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Office of Administrative Hearings

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In-Home Health Services

The D.C. Medicaid Program and the Elderly and Persons with Disabilities (EPD) Waiver Program provide in-home health services for qualified beneficiaries. These services may include Personal Care Aide (PCA) services to assist a beneficiary with activities of daily living, such as eating, dressing, bathing, using the bathroom, and moving around.

To receive in-home health services, a person must satisfy a financial eligibility determination and a level of care determination. Different D.C. agencies make these determinations.

  • The Department of Human Services (DHS) determines a person’s financial eligibility for the Medicaid and the EPD Waiver programs based on the person’s income and resources.
  • The Department of Health Care Finance (DHCF) determines whether a person meets the level of care for in-home health services under Medicaid or the EPD Waiver program and, if so, what services the person may receive. DHCF’s determination is based on a face-to-face level of care assessment, which is completed by the District’s Long Term Care Services and Supports (LTCSS) Contractor, Liberty Healthcare. Based on the assessment score, DHCF may qualify a Medicaid beneficiary for up to 8 hours of PCA services per day. If a beneficiary’s score reaches the level of care required for a nursing facility, then DHCF may qualify the beneficiary for the EPD Waiver Program, which has a higher income cap and allows for more than 8 hours of PCA services per day.

In other words, DHS only determines financial eligibility for the Medicaid and EPD Waiver programs, but DHCF administers the programs for qualified beneficiaries and determines the home health services a person may receive based on the person’s individual need.

If you disagree with a decision, action, or inaction from DHS or DHCF regarding Medicaid or EPD Waiver home health eligibility or services, you have the right to a hearing at the D.C. Office of Administrative Hearings (OAH). If you disagree with a DHCF decision to deny, terminate, or reduce in-home health services, you also have the right to have DHCF reconsider its decision.

This page can help you learn more about Medicaid and EPD Waiver home health services and the OAH hearing process. This page does not give legal advice. You can only get legal advice from a lawyer. If you are trying to find a lawyer, click on the “I need more help” tab below for information on who you can contact.

Also, OAH tries to keep information on this page up to date, but laws and procedures sometimes change. You should refer to agency notices, OAH orders, and official sources of laws and rules for the most current information and requirements regarding your case.

What are my options if I disagree with a decision from DHCF to deny, terminate, or reduce my home health services?

DHCF’s decision to deny, terminate, or reduce your services is generally based on an assessment of your need for assistance. If you disagree with DHCF’s determination, based on the assessment, you may request that DHCF reconsider its determination based on additional documentation (such as a letter from your doctor) showing your assistance needs. You may also file a hearing request with OAH to have an OAH judge hear the case and determine whether DHCF made a correct determination based on the facts and the relevant legal standards.

DHCF Reconsideration:

For this option, you must send a written request to DHCF’s Office of the Senior Deputy Director/Medicaid Director, asking the agency to reconsider its decision. You must make your request within 21 days of the date of the initial determination letter. If you are currently receiving services, you will continue to receive the same level of services while DHCF reconsiders its decision.

Overall, the DHCF reconsideration process gives you the opportunity to give DHCF more statements and medical documentation to show that you need more in-home care. Please refer to the DHCF’s determination letter for instructions on what your reconsideration request must include and where to send your request.

OAH Fair Hearing:

You can file a hearing request with OAH when you receive DHCF’s initial determination letter, or you can file a hearing request after DHCF’s reconsideration process. You have 90 days from the date of DHCF’s determination or reconsideration letter to request a hearing with OAH. But if you are currently receiving services and want to keep the same level of service pending the outcome of the OAH hearing process, you must file your hearing request with OAH before the date of DHCF’s proposed reduction or termination of services, which is usually sooner than the 90-day deadline. If you file your hearing request before the reduction or termination of services goes into effect, then DHCF cannot reduce or terminate the services before the OAH judge makes a final decision.

If you file a hearing request with OAH after DHCF’s reconsideration process, the OAH judge, when making a final decision, may consider information and documents available to DHCF at the time of the initial decision and the additional statements and medical documents provided as part of the reconsideration process. If you skip DHCF’s reconsideration process and request an OAH hearing instead, you may still offer existing medical records as evidence and ask your doctor to testify at your hearing. Click the “How do I prepare for a hearing” tab below for more information about preparing evidence for a hearing.

How do I request a hearing with OAH?

You can request a hearing in writing, in person, or by phone.

