The Department of Health Care Finance (DHCF) is the state Medicaid agency for the District of Columbia and also administers the Healthcare Alliance program. If DHCF or its contractors deny specific medical services to persons receiving Medicaid or Healthcare Alliance benefits, that decision may be appealed to the Office of Administrative Hearings. In addition, if DHCF terminates a Medicaid service provider agreement or attempts to recoup overpayments from Medicaid service providers, the Medicaid service providers may appeal to the Office of Administrative Hearings.
The Department of Human Services is the government agency that makes decisions concerning eligibility for Medicaid.
Administrative law judges issue a written decision for every case that is contested. The decisions below are examples of some issues raised in Office of Administrative Hearings’ cases involving this agency. You can review these decisions to get a sense of how prior cases were decided.
Please note that the facts of each case are different. These cases should be used for informational purposes only.
- Jones v. Dep’t of Health Care Fin., May 17, 2012 (dismissing case because Petitioner was properly denied coverage for emergency medical services from out-of-network providers)
- V.B. v. Dep’t of Health Care Fin., May 25, 2012 (reversing agency termination of Petitioner’s home health care services under the Elderly and Individuals with Physical Disabilities Waiver Program)
Administrative law judges base their decisions upon many sources of law, chief among them the District of Columbia laws (DC Official Code) and the District of Columbia regulations (DCMR). Depending on the type of case, federal law (US Code) and federal regulations (CFR) may also be relevant. Cases decided on the issues in other courts, especially the District of Columbia Court of Appeals, are relevant.
- General—Blank Submission Form
- General—Certificate of Service (in English and en Español)
- General—Customer Survey Form
- General—Electronic Filing Cover Sheet
- General—Subpoena Form (sample only)
- General—Notice of Appearance for Lawyers
- General—Request for a Different Hearing Date (in English and en Español)
- General—Request to Participate by Telephone (in English and en Español)
- General—Request for Audio Recording of Hearing