Written Testimony of Rachel Metz, Data and Research Manager, before the Committee on Health

February 16, 2023
Testimony
Person Testifying: Rachel Metz
Title: Data and Research Manager, DC Action
Testimony Heard By: Department of Health Care Finance
Type of Hearing: Performance Oversight Hearing

February 2023

Hello, Chair, and members of the Committee! Thank you for the opportunity to address the DC Council as it reviews the Department of Health Care Finance performance for fiscal year 2022. I am Rachel Metz, the Data and Research Manager at DC Action.

DC Action uses research, data, and a racial equity lens to break down barriers that stand in the way of all kids reaching their full potential. Our collaborative advocacy initiatives bring the power of young people and all residents to raise their voices to create change. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being.

Chair, we want to thank you and the DC Council for championing, passing, and funding legislation to expand Medicaid coverage for postpartum parents for a full year after the birth of a child. Knowing that they’re guaranteed health insurance gives parents one less thing to worry about as they embark on that critical first year of their child’s life.

As you know, postpartum coverage expansion is one of several Medicaid policies that was made possible by pandemic-inspired shifts. With Congress passing the Consolidated Appropriations Act days before the end of calendar year 2022, the landscape is about to shift once again. The performance oversight process is well-timed to facilitate dialogue on how DC Health Care Finance (DHCF) is preparing for those shifts, and how the DC Council and the public can partner to ensure that the District maximizes the number of eligible residents able to gain or maintain health insurance coverage. Our testimony today focuses on four Medicaid shifts in the Consolidated Appropriations Act that particularly impact children and families. These are: unwinding the Medicaid continuous coverage requirement, the option to make the expansion of postpartum coverage permanent, requiring 12-month continuous coverage for children next year, and changes for young people in public institutions in 2025.

Unwinding the Medicaid Continuous Coverage Requirement

Early in the COVID-19 pandemic, states began receiving an increased federal Medicaid matching rate in exchange for providing continuous Medicaid coverage to enrolled residents. In other words, states couldn’t disenroll anyone involuntarily. Nationally that’s been effective at increasing the number of insured children: in 2021 over 200,000 fewer children were uninsured than in 2019. In the District the trend is different, but it’s clear that Medicaid is filling an important need for children: while we have 2,000 more uninsured children in 2021 compared to 2019, the District’s Medicaid enrollment grew by nearly 10,000 children between February 2020 and August 2022 during that time. In fact, three-quarters of District children are enrolled in Medicaid or Healthy Families.

The new federal legislation phases out the increased matching rate and ends the continuous coverage requirement, which means states will have to recheck eligibility for everyone enrolled in Medicaid. Many people are likely to lose coverage for procedural reasons. The Georgetown Center for Children and Families estimated that nationally “at least 6.7 million children are likely to lose their Medicaid coverage and are at considerable risk for becoming uninsured for some period of time.”

We want to express our appreciation for some of the steps District officials have taken to mitigate this problem.

Those steps will likely help many District children and families maintain their coverage. We would also appreciate DHCF’s help to better understand how many children and youth might not be as secure in their Medicaid coverage based on these measures. Specifically:

  • How many District residents qualify for Medicaid through foster care/adoption assistance or as former foster care children rather than based on income, and will they be able to automatically re-certify in Medicaid?
  • How many children with long-term disabilities or complex medical needs qualify for Medicaid based on those conditions rather than based on family income, and what will the recertification process look like for those families?
  • Beyond District Direct, do you have data sharing agreements with the agencies administering any other public benefit programs so as to increase the share of Medicaid recipients who can avoid the administrative burden of actively re-certifying? Specifically, do you have any agreements with OSSE so that families who have applied for a child care subsidy can have that information used for their Medicaid recertification (or vice-versa)? If not, are you taking any steps to increase your data linkages with other agencies (as part of an Early Childhood Integrated Data System or otherwise)?

Postpartum Coverage Expansion

DC Council passed and funded expanded postpartum coverage based on what was, at the time, a temporary federal flexibility. We would love to better understand how many District parents benefited and the actual costs involved. Any data DHCF can provide would be welcome. More importantly, the new federal legislation makes the option for expanded coverage permanent. We ask this committee to continue the District’s commitment to maternal and infant health by taking advantage of that so babies and their parents have access to the care they need in their first year. As you know, the original legislation estimated the cost as only about 150 thousand dollars in local funds this coming year.

Continuous Coverage for Children

As part of the new federal legislation, starting January 1, 2024, states will be required to provide 12 months of continuous Medicaid coverage to children who qualify for Medicaid, even if their family income fluctuates over the course of the year. This is a policy that we have supported for several years because of the stability it can help bring to children’s medical care, and the harm that can be caused by “churn” when children cycle on and off the program. We would love to see it implemented as soon as possible. It would be helpful to know if DHCF anticipates any local costs associated with this policy (or, on the flip side, anticipates cost savings due to a reduced administrative load). If so, we would encourage this committee to fund this shift at the beginning of the District’s 2024 fiscal year rather than waiting the three months until the federal requirement begins. If the policy does not incur local costs, we would love to see it implemented as soon as possible, especially given the unwinding of the broader continuous coverage protection in this calendar year.

Juvenile Youth in Public Institutions

Two more positive changes in the new federal legislation include the requirement that, starting in 2025, states provide certain mental health screenings, referrals, and case management to juvenile youth in public institutions, and that states have the option to provide Medicaid coverage during the initial period pending disposition of charges. Anecdotally we know that children in these settings often have unmet physical and mental health needs. Recognizing that the timeline for those potential policy shifts is longer, we would still appreciate any insight DHCF can provide at this point into its existing data, or plans to collect data, related to those health and mental health needs.

 

Thank you again for the opportunity to provide this testimony. If you or Committee staff have any questions or need clarification, I would be happy to respond to your inquiries. I can be reached at rmetz@dckids.org.