports over two years. The reports are available here.

If the District does not meet its obligations, counsel for the Plaintiff class can ask the Court to intervene.

There is a required dispute‑resolution process before going back to Court.

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9. What Happens Next?

Before the Settlement Agreement becomes final:

·       The Court must approve it;

·       Class members will receive notice (in English and Spanish) – the Notices are available here.

·       There will be a Fairness Hearing at the U.S. District Court for the District of Columbia on August 13, 2026 at 10:00 am, where objections can be raised. More information is available in the Class Notice here.

·       If approved, the settlement goes into effect, and the consent decree will be vacated by the Court.

·       When the consent decree is vacated, individual class members will no longer be able to receive free legal assistance from counsel for the Plaintiff class. This will not happen sooner than August 13, 2026.

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9. Key Takeaways for Families

·       DC Medicaid must improve transparency, access, and accountability for children.

·       Families gain clearer reimbursement rights.

·       New tools will help families understand and compare managed care plans.

·       Escrow funds are being used for expert review, studies, stipends for parents and caregivers who attend committee meetings, and community grants.

·       Court oversight continues until at least October 2027 to ensure compliance.

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