Testimony of Rachel Metz, Data and Research Manager, before DC Council Committee on Health

Thank you for the opportunity to address the Committee on Health by providing written testimony regarding the budget of the Department of Health Care Finance. My name is Rachel Metz, and I am the Data and Research Manager at DC Action. DC Action uses research, data, coalition building, advocacy, and a racial equity lens to break down barriers that stand in the way of all kids reaching their full potential. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being in the District of Columbia.

We want to start by thanking this committee for your work to encourage the Executive to pause elimination of Alliance coverage for those who are currently enrolled, and to get dental and vision added back to the Alliance and the Basic Health Plan. We are also glad to see level funding maintained for the Nurse Family Partnership Home Visiting Program.

That being said, we have several concerns with the DHCF proposed fiscal year 2027 budget and we have an ask for each of these concerns:

1. Remove Age Limits on Health Care Coverage: We join the Keep DC Healthy coalition’s call to remove the age moratorium so DC residents of any age can enroll in the Alliance and receive healthcare. Kids need healthy parents and grandparents to thrive.
   
   1. Confirm Children Will Be Grandfathered Into Alliance Coverage As Adults:  We would also appreciate confirmation that, under the currently proposed policy, young adults under age 21 who are currently enrolled in the Alliance as children will be able to maintain continuous enrollment as adults as long as their incomes are below 138% of the federal poverty line. In other words, aging from child to adult status will not cause them to be treated as a new applicant to the Alliance which would, in fact, make them ineligible for the program given the prohibition on new adult enrollments. 
2. Create a Coverage Gap Grace Period for Healthy DC: While Medicaid has a 90-day coverage window following a re-enrollment deadline before an individual’s coverage is lost, this does not currently exist for the Healthy DC program. To ensure parity with Medicaid coverage previously available to Healthy DC enrollees, we encourage this committee to add adequate funding for DHCF to create a 90-day grace period for the Healthy DC Plan renewal before coverage is lost.  
3. Restore Access to Mental Health Services: It is concerning that the Department of Behavioral Health has decided to reduce services for participants whose incomes are above 138% to mirror DHCF’s eligibility restrictions (restricted coverage for individuals and households in the 138%-200% FPL income range). We encourage this committee to secure any funding needed to restore access to DBH services that were lost as a result of the Alliance and Medicaid income eligibility changes. 
4. Restore Higher Income Eligibility for Alliance: In a place as expensive as the District, making 138%-215% of the federal poverty line does not get you very far. For a family of three, that means making as little as $37,705 a year, while a family with two working adults and one child is estimated to need more than $119,000 just to meet basic needs. The income limit for the Alliance should be returned to 215% of the Federal Poverty Level so that more families struggling to make ends meet can access the medical care they need and deserve. 
5. Guarantee Health Care Coverage for All Residents Earning Less Than 215% FPL: Related to our above ask, while District residents (who are US citizens) with incomes between 138%-200% of the federal poverty line are able to enroll in Healthy DC, those with incomes 200%-215% FPL no longer have a publicly funded health program available. The District should expand Healthy DC eligibility or provide funding so these residents can have coverage on par with what they had in September 2025. 
6. Track Maternal Health Data and Ensure Seamless Transition with CHIP: We want to ensure that leveraging federal funds from the CHIP From Conception to End of Pregnancy (FCEP) Option to cover prenatal and postpartum care across all the District’s public health plans results in more care at this pivotal time for mother and baby, without administrative health insurance enrollment or other issues detracting from care. To that end we have the following asks: 
   1. It is our understanding that to leverage CHIP FCEP coverage, an expectant parent must enroll in the program, effectively changing their health insurance provider such that they show up as disenrolled in the District’s local programs. DHCF must guarantee it is tracking Alliance and Healthy DC enrollees in a way that allows them to seamlessly transition back onto these health plans following the postpartum period without treating them as new enrollees. This is particularly concerning for Alliance participants as the Alliance program is not accepting new adult applicants; these new parents should not be treated as new Alliance enrollees but should be grandfathered into coverage as they met previous reenrollment deadlines. Data must be tracked to demonstrate health insurance coverage is maintained when transitioning between CHIP FCEP and Alliance or Healthy DC. 
   2. DHCF should be tracking data on rates of access to both prenatal and postpartum care (for a year after birth) for pregnant people enrolled in CHIP FCEP, Alliance, Healthy DC, and Medicaid. It is important to know the usage of prenatal and postpartum care for those who were enrolled in the Alliance and Healthy DC prior to the start of their pregnancy compared to those who were not previously enrolled and are accessing health care for the first time through CHIP FCEP, as well as to those enrolled in Medicaid prior to a pregnancy. This can allow the District to more quickly identify and remedy disparities in access to prenatal and postpartum care.
   3. Ensure that DHS service center employees are trained to accept self-attestation of pregnancy as a basis for CHIP enrollment rather than any additional paperwork to establish proof of pregnancy (as described by Eugene Simms, Director of Health Care Policy and Research Administration at DHCF, in the May 6 DHCF Eligibility Meeting). 
7. Plan and Budget Now For Federal Interference in Health Care Coverage: Unfortunately the District is operating in an environment with federal cuts and restrictions to the social safety net. The Council must commit to securing local funds to cover any additional FY27 enrollees expected to require alternative health care coverage due to new federal Medicaid restrictions, and to allow current Medicaid enrollees who lose coverage due to federal changes to transition into the Alliance. 
8. Legislate Commitment to Health Care Coverage: While we appreciate that the Mayor’s proposed FY27 budget is intended to pause elimination of Alliance coverage for those who are currently enrolled, and to fund dental and vision services for Alliance and Healthy DC enrolless, it is concerning that these changes are not codified or guaranteed in writing through the Budget Support Act. We encourage you to ensure that they are included in a Budget Support Act subtitle.

Thank you for your consideration of this testimony.

Rachel Metz

rmetz@dckids.org