Testimony of Jodi Kwarciany at the Public Hearing on B22-194, “DC Healthcare Alliance Program Recertification Simplification Act of 2017″ April 24, 2017

by Jodi Kwarciany | June 6th, 2017 |

Chairperson Nadeau and other members of the committee, thank you for the opportunity to testify today. My name is Jodi Kwarciany and I am a Policy Analyst at the DC Fiscal Policy Institute. DCFPI engages in research and public education on the fiscal and economic health of the District of Columbia, with a particular emphasis on policies that affect low- and moderate-income residents. I am also part of a coalition of stakeholders interested in improving access in the DC Healthcare Alliance program.

I am here today to speak in favor of B22-194, the “DC Healthcare Alliance Program Recertification Simplification Amendment Act of 2017,” and to encourage the Human Services Committee to continue identifying strategies that will improve health access and outcomes for the DC residents that the Alliance is intended to serve.

DCFPI has long support efforts to simplify the recertification process within the Alliance program. We share concerns with many local organizations about eligibility requirements instituted in 2011 that have affected Alliance enrollment and access to care. Since then, DC residents participating in the Alliance have been required to visit an Economic Security Administration service center every six months to re-certify their eligibility.  The new requirement was followed by a rapid decline in enrollment, from roughly 25,000 beneficiaries to 15,000 beneficiaries in one year. Alliance participation has not changed much since then and now stands today at 15,300.

Improving access to the Alliance is important because the uninsured rate for DC’s undocumented immigrants, who are eligible to receive coverage through the Alliance, stands at 13.4 percent, or about three and a half times our District-wide average of 3.8 percent. This means we are still not reaching many eligible individuals.

The Alliance Recertification Simplification Act would address this by allowing Alliance participants to complete their six-month recertification over the phone or by visiting an authorized community health provider.

This legislation would will improve the current process and improve program outcomes in four key ways:

  • It will make it easier for eligible beneficiaries – especially those who work and/or have young children – to maintain their benefit. About 33 percent of Alliance participants do not re-apply at the six-month period, and at the 12 month period, nearly half do not. This seems clearly connected to the barrier of the recertification process. Completing recertification often requires arriving at an ESA center hours before opening to stand in line, or going several times to complete one re-certification.
  • It may help alleviate rising per-member costs and improve health outcomes. It appears to be the case that many residents only sign up for the Alliance when they are in high medical need, meaning that they avoid regular and preventive care. Per-member monthly costs for Alliance members grew by 22 percent in 2016, compared to a 6 percent increase for adults in our Medicaid program. By making it hard for residents to get health coverage, we have to be conscientious of the costs we’re potentially shifting to our emergency rooms.
  • It will reduce the strain on Department of Human Services. Data collected in 2015 suggest that Alliance recipients make up one-fourth of service center traffic in a given month, even though they represent less than 10 percent of individuals in DC’s health insurance programs. While DHS is working to implement a business process redesign initiative, reducing volume at service centers will further help alleviate congestion and streamline processes.
  • It will send a more positive message to individuals of immigrant status about their place in the community. The District has long been known as a welcoming city for immigrants, including its designation as a Sanctuary City. However, it is difficult to encourage immigrants to take advantage of programs like the Alliance when the District imposes additional barriers to participation. Some applicants have described the enrollment process as confusing, intimidating, discriminatory, and inflexible.

For all of these reasons, we believe that the Alliance Recertification Simplification Act is a critical step for Alliance beneficiaries that will help address community needs. We hope that other strategies to streamline the application and recertification process more similarly to Medicaid, like switching to a 12-month renewal, will also be considered. We welcome opportunities to work with you further on this important topic.

Thank you for the opportunity to testify, and I am happy to take any questions.


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