To request a hearing by phone, call OAH at (202) 442-9094. From the main menu, press “3” for a case filing, and then press “3” again on the next menu for public benefits. OAH staff can help you complete your hearing request over the phone.

To request a hearing in writing, you can use one of these forms, depending on the reason for the hearing request:

Please include with the form a copy of any notice you received from DHS or DHCF, if you are able.

Visit the Filings & Forms page for instructions on how you can file a written hearing request and instructions on how to find OAH if you would like to file a request in person.

OAH Rules 2971 and 2808 have more information about hearing requests.

What are the OAH Rules and where can I find them?

The OAH Rules explain all the steps required to complete the OAH hearing process, from requesting a hearing to appealing a judge’s final decision. You can find the OAH Rules on the Rules & Laws page. You must follow the OAH Rules throughout the process.

Chapter 29 has rules for specific case types, including Public Benefits cases. So, you should start in Chapter 29 when looking for rules that apply to a Medicaid or EPD Waiver case. Specifically, Public Benefits cases, including Medicaid and EPD Waiver, are covered by Rules 2970 through 2978. If a Chapter 29 rule does not have the information you are looking for, you should then look at the Chapter 28 rules, most of which broadly cover all case types at OAH. Chapter 29 rules sometimes refer to the related Chapter 28 rule to give you some guidance. Both Chapters also have a table of contents with section headings that can help guide you to the information you need.

Where can I find laws and regulations that apply to my case?

DHCF’s regulations are often the most relevant source of legal authority in many Medicaid and EPD Waiver home health cases, since DHCF is the agency that directly administers the Medicaid and EPD Waiver programs in D.C. However, Medicaid is a joint federal and state program, so federal laws and regulations may apply. This section gives a brief overview of each level of legal authority. But every case has its own facts and circumstances, so some cases may involve laws and regulations that are not included here.

The U.S. Congress created the Medicaid program through Title XIX of the Social Security Act. You can find these federal laws in Title 42, Chapter 7, Subchapter XIX of the U.S. Code (USC). With these laws, Congress gave authority to the Centers for Medicare and Medicaid Services (CMS), a federal agency within the U.S. Department of Health and Human Services (HHS), to work with states to administer states’ Medicaid programs. CMS passes regulations and guidance that states must follow. You can find CMS regulations in Title 42, Chapter IV of the Code of Federal Regulations (CFR). You can also visit the CMS website for more information about CMS regulations and guidance.

Federal laws and regulations give broad requirements regarding how states, including D.C., must administer Medicaid programs, but each state determines most of the specifics of its program. For example, as stated in CMS regulations: “Within broad Federal rules, each State decides eligible groups, types and range of services, payment levels for services, and administrative and operating procedures.” 42 CFR § 430.0.

Federal laws and regulations also give states the flexibility to create programs that target the needs of specific groups. For example, states can create home and community-based services (HCBS) waiver programs which target those in need of long-term care but prefer to receive care in their home or community rather than in an institutional setting, like a nursing home. These programs are called “waiver” programs because they allow states to waive certain broad Medicaid requirements, giving states flexibility to create targeted and innovative programs.

At the state level, each state, which includes D.C., must have a Medicaid “state plan” approved by CMS. The state plan is a formal agreement between the state and the federal government that allows a state to receive federal funding so long as the state agrees to follow federal laws and regulations. Among other things, the state plan designates the state agency to administer the program and specifies the scope of the state’s Medicaid program and the standards and processes for administering the program. Waiver programs are not included in the state plan, but a state must explain a waiver program in a “waiver application,” which must also be approved by CMS. You can find the D.C. Medicaid State Plan and waiver applications on DHCF’s website.

Once CMS approves a state plan or waiver application, a state’s Medicaid agency may then administer the program, which includes making regulations that establish legal standards for eligibility and scope of services. DHCF’s regulations for the Medicaid program and EPD Waiver program are in Title 29 of the D.C. Municipal Regulations (DCMR). These regulations have specific standards and requirements that apply to most Medicaid and EPD Waiver home health cases at OAH.

Specifically, regulations for the D.C. Medicaid program are in Title 29, Chapter 9, which includes sections that cover various Medicaid topics. For example, Section 989 covers the long-term care services and supports (LTCSS) assessment process. For both Medicaid and the EPD Waiver, DHCF uses this assessment process to determine whether someone is eligible for PCA services and, if so, how many hours of services a beneficiary may receive.

