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Medicaid or QMB Application and Renewal Court Order

posted Sep 29, 2016, 11:07 AM by DC Behavioral Health Association

From our friends at DC Fiscal Policy Institute, an update on Medicaid and QMB applications and Salazar v. District of Columbia. Please read and share as you see fit.



Hi all,

 

DCFPI is working with a group of Medicaid advocates to promote a new court-ordered relief for individuals who are having trouble applying for or renewing their Medicaid coverage. If you or anyone in your network works with Medicaid clients, we’d greatly appreciate it if you could share the information below and the attached materials. Thank you for your help!

 

 

Do you work with clients who are having trouble applying for or renewing their Medicaid coverage?  If so, you can help them using new court-ordered relief. 

 

Background:

In July, a federal judge in the long-running case of Salazar v. District of Columbia ordered the District to make two crucial safeguards available to residents facing delays in Medicaid application and renewal processing:

(1)Certain Medicaid applicants must be granted provisional coverage while their application is pending:

·         Who:

o   Anyone who is applying for Medicaid or QMB who does not need a disability determination AND

o   Has a good-faith claim that their Medicaid or QMB application has not been acted upon within 45 days

·         Relief available:

o   The District must grant coverage until a decision is made on the application and notice is provided to the applicant of the decision.

 

(2)Certain Medicaid beneficiaries who are trying to renew their coverage must have their coverage re-activated even after it has been cut off:

·         Who:

o   Medicaid or QMB beneficiaries who have been (or are about to be) terminated because the District says they have not submitted their renewal form or supporting documents AND

o   Have a good-faith claim that they either:

§  Did not get advance written notice of the need to renew or of the impending termination of their benefits OR

§  Already submitted the renewal form and supporting documents

·         Relief available:

o   The District must reactivate coverage and continue coverage until a decision is made on the renewal and notice is provided to the beneficiary.

 

What you can do:

(1)  Post the attached flyers (in English and Spanish) in your waiting rooms or public areas; and

 

(2)  If you encounter clients who fall into the categories described above, please:

·         Complete the attached referral form to refer the case to the Legal Aid Society of DC or Terris, Pravlik, & Mililan, LLP;

·         Have the client complete the attached “Salazar Application Relief Form” or “Salazar Renewal Relief Form,” depending on the nature of the problem;

·         Have the client complete the attached DHS release form; and

·         Send all these materials to either the Legal Aid Society of DC (csharon@legalaiddc.org) or Terris, Pravlik, & Millian, LLP (zsanchez@tpmlaw.com)

If you have any questions or want to see if a client would be appropriate to refer, please feel free to contact Chelsea Sharon (csharon@legalaiddc.org) or Zenia Sanchez Fuentes (zsanchez@tpmlaw.com).

 

 

 

Jodi Kwarciany

Health Policy Analyst

DC Fiscal Policy Institute

Office: (202) 325-8753

dcfpi.org | jKwarciany@dcfpi.org

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DC Behavioral Health Association,
Sep 29, 2016, 11:07 AM
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DC Behavioral Health Association,
Sep 29, 2016, 11:07 AM
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DC Behavioral Health Association,
Sep 29, 2016, 11:07 AM
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DC Behavioral Health Association,
Sep 29, 2016, 11:07 AM
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DC Behavioral Health Association,
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