Greetings, DC Council Committee on Health. My name is Rachel Metz, and I am submitting written testimony on behalf of 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. Thank you for the opportunity to address the committee on the proposed Fiscal Year 2026 budget – or lack thereof – for the Alliance, the Immigrant Children’s Program (ICP), and Medicaid.
For children, access to public health insurance has been linked to fewer chronic conditions, less frequent hospitalizations, and increased rates of educational attainment. For youth and adults alike, the expansion of Medicaid over the years has proven to improve access to preventative care and mental health services, decrease mortality by 6%, and reduce reliance on emergency services. Of course when adults struggle less with their health they likely have more capacity to support their children. Furthermore, research demonstrates that access to Medicaid/CHIP significantly reduces medical debt and family poverty. It is clear that access to affordable, high-quality, and comprehensive health care – like the services currently available through the District’s Medicaid and Alliance/ICP programs – can generate cascading positive impacts in the lives of children, parents, and families, and advance broader public health goals. If the District is now looking to curb health care spending, we should do so in a way that does not undermine the health outcomes or financial stability of our children and families.Â
DC Action has significant concerns about who will lose out due to the Mayor’s proposal in her FY26 budget submission to remove Medicaid coverage from childless adults, parents, and caretakers with incomes over 138% of the federal poverty level (FPL) and to instead transition many, but not all, of them to an, as of yet, unformed Basic Health Program (BHP). The BHP will only cover people with incomes up to 200% FPL. However, parents and caregivers with incomes up to 221% FPL, and childless adults with incomes up to 215% FPL, are currently enrolled in Medicaid, meaning that roughly 10% of the group being cut from Medicaid will be left without affordable health care coverage, and the 90% of Medicaid enrollees being transitioned will see significant cuts to the health services they are currently able to access (dental, vision, behavioral health). The Mayor’s proposal will leave parents of roughly 2,000 District children – nearly all of whom are Black – with incomes between 200% and 221% FPL scrambling to determine which household expenses they will sacrifice in order to maintain health coverage. When thinking about this proposal, it is important to remember that in the District, where the cost of living is estimated to be more than $90,000 for a single person each year, individuals and families making double or even triple the federal poverty line – $26,700 a year for a family of three – still struggle to meet their basic needs. Making major changes to public health insurance programs for economically vulnerable individuals and families without soliciting any proactive public input or going through a full Council review process (permanent legislation vs budget support act process) is incredibly reckless. We urge the District to take the planning time it needs to ensure smooth transition to new and fully comprehensive health plans before kicking anyone off of their existing health plan.
In addition to concerns about planned transitions from Medicaid, we are also concerned about public health care transitions for those who do not qualify for Medicaid – the nearly 6,000 children enrolled in ICP and roughly 27,000 adults enrolled in the Alliance. The mayor’s proposed changes will put financial pressure on providers trying to collect fees for services in FY25 and FY26 and likely create a greater reliance on emergency medical services beyond then which will drive up the costs of health care in the District for all residents and create poorer public health outcomes. To further complicate health plan transitions and cut costs, the Mayor’s Budget Support Act reverses the Council’s decision to remove burdensome hurdles to Alliance recertification, and calls for reviving the twice-a-year in-person enrollment interviews, as well as creating an additional enrollment burden of providing two forms of documentation to prove District residency – and applies these to the children being transitioned from ICP to the Alliance. These changes create not just logistical burdens but unsafe conditions for many immigrants – and those perceived as immigrants – in the District who are under constant threat from ICE, create unnecessary and costly work and system backlogs for DHS and DHCF. We urge the Council to strike the in-person, twice-a-year recertification interview requirement from the BSA.
If the District is going to backtrack on our commitment to ensuring health coverage for all our residents, we should at least take the time to do so as intentionally as possible to avoid exacerbating the damage of the cuts themselves. How policy changes are implemented is incredibly important and has wide ranging impacts on the success – overall, and in mitigating inequities – of new policies and programs. We share the concerns of many community partners who have spoken out about these issues, including DC Behavioral Health Association, DC Primary Care Association, DCFPI, La Clinica, and Legal Aid. We join them in encouraging the Council to ensure that whatever health plans result from this budget that the District ensure continuity of care, level of care, affordability of care, and access to care for District families.