Other Title 29 chapters may also apply, depending on the issues in a case. For example, Chapter 50 covers Medicaid reimbursement for PCA services; Chapter 42 covers the EPD Waiver Program more broadly; and Chapter 98 covers financial eligibility for long-term care services. Each title, chapter, and section of the DCMR has a general heading that summarizes that portion of the regulations. These headings can help guide you to sections that apply to the issues in your case.

Other resources are also available to help you learn more about laws and regulations. For example, you can look at DHS’s policy manual for more information about how DHS processes applications and determines financial eligibility for medical assistance programs. An agency’s policies are not law, but they can help explain how an agency applies laws and regulations. DHCF also has helpful guides, such as the EPD Waiver Participant Handbook. You can visit DHCF’s website and the D.C. Medicaid website for more information.

The language in the laws and regulations is often dense and technical, and understanding lengthy and detailed regulations can be complicated. For further assistance, you can also click on the “I need more help” tab below for additional resources and information about who you can contact for help.

How do I prepare for a hearing?

After you file a hearing request, generally the next step of the process will be explained in a “scheduling order” that OAH will send you by mail, and by email if you provide an email address.

For public benefits cases, the judge generally first schedules a “status hearing,” also called a “status conference.” The purpose of a status hearing is for the judge to meet with the parties to generally talk about the issues in the case and next steps. Some cases may require more than one status hearing. The scheduling order will explain the purpose of a status hearing, but there often is not much preparation needed for a status hearing.

If needed, the case will then be scheduled for an “evidentiary hearing.” The purpose of the evidentiary hearing is for each side to give “evidence” to support their side of the case. The scheduling order for an evidentiary hearing will have specific instructions, but hearing preparation generally involves each side collecting the information they want the judge to know and planning how to present the information during the hearing.

Information you present during a hearing is called “evidence.” There are two broad categories of evidence:

  • Verbal testimony (what you and other witnesses say at the hearing)
  • Documents, photographs, or other physical items

For testimony, you can practice telling your side of the story before the hearing. If you have witnesses that will testify on your behalf, you can ask your witnesses to practice their testimony as well. Practicing your testimony can help make sure you and your witnesses don’t accidentally leave out important information and can help you feel more comfortable on the day of the hearing.

If a witness won’t agree to come to a hearing voluntarily, you can ask the judge for a “subpoena.” A subpoena is a court order that requires someone to come to a hearing and testify. For example, a subpoena can be used to require a doctor to come to a hearing and testify about your assistance needs. Visit the Subpoena Request page, under “Filings & Forms,” for more information about the subpoena process.

Documents, photographs, or other items you plan to use to support your case are called “exhibits.” You should collect all your exhibits before the hearing so that you can file a copy of the exhibit with OAH and “serve” a copy on the agency by the deadline given in the scheduling order. “Serving” means delivering, mailing, or faxing a copy of the exhibit to the other party in a case. You can also serve exhibits by email if you and the agency have agreed in writing to allow service by email. You can find the contact information for the DHS or DHCF at the end of your scheduling order, on the page called “Certificate of Service.”

If you know that an agency or a person or organization related to your case has important documents about the facts in the case, but they will not give you copies of the documents, you can ask the judge for a “subpoena” that will require them to do so. Besides requiring someone to testify at hearing, a subpoena can also be used to require someone to share documents. You can also ask the judge to allow “discovery.” Discovery is the formal process of getting information from an opposing party. Discovery generally is not needed or permitted in most OAH hearings, but it may be an option if you have a good reason. Visit the Subpoena Request and Discovery Request pages, under “Filings & Forms,” for more information about these processes.

Also, as you prepare exhibits, keep in mind that OAH is a separate agency from DHS and DHCF. This means that OAH does not automatically have copies of DHS’s or DHCF's notices or records. To use those documents at the hearing, you still need to file copies with OAH.

You should also keep in mind that properly filing and serving an exhibit does not automatically mean that the judge can rely on the information in the exhibit when making a decision. Instead, you need to be prepared to introduce the exhibit during your testimony or a witness’s testimony. In other words, you or a witness will need to describe the item and may need to answer questions about it, so that the judge can be satisfied that the item is relevant to the case and is reliable. After you or a witness describe an exhibit and answer any questions from the judge or the other party, you can then ask the judge to admit the exhibit into evidence. If the judge allows the exhibit into evidence, you can then refer to the item in detail during your testimony, and the judge can rely on the item when making a decision. You need to be prepared for this process for each individual exhibit. It is a good idea to bring a list of all the exhibits you plan to use during the hearing, so you can keep track of what you have talked about and whether the judge has accepted the exhibit into evidence.

