Greetings, DC Council Committee on Health. My name is Rachel Metz, and I am testifying 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 implementation of changes to the Alliance, the Immigrant Children’s Program (ICP), and Medicaid.
First, we want to thank the committee for some of the changes you were able to make during budget season, particularly ensuring that Alliance recertification would remain annual and not require burdensome – and risky – in-person interviews. We also appreciate that DHCF has started elevating information on the CHIP From Conception to End of Pregnancy (FCEP) Option for pregnant individuals, and the children they birth, to benefit from the coverage for which they’re eligible even as the programs that may have previously covered them are no longer available. We encourage continued work to ensure that the actual enrollment process goes as quickly and smoothly as possible, particularly given persistent racial disparities for Black and brown women lacking first trimester prenatal care.
That being said, 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, because of changes to the Alliance, have been unable to access lifesaving medication or specialist services. We echo these concerns. 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. And we know that when adults struggle less with their own health they likely have more capacity to support their children, particularly if appropriate healthcare allows a parent to avoid disability or death. Furthermore, research demonstrates that access to Medicaid/CHIP significantly reduces medical debt and family poverty.1 We can subsequently deduce from Medicaid research that cuts and changes to the Alliance program will have harmful impacts not just those who lose coverage but their children and whole families.
In addition, while it is clear across DHCF materials that children who are being transitioned from ICP to the Alliance will retain some coverage that adults in the Alliance do not, such as dental care, we hope that the agency will confirm that the Alliance Children’s benefit is identical to the Medicaid benefit for children, as stated on one portion of the DHCF website but not made explicit in all the updated Alliance materials. Given some of the challenges adults in the Alliance have been facing, as well as language in the Alliances change resource guide that seems to group children and adults together in denying coverage for non-emergency transportation, vision/hearing, podiatry and home health services (see page 4), we worry that some providers may err on the side of denying coverage. This is wrongheaded and should be addressed in today’s hearing. Further, while vision and podiatry services are listed in the Alliance handbook as being covered for children (see pages 18-19), that information is not consistently clear across materials, and it is even less clear whether specialists such as pediatric orthopedists or transportation for appointments (which is a benefit under Medicaid) are covered for children. We would love to have confidence that it is clear to everyone that children have not, in fact, lost any coverage with the transition from ICP to the Alliance, but unfortunately the transition was done so quickly that it seems prudent to ensure that weedy issues like these are clearly communicated throughout DHCF, to health care practitioners and offices, and to patients and their parents. We appreciate you holding this hearing so that issues like these can be surfaced.
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. Again, loss of health care can create wide ranging harm to individual, family, and community health.Â
Last but not least, with the risk of so many District residents losing coverage in various ways due to all these changes, we urge this committee to stay on top of data on the capacity of the District’s emergency services.
Thank you for your attention to these issues and for your time.