January 27, 2026
Thank you for the opportunity to address the Committee on Health by providing written testimony regarding the performance of the Department of Health Care Finance. My name is Rachel Metz, and I am the Research and Data 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 write to urge this Committee to use the oversight hearing with Director Turnage and DHCF to continue elevating the importance of smoothly implementing and widely promoting pre- and postnatal care available to Alliance and former Alliance enrollees through the CHIP From Conception to End of Pregnancy (FCEP) Option. Given the two-generational impact of this provision of access to public health insurance and the District’s persistent racial disparities in maternal health, especially regarding first trimester care, we are concerned that the Agency is not doing enough to ensure successful implementation. Specifically:
- Guidance from DHCF to providers suggests that even those individuals already enrolled in the Alliance need to use CHIP for health coverage during pregnancy and birth. This creates an administrative burden on patients and providers during the already challenging period of early pregnancy. We anticipate similar issues for those who will be enrolled in the new Basic Health Program as that is more fully implemented. This burden must be removed and the Agency must leverage backend solutions to maximize access to federal funding without straining pregnant enrollees.
- CHIP From Conception to End of Pregnancy coverage only extends for two months postpartum, not even long enough to fully cover the “fourth trimester,” let alone the time span in which common post-pregnancy issues like postpartum depression, incontinence, or cardiovascular complications may occur. Previously, Alliance enrollees had access to 12-months of postpartum coverage (comparable Medicaid enrollees) and reducing their coverage to align with a limited federal program contravenes what is smart public health policy. This Committee and DHCF must find a way to fully restore postpartum care, even if the Agency leverages CHIP to cover pregnancy and birth.
- We have heard from doctors and health care institutions that the process of enrolling in CHIP is taking weeks for some pregnant patients, meaning they are losing out on critical early prenatal care. Processing needs to happen faster so people are actually covered in their first trimester. Allowing Federally Qualified Health Centers to qualify patients as presumptively eligible would speed up this process and we urge the Committee to explore this option – or other solutions – with DHCF during their oversight hearing.
Regarding the health of District families more broadly beyond pregnancy and birth, DC Action shares the concerns of many community partners who are speaking out about the Alliance, including DC Primary Care Association, Jobs with Justice, DCFPI, Briya, La Clinica, and Legal Aid. You have and will continue to hear from many healthcare providers and community members who know that as eligibility for the Alliance becomes more and more restricted District residents will suffer, and in some cases die from preventable deaths. We echo these concerns. Further, cuts made to the Alliance will have harmful impacts on enrollees’ children and whole families for years to come. To keep residents insured for as long as possible, we encourage you to ask DHCF in their hearing about recourse available to Alliance enrollees whose recertification was wrongfully denied if they were not able to resolve the issue within the 90 day grace period.
We also echo partners’ concerns regarding the implementation of funding budgeted for FY26 on a contingency basis which the Chief Financial Officer recently certified; it is our understanding that the Agency has yet to restore health the critical services as approved by the Council last summer. Questions we would appreciate you asking DHCF during their government witness hearing include:
- What is the timeline for restoring services using the approved contingency funding and why is implementation taking so long, especially since the Agency has known for more than 5 months that Alliance restoration was on the contingency budget list and has known for at least 3 months that the District’s finances at the close of FY25 would support the contingency list?
- How will patients be informed about restoration of services? Will they be receiving a description of their benefits?
- How will health care providers be informed about restoration of services? What resources is the Agency preparing to help providers inform patients?
- If Alliance enrollees are wrongfully denied or delayed from accessing benefits the Agency is required to restore, what recourse do they have? And how are these appeal processes being promoted and communicated?
In addition, we remain concerned about the District residents with incomes just above 200% of the federal poverty line who are being cut from Medicaid but are not eligible for the new basic health program – 1,630 people, or more than 11% of those losing Medicaid coverage based on DBX’s November 24 responses. We encourage you to ask DHCF and DBX how many of these people have successfully enrolled in coverage through the exchange. Again, loss of health care can create wide ranging harm to individual, family, and community health. Thinking ahead to the FY27 implications of the reduction in Medicaid coverage, DC Action will be closely monitoring the potential impact on early childhood educators if the Mayor fails to fully restore the Pay Equity Fund and Healthcare4Childcare; many educators could return to earning poverty wages with household incomes just over 200% FPL and subsequently struggling to afford healthcare for themselves and their families. Seamless access to a public health plan or an affordable one on the exchange will be essential for educators even with just cuts to Healthcare4Childcare but certainly if the worst case scenario plays out and the Pay Equity Fund is repealed.
Finally, as Data Manager, I want to draw attention to the importance of disaggregating health data on young parents. Teen mothers are more likely to have low birthweight babies than mothers of other ages and mothers in their early 20s have higher rates of infant death than older mothers (see pgs. 33 and 42). Currently we do not know if this is due to lack of access to health insurance, challenges with scheduling or transportation for appointments, or other factors. It would be helpful to know how many young parents had public vs private vs no health insurance coverage during pregnancy and at the time of birth, and of those how many received first trimester prenatal care. Investments in young parents can pay dividends across generations, and having data about how they are being served – and where there are gaps – is foundational for improving public health outcomes and reducing racial disparities in care.
Rachel Metz
