Officials at D.C. Department of Human Services (DHS) and Department of Health Care Finance (DHCF) are in the midst of Medicaid redetermination, the process by which the District’s Medicaid rolls receive an update that’s more than three years in the making.
With redetermination scheduled to end this summer, DHCF officials say that the majority of District residents have renewed their coverage.
By the end of 2023, 283,631 District residents were enrolled in Medicaid, a DHCF spokesperson told The Informer. That figure represented a decline from 311,332 that the agency recorded in May. Within that seven-month period, more than 27,000 enrollees failed to submit renewal paperwork or were found to no longer be eligible for Medicaid, the spokesperson said.
However, for some service providers, like Abraham “Abe” Plaut, there’s more to the picture when it comes to that decline, especially with what he described as inadequate communication between DHS and DHCF.
Plaut also mentioned DHS’ refusal to provide receipts or confirmation for Medicaid recipients who submit renewal materials inside the physical dropbox at DHS service centers.
“You’re going to get conflicting information,” said Plaut, a coordinator at Bread for the City’s medical clinic. “DHS thinks people are insured, but DHCF says they’re not.”
Plaut told The Informer that, since October, he and his colleagues at Bread for the City’s Northwest and Southeast locations have met dozens of clients, many of whom with incomes at 250% or below the federal poverty line, who unknowingly lost their Medicaid coverage or are struggling to renew their coverage.
Those in the first group didn’t know about their change in status until they attempted to secure medicine and medical treatment, Plaut said. Many of these clients, he added, aren’t receiving letters about Medicaid redetermination.
When it comes to those actually going through recertification, he pointed out that District Direct, DHS’ online portal, sparks confusion among applicants about when their coverage is ending versus when they are due for recertification.
The application process, Plaut said, can be just as arduous, especially for English language learners and those who are turning 65 years old. He told The Informer that as of Feb. 12, Bread for the City’s legal clinic has 43 cases related to Medicaid and Alliance health insurance eligibility issues that haven’t been resolved yet.
For him, reaching out to DHS via phone is a futile exercise, as many clients are left on hold for at least an hour. If not for Bread for the City’s rapport with DHS personnel, staffers wouldn’t be able to get direct contact with the agency to address clients’ questions, Plaut told The Informer.
“Delays are going on well past the 45-day timeline and recertifications that are submitted well in advance of a deadline are not processed correctly,” Plaut said. “We have cancer patients who are turned away from treatments and diabetics who are forced to start rationing their insulin. All the worst-case scenarios are happening with our patients.”
DHCF Answers Questions About Outreach Strategy
A DHCF spokesperson told The Informer that residents receive renewal packets at the address stored in the agency’s database. Residents, they added, then have the option of filling out the renewal and submitting it through the mail or dropping it off at a DHS service center.
They could also use District Direct, via desktop or mobile app.
DHCF manages and funds District Direct, a tool that was implemented in 2021. Once applications are submitted, DHS’ Economic Security Administration makes a determination of benefits eligibility.
The timeline for application completion varies based on eligibility group.
The DHCF spokesperson said that processing an application for those designated as “modified adjusted growth income,” or MAGI, takes 45 days. Members of that group receive a 60-day notice before renewal is due, along with a 30-day notice and another notice once renewal isn’t done.
Meanwhile, non-MAGI receive a 90-day notice with a complex renewal application.
Residents who don’t return their forms have a 90-day grace period after termination to return their renewal form, the spokesperson said. After 90 days, they would have to re-enroll for Medicaid coverage. Some Medicaid recipients, the spokesperson explained, receive passive, or automatic, renewal with the certification of their income and residency.
The number of people who meet that requirement varies by the month, the DCHF representative added.
When Medicaid redetermination started in April, the District had 311,000 people — nearly half of the District population — on the Medicaid rolls.
That amount represented an increase of more than 50,000 people who enrolled during the pandemic. Due to the automatic renewal that occurred throughout the public health emergency, they hadn’t been kicked off, despite some of them not meeting the eligibility requirements.
The DHCF spokesperson told The Informer that since last spring, 220,000 out of the 311,000 have been given renewal dates through December 2023. Out of that 220,000, 175,000 have coverage that are pending renewal or have been fully renewed.
Meanwhile, many of the 45,000 people remaining through December are expected not to be renewed, the spokesperson said, due to lack of eligibility or having left the District. By June, when Medicaid redetermination is expected to end, a great number of Medicaid enrollees would be up for their second renewal after the public health emergency ended.
In the months leading up to, and during, Medicaid redetermination, DHCF launched banner ads, conducted live discussions about redetermination, and sent reminders via vendor phone calls, text messages, and social media posts. The agency also participated in citywide events and since April has hosted 19 community meetings about medical renewal.
