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Transmittal 21-04 - Reimbursement of Out-of-Pocket Expenditures for Managed Care Medicaid Beneficiaries

Wednesday, January 27, 2021

Pursuant to the terms of the contract entered into by the Managed Care Organizations (MCOs) and the District of Columbia, each DC Medicaid MCO is required to comply with the terms of the Salazar Settlement Order, including any subsequent Orders entered by the Court in Salazar v. District of Columbia, Civil Action No. 93-452 (TSC) (D.D.C.).

On September 2, 2005, in the Salazar case, the Court approved and entered the Order Setting Reimbursement Procedures for Medicaid Beneficiaries Enrolled with a DC Medicaid Managed Care Organization. The Order sets the procedure for the MCOs to make and communicate to their enrollees determinations on reimbursement claims that are submitted by an MCO enrollee to the MCO directly, or to the Recipient Claims Research Team at the Department of Health Care Finance (DHCF).