WASHINGTON (CN) - D.C. must correct Medicaid problems related to President Barack Obama's health care law that keep poor children from getting medical services they deserve, a federal judge ruled in a decades-old case.
The underlying settlement stems from a 1993 federal lawsuit alleging the District of Columbia made several statutory and constitutional violations in its handling of Medicaid cases, including those involving "much-needed benefits for children and low income adults," according to court records.
U.S. District Judge Gladys Kessler ruled in 1996 that D.C. had violated several provisions of the federal Medicaid statute. The parties agreed to a settlement in 1999 outlining "the District's obligations to remedy these violations," court records show.
After years of appeals by the city, the plaintiffs - led by Oscar Salazar - asked for more than $1.2 million in attorneys' fees for work performed from 2010 through 2012.
Though the district requested an overall 20 percent reduction to the plaintiffs' request, Kessler in 2014 made a series of specific reductions, typically 20 or 35 percent. The judge sliced the co-counsel fees down to 50 percent of what was requested.
The next year, the plaintiffs moved to preliminarily enjoin D.C. from its methods of altering its Medicaid program to comply with the Affordable Care Act (ACA) of 2010, Obama's signature health care law.
The plaintiffs then moved to permanently modify the settlement on Feb. 9 of this year.
Kessler granted the motion to modify Monday, finding that "there is no question that many of the class members are being irreparably harmed by their inability to obtain Medicaid benefits, even though the District is acting with the best of intentions to comply with the ACA."
D.C. has failed to timely process initial applications, deliver adequate and timely renewal notices, and efficiently process renewal requests, the 59-page ruling states.
"Plaintiffs have identified severe technical and logistical problems in the processing of initial Medicaid applications and in the Medicaid benefits renewal process," Kessler wrote.
The issues "have affected thousands of Medicaid beneficiaries and have deprived many District residents of necessary medical care to which they are entitled," Kessler added.
The problems include "severe backlogs in the processing of Medicaid applications, delays in the Medicaid renewal process, and a number of computer glitches caused by ACA-related changes to the District's administration of the Medicaid program," the ruling states.
The District has not done enough since December - when there were still close to 5,000 Medicaid applications in the backlog - to remedy the situation, the judge ruled.
Since then, "the District has been able to resolve all of the thousands of remaining cases in just over one month's time," Kessler wrote. "While the district's progress is commendable, the timing of it suggests that court oversight has been a boon rather than a hindrance. Moreover, the court has no assurance that the significant problems (and violations of the law) that arose will not arise again." (Parentheses in original.)
Kessler ordered D.C. to provisionally approve all Medicaid applications pending over 45 days - the amount required by law to make a final determination - noting that the District reported in August 2015 that there were 5,263 applications pending more than 45 days.
But the judge refused to order the District to continue the eligibility of all Medicaid recipients due to have their Medicaid benefits renewed or recertified.
"Although the situation faced by many beneficiaries due to renew their benefits is indeed dire, that does not justify obligating the district to indefinitely continue the Medicaid benefits of individuals who may no longer be eligible to receive them," Kessler wrote.
The D.C. Federal Court instead ordered the District to prolong these beneficiaries' eligibility for 90 days after their renewal or recertification deadline, unless they are found no longer eligible.
One of the plaintiffs' attorneys, Zenia Sanchez with D.C.-based Terris, Pravlik & Millian, said they are "very pleased with the court's thoughtful and balanced opinion recognizing that systemic problems exist within the District of Columbia's Medicaid program."
"This decision will have a dramatic impact on the lives of thousands of Medicaid applicants and beneficiaries in the District of Columbia, many of whom were unable to access needed health care and medications through no fault of their own," Sanchez wrote.
D.C. Attorney General's Office spokesman Robert Marus declined to comment on the ruling, but said the city is reviewing the opinion.
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