The District’s managed care plans — AmeriHealth Caritas District of Columbia, MedStar Family Choice DC, and Amerigroup DC — made similar efforts.
The spokesperson said that text messages reached 4,500 phones with more than half of those messages being retained and 78 enrollees asking for real-time assistance renewal assistance.
They acknowledged that, despite efforts to spread the word about Medicaid redetermination, the agency has had trouble reaching the housing insecure, those who possess a burner phone, those who used the address of a local shelter on their enrollment paperwork, and others who, for whatever reason, don’t want to be found.
Melisa Byrd, DHCF’s state Medicaid director, explained her agency’s strategy to overcome such hurdles.
“We’re working with our federally qualified health centers that are working with homeless folks,” Byrd said. “We’re working with some of the housing providers in the District as well, and connect with folks, person by person.”
Concerns Persist About District Direct
Throughout the Medicaid redetermination process, D.C. Council member Christina Henderson (I-At Large) has asked questions about the effectiveness of District Direct. Navigating the online application process, she said, is leaving Medicaid recipients in a state of limbo that threatens their coverage.
During a joint oversight roundtable that the Council Committee on Health and the Committee on Housing conducted in December, Henderson, chair of the Committee on Health, questioned DHS and DHCF officials about the causes of application processing delays and how they are rectifying them.
She later told The Informer that getting both agencies in the same room, to an extent, rectified discrepancies about processing gaps.
Henderson said she continues to hear from constituents whose benefits had been terminated while DHCF processes their Medicaid renewal paperwork. WIth what she estimated as 20,000 applications still pending, Henderson told The Informer that she worries if DHCF and DHS will be able to facilitate Medicaid redetermination without federal interference.
“I’m confident that DHCF doesn’t want D.C. to be in a position where the government needs to stop doing renewals because too many people are being kicked off the rolls who shouldn’t be kicked off,” Henderson said. “Deputy Mayor Turnage is monitoring it but I’m having concerns about the timely keep-up of applications that require attention.”
Byrd pushed back against the notion that DHCF didn’t process renewal applications in a timely fashion, calling delays in processing updates more of a “recent phenomenon” that occurred with the increase of renewals between June and December of last year.
The total number of renewals, she said, proved to be significantly higher due to automatic Social Security-based renewals.
Agency responses to the volume increase, Byrd told The Informer, included the hiring of 12 temporary staff members charged with scanning applications and supporting the DHS service center in other ways that don’t involve determining Medicaid eligibility.
She also mentioned how, during the latter part of last year, DHCF stopped the disenrollment of those designated as “modified adjusted gross income youth” and made a permanent fix that allowed children to go through passive renewal correctly.
Even with what she described as the learning curve that new enrollees and case workers initially experienced with electronic renewal, Byrd said that Medicaid redetermination has been, for the most part, a success in the District.
“It’s important to look at the totality of where we are with renewals,” Byrd said. “We’re in the top 10 [of jurisdictions in the U.S.] that renewed. We had times when we ran into challenges. Once we identify them, we let folks know about them. Making that quick action to fix it and make sure we’re addressing it is a complicated process.”
A Social Workers Asks for More Options
In December, Ashley Moore, a social worker at Bread for the City, testified at the D.C. Council’s Committee on Health and Committee on Housing’s performance oversight roundtable.
While Moore described District Direct as a “game-changer” for assisting people applying for benefits, she raised concerns about functionality.
Qualms included repetitive application questions that confused applicants about whether their application was completed, inconsistent recertification notifications and glitches in DHCF’s Medicaid portal, a lack of clarity around whether uploaded documents have been stored, and repeated requests for verification.
Moore also recounted case workers’ unsuccessful attempts to submit recertification applications before their Medicaid coverage was set to expire. In situations where they were able to successfully submit applications, the DHCF Medicaid portal didn’t provide explicit notice that materials had been processed.
Other hurdles include the lack of documentation, a receipt or otherwise, that confirms that someone submitted or completed their recertification in person. Many patients, Moore said, also find it difficult updating addresses on District Direct so that it’s correctly reflected across the board in other databases, including that of organizations that deliver care to Medicaid enrollees.
While Moore didn’t count District Direct out as a resource for Medicaid redetermination, she told The Informer that it shouldn’t be the end all, be all.
“It’s important to get that tool in people’s hands,” Moore said.
“You can connect on your account and see what DHCF sees. You can see your notices and when you have a recertification due. But it shouldn’t be a total replacement for in-person help,” she added. “We send people down to DHS but we have no idea of what happens because people don’t get receipts. They’re not being helped or they’re being redirected to District Direct.”