The Districts Dime

Mayor Bowser Will Need to Find More Revenue to Avoid Deep Cuts in Services

March 10th, 2015 | by Ed Lazere

Unless Mayor Bowser can find additional resources, it is likely that she will have to cut many services that DC residents and businesses count on. That’s why it makes sense to use some of last year’s surplus and to consider other new sources of revenue to maintain investments that matter to the quality of life in the District.

The mayor faces a serious challenge as she puts together her first budget: The city currently doesn’t have enough money to maintain schools, health care, and other important services and to make progress on critical issues such as providing more affordable housing and combating homelessness.

City leaders have known since last year that tax collections for 2016 would not be enough to pay all of our bills. DC’s Chief Financial Officer reported last week that taxes are now coming in a little higher than expected – by about $40 million – but that still leaves the city $200 million short of what is needed to fund services, from public safety to libraries to job training. That gap is about the size of the Fire and Emergency Medical Services budget.

Beyond that, Mayor Bowser has committed to addressing important challenges, especially affordable housing and homelessness, and she faces rising costs in areas such as Metro and possible school enrollment increases. These create an even larger gap between expected revenues and the services that the mayor wants to provide.

How Mayor Bowser addresses these challenges will have a big impact on us all. Will DC public schools and public charter schools have to make cuts? Will we be able to start closing down the troubled DC General homeless shelter? Will police, firefighters, and libraries have the resources they need to serve DC residents well? Will parents have a robust set of summer recreation options for their children?

 A cuts-only approach would hurt efforts to continue to make the city attractive to residents and businesses, and it would limit Mayor Bowser’s desire to address growing inequality in DC.  That’s why she should look for ways to raise additional revenues and limit the need for damaging cuts.  

  • Use Last Year’s Surplus: The District set aside over $1 billion in savings over the past four years, bringing our fund balance to a record high. Using some of the recent $200 million surplus could support a range of one-time investments, such as helping families facing eviction or utility shutoffs, helping moderate-income residents buy their first home or adding to library collections.
  • Find ways to raise additional revenues. At recent forums held by Mayor Bowser across the city to get input on budget priorities, many residents voiced support for raising taxes if that is needed to maintain funding for top priorities like education. 

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Making Sure DC Residents Keep Benefits That Help Them Stay Healthy

March 9th, 2015 | by Wes Rivers

The District could do a lot more to ensure that residents have health benefits that connect them with services that will truly improve their health. That’s true even though DC is a national leader in expanding health insurance and the vast majority of the District’s low-and moderate-income residents have health insurance as a result of DC’s Medicaid and Healthcare Alliance programs.

To be sure, there are important signs of progress. The Department of Health Care Finance is implementing technology to make it easy to apply for and renew health benefits, including online applications. Many Medicaid beneficiaries can now “passively renew”– meaning they never have to complete any paperwork or visit a service center. The Department also is sharing more information on the health services provided by Medicaid Managed Care Organizations (MCOs) – the three companies that cover most of DC’s Medicaid recipients – by publishing a quarterly report on the programs’ performance.

Still, there is a lot of work to be done.

Making it Easier to Get Health Coverage: About 1,000 households recently lost their Medicaid coverage because they were not able to renew passively and because they did not complete the complicated renewal form. The Department needs to increase collaboration with the MCOs, advocates, and others to reach out to these residents so that no one is left out of this new system.

Many residents also face challenges in enrolling in the DC Healthcare Alliance program. The District requires participants to come in every six months to maintain eligibility, which is hard for anyone with a job and parents with young children. It also increases the volume of people at social service centers, which leads to long wait-times, delayed processing of applications, and gaps in benefits. The Department could help by requiring interviews just once a year and by allowing residents to renew in a community environment, like at their neighborhood health centers.

Improving the Quality and Efficiency of Health Services. All three MCOs contracted by the city need to do a better job of connecting residents with health services. The new performance reports show that primary care visits are down among adults, and that only a small number of residents are getting case management for chronic conditions like diabetes, asthma, or heart disease. What’s worse, the MCOs spent $34 million on avoidable costs like emergency room visits for routine care and avoidable hospital readmissions.

The District is in the process of setting new performance benchmarks for the MCOs. Those should be tied to things that are known to improve the health of beneficiaries, especially for those in need of case management. The Department should then step up its enforcement to seek real performance improvement from the MCOs.

To read a full copy of our testimony for the Department of Health Care Finance, click here.

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Using Data and Evaluation to Improve DC’s Education Programs and Services

March 6th, 2015 | by Soumya Bhat

Today, DCFPI is testifying before the Council Committee on Education about the performance of the Office of the State Superintendent of Education (OSSE). Highlights of our recommendations are below, and you can read our full testimony here.

Explore the adequacy of services to students who are homeless: Given DC’s family homelessness crisis, providing educational continuity to homeless students is critical to ensuring that all students can succeed in school. Are children who are homeless being identified? Is the city doing enough to help homeless students get to their school of origin if they want to? The city should assess the capacity of homeless liaisons at schools, ensure the state level coordinator at OSSE is able to effectively support liaisons, and that transportation and other direct supports to students are adequate. 

Continue to engage the public and release data on issues facing the District’s education system: Last year, DCFPI testified on the value of the Statewide Longitudinal Education Data System (SLED) to inform education policy decisions, urging OSSE to develop a more systemic, streamlined way to engage with the public and respond to data requests. Since then, OSSE’s Division of Data, Assessment, and Research staff held meetings with community organizations to share their research agenda and also better understand the data and research priorities of the larger community. We hope this work continues in the next year.

Evaluate the Community Schools pilot program to highlight the program’s impacts: Community Schools use public schools as central hubs for students and the larger community to access integrated services and supports. There are currently six grantees operating Community School partnerships in the District. Ultimately, the District should expand the program, but right now, we should prioritize data collection and evaluation of the model. The city should collect information on key indicators such as school readiness, student attendance, adult education, and families’ access to key services to assess the impact of Community Schools. This will be particularly important to attract additional funding from non-public sources, but also to show District leaders the impacts on student learning, health, family engagement, and other outcomes over time.

Maintain the focus on child care quality, particularly for infants and toddlers: DCFPI would like to hear about progress made with OSSE’s new quality improvement “hubs” in high-need DC neighborhoods, an initiative funded in the FY 2015 budget that has our support. During oversight, we would like to learn more about how this work is leading to increased access to quality child care in the District.

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On March 19th, Come to DCFPI to Learn What’s in Store for the Fiscal Year 2016 Budget!

March 4th, 2015 | by Ed Lazere

With just a few weeks before Mayor Bowser releases her first budget on April 2, join DCFPI for a forum on March 19 on what you can expect in the fiscal year 2016 budget!

Mayor Bowser has made important commitments to invest in affordable housing and address homelessness. Yet the city faces a large shortfall – there isn’t enough money to maintain current support for schools, health care, and DC’s other important services.

What will the mayor do to ensure that residents and businesses continue to get the services they rely on in the face of these challenges? DCFPI has invited key DC government finance leaders to help understand the city’s financial situation and how that affects the upcoming budget.

Matt Brown, Director, Mayor’s Office of Budget and Finance

Jennifer Budoff, Budget Director, District of Columbia Council

Fitzroy Lee, Chief Economist, Office of the Chief Financial Officer

The forum will be held Thursday, March 19 at 9:30 a.m. at DCFPI, located at 820 First Street NE (near Union Station Metro). Coffee and pastries will be available starting at 9:00 a.m.

Please R.S.V.P to Francine Richards at frichards@cbpp.org.

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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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