Bread for the City attorney Allison Miles-Lee had the opportunity to testify at a Council roundtable hearing on the continued challenges with the DC Access System and public benefits enrollment. During her testimony, she highlighted critical issues that our patients and clients at Bread have been facing. Her full written testimony can be read below.

Testimony of Allison Miles-Lee, Bread for the City 

Council of the District of Columbia
Committee on Health 
Committee on Housing 
Public Joint Oversight Roundtable: Continued Challenges with the DC Access System and Public Benefits Enrollment

July 2, 2024

Watch Allison’s live testimony here.

My name is Allison Miles-Lee, and I am a Managing Attorney at Bread for the City, a non-profit organization located in Southeast and Northwest DC. Most of our clients and medical patients rely on the DC Department of Human Services (DHS) for critical public benefit programs such as Medicaid, Food Stamps (SNAP), TANF, and DC Healthcare Alliance. 

Bread for the City’s Legal Clinic runs a public benefits practice. We advocate for clients who are not receiving the public benefits to which they are legally entitled. Bread for the City is also a Federally Qualified Health Center (FQHC). In addition to primary care and dental services, we help eligible patients apply for public health insurance programs.  Our care management team, located within our medical clinic, helps patients troubleshoot problems with their DHS benefits programs and has extensive experience navigating the DC Access System (DCAS).

Members of our legal and medical clinics have been testifying about DHS before this Council for many years.  Almost three years ago, DHS and the Department of Health Care Finance (DHCF) rolled out the new District Direct portal through DCAS. Since that time, Bread for the City and other advocates have repeatedly sounded alarms about system breakdowns, both with DCAS and with DHS operations. 

I thank Councilmembers Robert White, Jr. and Christina Henderson for convening this roundtable. Since the last DCAS roundtable in December 2023, we have seen many of the same problems continue, and since then, there has been a further breakdown of DHS operations. Although the District provides residents with many services and support, DHS’s complexity and red tape require legal or social work support to apply for, access, or appeal a denial of services. Complexity and administrative finger-pointing do not make access for District residents any easier. DHS and its sibling agencies must improve customer service, become efficient, and work together to better serve District residents. 

When we testified in 2023, we raised concerns about technical problems that customers experienced when accessing District Direct, including requests for unnecessary or duplicative documents and glitches that prevented people from completing applications and recertifications online. These issues persist. Back in 2023, we were concerned about unrepresented customers who would not be able to resolve problems on their own without a lawyer or other advocate, but at that time, advocates enjoyed a relationship with DHS that allowed us to resolve individual customer issues in a timely way. Now, that system has become strained. More and more often, advocates are told by DHS staff to file a fair hearing request with the Office of Administrative Hearings (OAH) in order to get an undisputed issue resolved. 

Here is what the system looks like for us now: a client reaches out to an advocate when there is a problem with their benefits. The advocate is able to access the client’s District Direct account and confirm that an error occurred, for instance an application was not processed in time or a client’s benefits were terminated with no advance notice. The advocate then downloads the documents and screenshots that show the error and sends an e-mail to our contacts at DHS explaining the situation. Often, the advocate will send a number of follow-up emails to DHS without receiving any response. 

If the issue relates to Medicaid or Alliance health insurance, the advocate will e-mail a contact at DHCF. The DHCF contacts do respond promptly but say they are stuck trying to follow up with DHS, which is the entry point for applications and recertifications. When these health insurance eligibility issues persist for weeks and months at a time, it means people with cancer are forced to go without treatments, people with diabetes are forced to ration insulin, and people with vision or hearing problems are forced to slowly go blind and deaf. 

During this limbo period of waiting for informal resolution, DHS sometimes tells the advocate to file a fair hearing request, or the advocate may just go ahead and take that step on their own.  OAH is experiencing a backlog of public benefits cases, and it may be a month or more before a hearing is scheduled at OAH. Sometimes an Administrative Review Conference (ARC) is scheduled with DHS in advance of the initial fair hearing, other times it is scheduled after the first hearing date. At the ARC, the DHS hearings examiners often try to resolve the issue but appear to get stuck on what they call “remand.” At the first hearing before a judge at OAH, a DHS policy analyst appears, and that person generally has not reviewed the case at all and has not communicated with the ARC hearing examiner. This leads to a continuance, pushing the matter out even further. Advocates and their clients may have a number of additional hearings before the matter is finally resolved, all by agreement. 

Time and time again, our clients must endure lengthy processing delays and the protracted resolution of matters that are not substantively in dispute, just because of system errors, technical glitches within District Direct, and disorganized administrative handling of client concerns by DHS.

In one particularly egregious case, a client, who we will call Ms. K, stepped in to provide a home for her teenage niece and nephew in November 2022 after her sister suddenly passed away. She was already caring for two children of her own who received DHS public benefits. Ms. K sought to add her niece and nephew to her benefits household as soon as they came to live with her. She encountered numerous roadblocks with DHS, though, and the children were never added. Ms. K finally came to our legal clinic for help in 2024. When Ms. K began working with us, she had already attempted to add the children to her household at least five times, but no changes had been made. Ms. K never received any notices about why DHS was not adding the children to her benefits household. 

Even once she was connected to legal assistance, it took an additional four months for Ms. K’s niece and nephew to be added to her case, meaning that 18 months passed between the time of her initial report of a change of circumstances and the actual processing of this change. This included more than two months of efforts by her advocate and a fair hearing at OAH before our client received the uncontested back benefits owed to her. Ms. K ultimately received more than $11,000 in back-TANF and SNAP for her niece and nephew: resources that were not available to her at the time she was actually providing the care for them. Unfortunately, this case is closer to the norm than the exception for families with non-traditional family structures attempting to use District Direct to add members to their household.

Ms. K shared that when you have a family, you stretch out your resources and you make it work. It is hard to do this, though, when you are receiving benefits for a family with two children when you are really a family with four children, and there were three months in the winter when she had no resources to stretch out. 

Going to OAH to resolve undisputed District Direct issues is not an appropriate use of that tribunal. OAH judges are tasked with resolving disputes between a government agency and a customer, not with babysitting a case or pressuring DHS to do what it agrees it needs to do. There is one benefit to clients whose matters languish at OAH: in a number of our cases related to SNAP and TANF, OAH judges have sanctioned DHS for the unduly long time it has taken the agency to provide these acknowledged benefits. However, we would much rather see these clear issues resolved in advance of the hearing process. After all, OAH-imposed financial sanctions cannot appropriately compensate a client who learns of a cancer diagnosis months later than they could have after being forced to forgo medical appointments because of an error with their health insurance coverage that DHS did not resolve.

This testimony is not intended as a criticism of specific DHS employees. However, well-meaning and very competent DHS staff in high-level administrative, hearing review, and policy analyst positions are spending far too much time dealing with issues that should be easily resolved. We are very concerned about DC residents who are not working with a lawyer or other advocate to resolve their issues with DHS public benefits. People who need services should not have to find legal or social work support for access, applications, and appeals. DHS must improve its systems and intergovernmental coordination. Before the Council considers the budget for Fiscal Year 2026, there must be measurable progress made toward efficiency. 

Watch Allison’s live testimony here.