Bread for the City attorney Allison Miles-Lee had the opportunity to testify at a Council roundtable hearing on the DC Access System, the platform used for public benefits and medical insurance application and processing, and the operations of DHS/DHCF. During her testimony, she highlighted several 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
Performance Oversight Roundtable: Health and Human Services Benefits Enrollment and the DC Access System

December 3, 2023

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. Bread for the City provides food, clothing, medical, legal and social services to thousands of low-income District residents each year. 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. We are often able to resolve clients’ concerns informally, utilizing our contacts at DHS. If that is not successful, our attorneys and non-attorney staff represent clients in public benefits matters before the Office of Administrative Hearings (OAH).

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 patient 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. Two 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. These problems with District Direct and DHS operations have been well documented and reported.

I thank Councilmembers Robert White, Jr. and Christina Henderson for convening this roundtable, and I appreciate the opportunity to attend along with DHS and DHCF. I hope that we can have a candid discussion about what support the agencies need from the Council to remedy existing problems, how advocates can help people better navigate these systems, and what the path forward looks like so that we aren’t repeating ourselves year after year at oversight hearings.

Earlier this year, advocates met with Councilmember White’s office and representatives from DHS to start this conversation. Following that meeting, we sent a list of questions to DHS through Councilmember White. I would like to focus today on DHS’s responses and where advocates still feel that matters are unresolved.

First, advocates asked how DHS is addressing technical issues that customers encounter with District Direct, such as the inability to process changes of circumstances or unnecessary or repetitive document verification requests. DHS just responded that the “DCAS team provides system updates to fix outstanding issues or to enhance functionality.” We were disappointed in this response, as we were hoping to hear that DHS had a plan in place, including a timeline, to resolve technical issues with District Direct that customers and advocates have reported. DHS specifically responded that document verification requests seem repetitive, but are actually the result of a client applying for multiple programs at once. We maintain that document verification requests in District Direct are often both repetitive and unnecessary. For instance, we regularly see “SSN” verification requests for people who are not claiming to be citizens, such as Alliance applicants. Some people see five or six of these SSN requests, and each application is apparently not processed until the system receives all of the requested verifications. Clients also often see verification requests for things like “MEDICAL INSURANCE” for SNAP applications.

When advocates asked what specific actions DHS is taking to resolve technical issues that advocates have already raised with the agency, DHS focused instead on system features that are already in place, not problems that advocates raised. For instance, DHS stated that customers now have the ability to complete a SNAP recertification during the 30-day grace period, which we understood was always a function of District Direct since its inception, once SNAP recertifications resumed. On the other hand, some of the system issues that we did raise have not been resolved or addressed. When we brought up that the password reset process is not always functional, DHS responded that it is because clients are not checking their spam folders. That is not the issue. When we raised that the system often asks people for verification of something called “STATE,” we learned that DHS means proof of DC residency, but this is not something that individuals will understand, and continues to be a verification request that clients see.

Advocates asked DHS who is responsible for creating District Direct and resolving issues with the portal. DHS responded that it is DHCF that is “fully responsible for oversight and management.” Our understanding is that DHS has an obligation as the state agency responsible for determining eligibility and administering federal public benefits. This responsibility cannot be totally shifted onto the Department of Health Care Finance, even if that agency may control DCAS.

We asked DHS whether the agency is complying with federal law requiring applicants to be able to submit applications with basic information only and with the requirement to allow customers to retain a copy of their completed application. DHS responded that the agency is in compliance, accepting these applications, and said that it is “always able to provide either a photocopy, e-copy or printout” of customers’ completed applications. This has not been the observation of advocates. Our clients routinely submit applications in person at DHS service centers and find that their applications were never processed or even entered in the system. Likewise, our clients are unable to get any receipts from DHS to prove that they have submitted an application, much less a copy of their completed application.

Finally, advocates asked DHS what the agency is doing to comply with OAH orders. The response was: “DHS has corrected the customers’ public assistance benefits in all cases in which it has determined the benefits were incorrect or in which OAH has ordered the Agency to do so.” This is true, eventually. But it should not take filing a fair hearing request, attending an administrative review conference and appearing in front of an OAH judge before DHS provides undisputed benefits owed to a customer. In a number of our cases, OAH judges have sanctioned DHS for the long time it has taken the agency to provide undisputed benefits. In some cases, the agency has been fined yet again for failure to timely pay the original sanction. This approach to resolving client matters is a terrible waste of time and resources for customers, the agency, advocates, and OAH judges whose calendars are already full of matters that are actually in dispute.

We are very concerned about DC residents that are not working with a lawyer or other advocate to resolve their issues with DHS public benefits. Our legal clinic and care management team has had success sending batches of problems for resolution, and we have also had success following up on individual problems. But our concerns over larger system problems remain.

It is critical that DHS, and to some extent DHCF, improve the DCAS and in-person infrastructure to support customers who cannot navigate District Direct at all on their own, or who are running into system glitches during the recertification or application process. As things stand now, we have nowhere to send people who are struggling. As I mentioned before, we do not recommend that people go to DHS in person to drop off applications or materials. Their materials are likely to be lost, and they will not encounter any DHS staff members that are able to do anything other than accept completed paperwork. Clients have reported calling the DHS call center and waiting for more than three hours before the call cuts out.1 Recipients who request fair hearings on their own face a time consuming process and may not know how to push forward when DHS Policy Analysts request continuances and fail to provide undisputed benefits owed.

Organizations like Bread for the City are available to help clients with problems at DHS, but we are constantly at capacity. Our legal clinic staff would be better used helping people with substantive disagreements at DHS rather than system glitches and processing problems. Likewise, 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. This system cannot continue as-is, and we look forward to working with the agency toward solutions.