Hospital IV stand
Credit: Darrow Montgomery

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Santos Ventura was well aware her health insurance was set to expire Oct. 31, and she was on top of it. She went to the Department of Human Services office on H Street NE on Sept. 5 to drop off the necessary paperwork for her and her husband: pay stubs, copies of their identification, and a utility bill.

Santos, who spoke with Loose Lips through an interpreter, and her husband receive health insurance through the DC Healthcare Alliance, a locally funded program that insures more than 15,000 low-income people, mostly immigrants, who don’t qualify for Medicaid. The program is unique among public insurance programs in D.C. in that it requires enrollees to reapply twice a year. The D.C. Council considered, but ultimately failed to remove the arduous requirement during last year’s budget cycle.

For nearly two months, Ventura waited without a word from DHS. Then on Oct. 31, she received a call telling her that her health insurance had been terminated. She showed up at the DHS offices again Nov. 2 to submit application materials for a second time. She says DHS employees could not explain why the materials she submitted the first time were insufficient.

“When I went to the [DHS Economic Security Resource] center the rep told me, ‘Oh we just saw your documents here,'” Ventura says. “So I asked, ‘How is it possible it has not been renewed at this point?’ And she didn’t give any response.”

Ventura says the DHS rep told her that her insurance likely would not be reinstated until Nov. 19, which presented a significant problem. She is diabetic and had a doctor’s appointment Nov. 6. The rep was unable to help Ventura, and her doctor’s office canceled her appointment, she says, because she didn’t have any insurance.

Ventura is not alone. About 7,000 Alliance enrollees who needed to reapply for their health care by Oct. 31 were terminated, according to an email from Deputy Mayor for Health and Human Services Wayne Turnage, which was shared with LL.

Turnage writes in a separate email to LL that DHS “has a backlog of recertifications as well as applications for other benefit programs. Work is underway to alleviate the problem.”

Turnage says the people whose health care coverage was terminated have been reinstated (except those who DHS determined were “not eligible”), and DHS will not terminate Alliance members “until the backlog problem is appropriately addressed.”

Legal aid providers who help Alliance enrollees cut through the bureaucratic red tape say their clients have run into several issues applying as new enrollees and for recertification.

Lucy Artiga Gallegos, who works for the LGBTQ social services organization Casa Ruby, recalls one pregnant client who tried to apply for three months.

“I think this is the third time she’s applied,” Artiga Gallegos says. “The last time, I applied for her, and we’re still waiting for an answer. She has all the papers in order that they’re supposed to have. She has sent everything. And they haven’t sent any letter. Nothing.”

Allison Miles-Lee, a managing attorney at Bread for the City, describes a confusing process for people she’s tried to help recertify. Those who submit their application materials in person, like Ventura did, don’t get a receipt or confirmation number. The documents are simply left in a drop box, and there’s no way to ensure they make it into the right hands.

People who submit materials through the web portal do receive a confirmation number, Miles-Lee says, but after they click submit, the portal says “you may need to submit additional documents. But it doesn’t tell you what those documents are,” she adds.

Miles-Lee and other legal aid providers say DHS has told applicants that they have no record of their materials after they’ve submitted them.

Damon King, director of policy and advocacy for the Legal Aid Society of D.C., says recertification notices are being mailed in English to Spanish-speaking enrollees. He says some notices were sent to enrollees’ old addresses even after they alerted DHS that they’ve moved during the pandemic. He’s also seen “false alarm” notices to recertify and notices with conflicting information, which adds to the already confusing process.

“There are two issues here,” King says. “One is transitioning out of COVID protections in an orderly way that doesn’t harm people, and the second is the Alliance population that has had to deal with years of being treated differently even when compared to folks in other public benefits programs.”

King notes that the D.C. government had the opportunity to end twice annual recertifications.

“It’s incredibly frustrating,” he says. “It’s unjust and it implicates people’s health care in a time when access to health care is fundamental for everybody.”

As of today, Ventura’s coverage has been restored, according to Veronica Hernandez, a supervisor for the bilingual health access program at Mary’s Center. But Hernandez says the system that pharmacies and doctors use to verify eligibility had not been updated as of yesterday afternoon.

She says Ventura went to the pharmacy yesterday but was denied her medication because the recertification date wasn’t updated.

“The pharmacy told her that her medical coverage was not active,” Hernandez says. “I checked other cases and [they are] in the same situation.”