The Districts Dime

Better Oversight Needed to Improve Access to Health Services For 175,000 DC Medicaid Participants

February 27th, 2015 | by Wes Rivers

The District should do more to connect residents on Medicaid with basic health services, which would improve their health and reduce District costs by avoiding costly emergency services. That conclusion is based on a recent report on three managed care organizations (MCOs) that have served 175,000 DC Medicaid participants for a year, but have not improved access to health services or coordination of patient care. Better oversight of this program, including more information on the care they provide, could help to improve access, contain health care costs and improve overall health for DC residents.

2-27-15 MCOMost DC Medicaid recipients are assigned to one of three MCOs. The District pays each MCO a fee for each enrollee and in return the company reimburses doctors and hospitals for health care services used. An annual review of the MCO program, from the DC Department of Health Care Finance, suggests that the three managed care organizations have struggled to manage patient’s care and as a result, failed to keep costs down.

  • Only two-thirds of participants regularly visit with a primary care doctor. Seeing a primary care doctor regularly is important to managing health needs, which reduces the use of more costly and intensive services.
  • Over three-fifths of emergency room visits by DC Medicaid recipients are for basic care, and a large portion could have been avoided.
  • One in twelve hospital visits result in a readmission, some of which could be avoided through better service delivery and follow-up care.
  • No MCO provides case management – services for people with higher health needs and chronic health conditions like asthma – to more than 5 percent of members. Case management helps patients get appropriate referrals and follow-up care after seeing a doctor. Given the range of conditions that MCO’s must offer case management services for – including HIV, asthma, mental illness, substance abuse, diabetes, and cardiovascular disease – MCOs should be doing more to identify patients and connect them with services.

Over-reliance on the emergency room and high rates of hospital readmissions cost the MCOs more than $34 million in this first year – which means the MCOs will charge the District more next year.

DCFPI’s transition document for health care details how DC can establish stronger oversight of the Medicaid managed care program. One of the major steps is to collect more data and establish performance benchmarks. Setting standards for things like avoidable emergency room visits can help the city create a payment structure and financial incentives that will lead to better outcomes. The District has already begun this process by collecting the data for the quarterly report, but now that a year has passed, it is time to refine the data and create benchmarks. DCHCF should also allow the public to comment and contribute to the formulation of further data collection and performance standards.

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DC Health Link’s Success Results from Strong Partnerships with the Community

February 25th, 2015 | by Wes Rivers

DC’s online health insurance exchange,, has helped over 80,000 residents get access to affordable private health insurance and Medicaid. The District’s success in enrollment is due to the efforts of the exchange’s leadership and staff to form meaningful partnerships with community organizations, small businesses, and the health industry.

Community feedback has informed a lot of DC Health Link’s decision making over the last year – building broad support for the exchange’s consumer-friendly rules and regulations, for the way its operations are funded, and for its efforts to educate and assist consumers. The DC Fiscal Policy Institute testified to some of these successes today before the Committee on Health and Human Services. Here’s what we said:

DC Health Link has involved consumers, doctors, and health insurance companies in making policy decisions. The exchange has used working groups to get recommendations from stakeholders regarding key policy issues. This year, DC Health Link sought input to develop the set of requirements that a health plan must meet in order to be certified and sold on the exchange. As a result, health plans will be required to provide standardized data on the number and type of doctors in their network. They also will have to submit information and justification for changes in plan prices. We hope DC Health Link continues to involve the community in policy decisions – especially when developing rules for what it means for a health plan to have an adequate set providers in its network.

DC Health Link has involved stakeholders in their budgeting and financing discussions. This year, DC Health Link held two public forums on its fiscal year 2016 budget request and took community suggestions on funding for its different operations. The exchange also implemented a consumer-friendly way to pay for its operations, on a one-year-basis, using a strategy recommended by one of its stakeholder working groups. While this community engagement was helpful, other agencies that fund activities interconnected with DC Health Link, such as consumer assistance for Medicaid applicants supported by the Department of Health Care Finance, should also be included in budget discussions for the exchange. A report on the funding and activities of all agencies connected to the exchange would help advocates and policy makers understand and assess how well the city is implementing health reform.

DC Health Link relies on partner organizations that help with consumer assistance and outreach. DC Health Link staff have used community feedback to improve the consumer experience. DC has had some technology issues, as the federal government and all state exchanges have, but quick responses by staff and a strong network of people hired to assist consumers have mitigated many enrollment issues. DC Health Link is also using the experiences of brokers, small businesses, and trade associations to inform quality improvement. 

To read a copy of the full testimony, click here.

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Education and Enforcement Are Key to Making Sure Workers Benefit from Minimum Wage and Other Changes

February 24th, 2015 | by Ed Lazere

2.24.15 DOES perfThe District’s leaders have adopted a number of new benefits and protections for people who work in the city, and now it is important to make sure they are fully implemented and enforced.

The city’s minimum wage will rise to $11.50 an hour in 2016, and all workers in the city earn paid sick leave starting with their first day on the job. Legislation adopted in 2014 prohibits employers from asking about an applicant’s criminal record until a job offer has been made. Pregnant workers have the right to reasonable accommodations and are guarded against discrimination. Unemployed residents are now protected against job discrimination.

