Testimony to DC Council on Public Health Insurance

description of importance of health insurance programs

Testimony to DC Council on Public Health Insurance by Rachel Metz, Research and Data Manager, DC Action for Children

Because of the impact of historic and current racism, poverty is racialized in DC. According to the most recent Census estimates, the average income for DC’s white households is almost four times that of Black households and three times that of Latino households ($208,622 vs $54,778 and $73,053), with even bigger gaps for households with children. As a result, programs that support the health and economic security of families making low wages- including DC Medicaid and Healthy Families, the DC Health Care Alliance, and the Immigrant Children’s Program - are necessary for a racially equitable budget.

We appreciate DHCF's commitment to ensuring that DC residents enrolled in Medicaid, Healthy Families, the Health Care Alliance, the Immigrant Children’s Program (ICP), and other public benefits were able to continue receiving benefits during the COVID-19 pandemic without taking further action. 

Even before the pandemic, these programs filled a major need in DC, particularly for children. DC Medicaid and DC Healthy Families insure more than a quarter of a million people, or more than one in three District residents. They are incredibly effective and critical in covering children in the District; 98% of all eligible children are enrolled – the highest rate in the entire United States. Approximately 7 out of 10 of all children in the District are covered by these programs. An additional 3,651 children are insured by ICP, and it is likely that many of their families are among the 15,569 DC residents covered by the DC Health Care Alliance.

These programs are four tools among many to help counter the negative effects of historic and ongoing racial inequity. Because of the ongoing racial discrimination, Black children in DC are 10 times as likely as white children to be living in poverty (36 vs. 3 percent), and poverty rates are high for Latino DC residents as well, making DC Medicaid and Healthy Families vital programs for giving children of color access to medical care. 81 percent of children enrolled in Medicaid and Healthy Families in DC are Black and 17 percent are Latino. DC Health Care Finance does not report program demographical data for the Alliance or ICP.

During the current pandemic, access to health insurance is even more important for both individual and public health. Unfortunately, in a US Census survey done the week of May 21-26, 1 in 10 DC respondents – including 13 percent of Black respondents and 20 percent of Latino respondents – reported being uninsured.

Moving forward, the Council must maintain level funding and pay for improvements in coverage. Specifically:

  1. Maintain Ease of Program Certification as DC Re-opens
    Once DHCF is able to resume the recertification process for Medicaid, Healthy Families, the Alliance, the ICP, and other public benefits, phase in that requirement to avoid posing administrative hurdles for families in need. At the same time, build on the remote application infrastructure that DC has built during the pandemic to continue making application and screening processes more accessible, for example by allowing screening for the Alliance by phone or at clinics rather than requiring people to go to a DHS Service Center in person.
     
  2. Continue Investments in Community-Based Services
    DC has invested in community health centers with wraparound services that can help make both traditional health care and resources that impact health (e.g. WIC, SNAP) more accessible for residents. DC should continue this investment in the health of all its residents.
     
  3. Provide children with 12 months of continuous coverage through Medicaid and CHIP, even if the family experiences a change in income during the year
    Such continuous eligibility has been shown to reduce the rate at which individuals cycle on and off the programs and therefore help enrollees maintain improved health outcomes that result from Medicaid enrollment. About half of all states have adopted continuous eligibility for their Medicaid and/or CHIP programs. In order to further maximize the efficiency of these programs, the District of Columbia should join these states and implement continuous eligibility for its DC Medicaid and DC Healthy Families programs.
     
  4. Prevent lapses in coverage in DC Medicaid’s transition to managed care
    With DC transitioning its Medicaid system toward a managed care model over the next few years, approximately 50,000 enrollees have started shifting from fee-for-service to managed care, or will soon. While this move to managed care may ultimately result in decreased Medicaid costs and higher quality care, DHCF officials must take steps to ensure that enrollees who move from fee-for-service to managed care do not experience any lapses in coverage or services. Based on a similar transition elsewhere, special attention should be given to enrollees with mental illness, who are frequently not given proper support to successfully navigate the transition. In part to help with this transition, DHCF announced that it will implement universal contracting for critical providers in the District of Columbia to give every provider an opportunity to join the Medicaid program. While this will certainly improve access and ease the transition, it is important to note that this contracting only applies to hospitals; individual specialists (like mental health specialists) may not be included. As such, DHCF should ensure that care coordinators are available to all DC Medicaid and Healthy Families enrollees who transition from fee-for-service to managed care. 
     
  5. Extend Alliance Recertification Period to 12 Months
    Extending recertification is important because only about half of all enrollees successfully recertify. This high churn rate (the rate at which individuals transition between different types of insurance and/or lose insurance coverage) is likely the result of the burdensome in-person recertification requirement as opposed to a loss of eligibility due to a change in income or residency status. Such churn has been shown to lead to numerous adverse effects for individuals, including delayed health care access, reduced medication adherence, and increased emergency room visits. In DC, where 43 percent of residents who do not have US citizenship are Latinx, 18 percent are Black, and 15 percent are Asian American, churn in health care access for immigrants disproportionately impacts people of color. Extending the recertification period to 12 months would not only reduce this harmful churn but also align the program with Medicaid’s 12-month certification period. Similar to Medicaid’s shift from fee-to-service to managed care, in the long run better continuity of coverage has the potential to save the city money if residents access preventative care, which alleviates the need for more expensive treatments in the future.

We recognize that improving accessibility is not without costs. Particularly in a recession, every drop of revenue is precious, and we shouldn’t leave needed resources on the table when doing so could help create a more just and resilient future for the city. That is why we support the revenue strategies being proposed by the Fair Budget Coalition in a community sign-on letter. Now is the time for the District to responsibly use more of our rainy day funds and raise revenue from our wealthiest residents and most successful businesses who have benefited from significant federal tax giveaways in recent years.