Lastly, you should have copies of all exhibits, both your own and the other party’s, when you come to your hearing. Even if your hearing is in person at OAH, OAH does not provide copies of the exhibits for the parties. Each party needs to bring their own copies.

Here are some of the common OAH Rules that apply to hearing preparation: Rule 2809 (Filing of Papers); Rule 2811 (How to Serve a Paper); Rule 2812 (Calculating Deadlines); Rule 2813 (Motions Procedure); Rule 2821 (Hearings and Evidence). Other rules may apply, so it is a good idea to familiarize yourself with the OAH Rules’ table of contents so that you know where to go to look for particular requirements. The OAH Rules are on the Rules & Laws page.

How do I send documents or other exhibits I want to use for my case?

All exhibits must be filed with OAH and served on the other party.

You can file exhibits with OAH in person; by mail, email, or fax; or through the OAH E-Filing Portal. Visit the Filings & Forms page for specific filing instructions.

Serving” means delivering, mailing, or faxing copies of your exhibits to the other party. If the other party has agreed in writing, you may also send exhibits by email.

Each party must file and serve exhibits by the deadline given in the scheduling order to make sure both sides have opportunity to review all the documents and other items the other side intends to use to support their case.

If you do not know the contact information for the other party, look at the “Certificate of Service” at the end of the scheduling order you receive from OAH. The Certificate of Service lists the contact information for each party.

What can I expect at a hearing?

You should look closely at your scheduling order for information about how your hearing will be held, but most OAH hearings are currently remote and are scheduled to take place by telephone. OAH uses a program called Webex to hold remote hearings, but only a phone is required for anyone to join. Visit the Webex Hearings page for more information about joining a remote hearing by phone.

If you are scheduled for a telephone hearing, you can request a video hearing or an in person hearing, using the Request for Video Conference or In-Person Hearing form. Or, if you are scheduled for an in-person hearing, you can request to join the hearing by phone, using the Request to Participate by Telephone form.

Whether remote or in person, an evidentiary hearing is generally divided into three main parts:

  • Opening statements
  • Presentations of evidence
  • Closing arguments

An opening statement is your chance to give the judge a broad overview of your case and what you intend to prove through your evidence. The opening statement is not testimony and does not count as evidence, however. So, remember to present all of your evidence during the next part of the hearing, even if you talked about it already in your opening statement.

The presentation of evidence is the main part of the hearing, and each side takes turns. The judge will explain the how the hearing will go before it begins, but the agency normally goes first in presenting evidence, even if the “burden of proof” is on you. The side with the “burden of proof” must prove certain facts to win the case. For example, If DHCF decided to reduce or terminate your benefits, the agency must prove facts that justify that decision. If DHCF can’t do so, you win the case. But If DHS or DHCF denied your initial application for services or a request for increased services, you need to prove facts to show that you meet the legal standards for the services. But even if you need to prove your eligibility to win the case, the judge normally still has the agency present evidence first, since it can be helpful to have the agency explain why it decided to deny an application or a request for additional services.

When it is your turn to present evidence, you can give testimony and talk about the documents or other items you have as evidence, if the judge allowed your exhibits into evidence (see the “How do I prepare for hearing” tab above for more explanation about how exhibits are admitted into evidence). You can also have your witnesses attend and ask them questions to get them to testify on your behalf. Asking questions of your own witnesses is called “direct examination.”

After you or a witness are done giving testimony, the other side can ask questions about the testimony that was given. This is called “cross examination.” Likewise, after the other side’s witnesses give testimony as part of their presentation of evidence, you will have the opportunity to ask them questions. However, neither side is required to ask cross examination questions, and the judge will not assume you agree with the testimony of the other side’s witnesses if you choose not to question them. The judge may also have questions for the parties and witnesses throughout the hearing.

Finally, after both sides have presented their evidence, each side can give a closing argument. A closing argument is not required but is your opportunity to summarize your evidence and legal arguments as to why you should win. The closing argument is not evidence, and you generally cannot introduce new exhibits during your closing or talk about information that was not admitted into evidence.

Throughout the process, keep in mind that all evidence and arguments are being given directly to the judge. An evidentiary hearing is not an opportunity for the parties to talk and argue between themselves. So, you should practice your opening statement, presentation of evidence, and closing argument as if you are speaking directly to the judge.