These new benefits and protections are only meaningful, however, if both employers and workers are aware of them, and if the District makes sure they are enforced. The city should take vigorous steps to inform workers and businesses of these new rights and benefits, and it will need adequate staff to enforce them, including responding to instances when employers fail to comply. The DC Fiscal Policy Institute and others recommend additional resources be provided in the following ways:

  • Public Education: As little as $300,000 would support meaningful dissemination of information on the minimum wage, earned sick and safe leave, and wage theft changes.
  • Ensuring All Workers Get the Minimum Wage and Paid Sick Days: The office that receives and investigates claims from workers when employers do not follow these laws – the Office of Wage Hour within the Department of Employment Services – needs additional staff.  In addition, the city uses administrative law judges to adjudicate claims that are found to be credible, and the city could use more.
  • Protecting Workers against Job Discrimination: The Department of Employment Services and the DC Office of Human Rights would be better able to address discrimination against pregnant workers and jobseekers who are unemployed if they had additional staff.

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DC’s New Team to Help Homeless Families Find Housing Is a Good Start

February 20th, 2015 | by Kate Coventry

Mayor Bowser’s creation of a “housing navigator” team to help homeless families find apartments and negotiate with landlords is an important first step to providing the stability families need to do things like find a job and help their children succeed in school. It also is one key way to reducing the city’s over-reliance on shelter.

Homelessness is a problem that goes deeper than not having a roof of your own. It’s much more than an inconvenience. Families that don’t know where they’ll spend the next night can’t make the most basic plans to ensure their children’s wellbeing or to work toward a better future.

9-5-14-winter-plan-blog-f1For example, a parent might get a job that is easy to get to from shelter only to have to quit because the job is hard to reach from the new home.

As the District has struggled in recent years with an alarming increase in family homelessness, one of the biggest challenges has been to get families out of shelter quickly. Even with the availability of Rapid Re-housing subsidies to help pay rent, it is hard to find housing in DC’s competitive market. Many homeless families appear to be a risk to potential landlords, and a large share of homeless families in DC are young and have limited experience securing housing. The longer it takes to get out of shelter, the longer it takes for families to get back on their feet and the less space there is for other newly homeless families. Getting people get into permanent housing also saves money; it costs the District about $150 a night for every family in a shelter.

The new “housing navigator” team will speed up the move-in process by helping families find apartments and negotiating with landlords to reduce rents and overlook poor credit and rental history. The team will also expedite required housing inspections and other paperwork. In other communities, this kind of coordinated, personalized assistance has proven effective.

Next, the District needs to build on this good start. Strategies that have worked elsewhere to ease homelessness include extending the length of temporary rental aid when it is clear a family needs it to succeed, and finding long-term help for families facing challenges paying rent on their own after the assistance ends.

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Melinda Gaino: Working But Left Behind in DC’s Prosperity

February 18th, 2015 | by Ed Lazere (DCFPI) and Ari Schwartz (DC Jobs with Justice)

Melinda Gaino has a full-time job in DC, but she struggles to make it. She earns $9.90 an hour as a cashier at Walmart on H Street, NW, bringing home about $20,000 a year. That is too little to support her and her four children in their SE apartment.

2.18.15 gaino left behindMelinda is an example of the many workers who have been left behind despite DC’s growing economy, according to a recent report from DCFPI. She is a victim of an economy that is failing to create shared prosperity, to ensure that everyone who works hard can get by.

Melinda’s life as a low-wage worker is not unique. There are thousands who work in DC every day but barely stay afloat: the lot attendants who park our cars ($9.72 average wage), the cashiers who check us out ($11.03 average wage), the people who make our sandwiches for lunch ($11.43 average pay for food prep workers).

These workers have not fared well, according to DCFPI’s report. Hourly earnings for DC’s lowest-paid workers grew just 7 percent over 35 years – about 2 cents per year, taking account of inflation – while the highest paid workers saw their paychecks grow by 55 percent. The pay gap between the people who earn the least and those who earn the most in DC is at a record high.

Melinda typifies the challenge to stay ahead in other ways. She worked at Blue Cross/Blue Shield for three years, earning $15.60 an hour, but then got laid off. She searched for employment for six months before starting at Walmart at a much lower salary. Her experience was typical – nearly three-fifths of high school graduates who lost a job in 2013 were out of work for more than six months.

Working at Walmart has been hard for Melinda for other reasons besides low pay. Last year, despite DC’s requirement that all employers provide paid sick leave, Melinda was disciplined for missing work when her 18-year-old was hospitalized.

“Even though I’m considered full-time and work 40 hours a week, I still rely on government assistance to get by,” said Melinda. “Living off $9.90 is too hard, having to provide for a college student and relying on food stamps.”

But Melinda’s story has some happy news, too, including the fact that her pay will rise to $11.50 in 2016, not as part of Walmart salary policy but because of scheduled increases in DC’s minimum wage. That will increase Melinda’s pay by $3,000 a year. It is an indication of what we can do to make DC’s economy work better for everyone.

While grateful, Melinda knows this is not enough. In November, she joined other associates with the worker organization OUR Walmart in calling on the mega-retailer to pay a living wage of $15 an hour. That way, she would no longer need to rely on public assistance despite working full-time.

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