Finally, if you are ever confused as to what’s going on during the hearing, ask the judge to explain.

I do not speak English very well. Can I get an interpreter?

Yes. Upon request, OAH will provide a free court-certified interpreter at your hearing. You cannot have a friend or family member interpret for you during a hearing.

You may request an interpreter when you file your initial hearing request, or you may request an interpreter at any other time by calling OAH at (202) 442-9094 or by emailing [email protected]. But please let OAH know as soon as possible that you need an interpreter for your hearing to give OAH time to schedule an interpreter.

If you have not requested an interpreter by the day of your hearing, you should let the judge know that you need an interpreter, and the judge can try to get an interpreter. If the judge cannot find an interpreter right away, the judge will need to reschedule the hearing to give time for OAH to schedule an interpreter for a new hearing date.

will also provide an interpreter if you need to speak with an OAH Customer Service Representative or Resource Center staff, whether visiting in person or calling OAH by phone. Simply ask for an interpreter and identify your language when you visit or call, and OAH staff will contact an interpreter to assist.

I have an impairment that makes it hard for me to attend a hearing. Can I get an accommodation?

Yes. Upon request, OAH will provide reasonable accommodations to allow you to participate in your hearing. You may request an accommodation when you file a hearing request, or you may request an accommodation at any other time by calling OAH at (202) 442-9094 or by emailing [email protected].

Please explain the accommodation you need, and OAH staff will be in touch with you to arrange reasonable accommodations for the day of your hearing. OAH may need some time to arrange the accommodations, so please let OAH know as soon as possible what accommodations you will need for your hearing.

What if I need to change my hearing date?

You may ask the judge in writing for a different hearing date, also called a “continuance.”

For this type of request, you must first reach out to the other party to see if they will agree to a different hearing date. The other party doesn’t have to agree, or even respond. But you at least need to make a good faith effort to get the other party’s consent.

You then must file your request with OAH and send a copy of the request to the other party. To make sure you give OAH all the information needed for this type of request, you may use the Request for a Different Hearing Date form.

You should never assume that a request is granted. If your hearing date is approaching and you have not received a written response, contact the OAH Clerk’s Office to see if the judge has acted on your request. If the judge has not acted on the request by your hearing date, then the hearing will be held as originally scheduled and you will be required to attend.

OAH Rule 2813 has more information about filing case-related requests, also called “motions.” The OAH Rules are on the Rules & Laws page.

What if I miss my hearing?

If you missed your hearing, and you still want a hearing, you must ask for a new hearing date in writing as soon as possible. Even if the judge sends a Final Order in the other party’s favor before you file your request, the judge can still grant a new hearing and change the final order. However, you must give a good reason for having missed the hearing. To make a request, you may complete the Request for a New Hearing form and file the form with OAH and serve a copy on the other party.

OAH Rule 2828 explains more about this type of request. OAH Rule 2813 has more information about filing case-related requests, also called “motions.” The OAH Rules are on the Rules & Laws page.

How does a judge make a final decision?

The judge will not make a final decision about your case during the hearing. Rather, the judge will take time after the hearing to carefully consider all the evidence before making a final decision in writing. The judge’s written decision is called a “final order.” The final order will be sent to all parties to the case and will explain the facts of the case as determined by the judge, the laws that apply to the case, and the judge’s legal conclusions based on how the law applies to the facts.

The final order will also explain your appeal rights, in case you disagree with the judge’s decision.

What can I do if I disagree with a judge’s final order?

If you disagree with a final order, you may either:

  • ask the OAH judge to reconsider the decision or grant relief from the final order, or
  • file an appeal with the D.C. Court of Appeals.

Visit the Closed Case Forms page, under “Filings & Forms,” for more information and instructions.

I need more help.

If you are trying to find a lawyer to give you advice or represent you in your case, you may contact the OAH Legal Assistance Network (OLAN), a network of legal service providers that give free legal help.

Other legal service providers outside of OLAN may also be able to help if looking for legal advice or representation.

If you cannot find a lawyer or choose to represent yourself, you may talk with someone with the OAH Resource Center for additional help. Please call (202)-442-9094 and press “4” from the main menu, or send an email to [email protected]. The OAH Resource Center cannot give legal advice or be your lawyer, but our staff are happy to answer questions and give general information about SNAP and the OAH hearing process.