Testimony of Wes Rivers, Health Policy Analyst, At the Public Hearing on the Fiscal Year 2013-2014 Performance Oversight Hearing for the DC Department of Health Care Finance

Chairwoman Alexander and other members of the committee, thank you for the opportunity to testify today. My name is Wes Rivers, and I am a Health 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 the chair of the Medical Care Advisory Committee (MCAC). 

I am here today to applaud and thank the Department of Health Care Finance for their part in providing access to healthcare for the District’s lowest-income residents. DC has led the nation in implementing the Affordable Care Act, and DHCF continues to improve the scope and reach of DC’s Medicaid program. I am also here to share a few areas where I believe the Department can improve their performance and outcomes — including coordination with other health reform agencies, planning for future needs related to the ACA, and information sharing with consumers and the community. 


As you know, in October of last year, the District began an overhaul of its entire public benefits IT system, including the implementation of DC Health Link and sweeping changes to the Medicaid eligibility and enrollment processes. Three agencies are overseeing this transition — Health Care Finance, the Health Exchange Authority, and the Economic Security Administration of the Department of Human Services. While this process has been relatively successful when compared to many states, IT snags, delayed implementation timelines, and inadequate staffing have caused Medicaid and Healthcare Alliance consumers many problems when applying for or renewing benefits. Problems include long wait-times at service centers, delayed processing of applications, and even inappropriate termination of benefits. 

While staff from all three agencies acknowledged problems, no clear solution emerged. Moreover, client inquiries by legal service providers were met with differing answers depending on the agency asked. From a consumer representative standpoint, it seemed there was no systematic, coordinated effort by participating agencies to address eligibility and enrollment issues.  

I applaud Health Care Finance for taking a leadership role on this issue by delaying Medicaid renewals for the first half of 2014 and moving toward a passive renewal system. However, a more coordinated communication and planning process is needed for the agencies involved with health reform. As I mentioned before, the District is only in the early stages of overhauling its public benefits systems, and IT and staffing issues will persist. A more coordinated and transparent partnership is needed, so that all agencies are aware of problems when they arise and can address issues in unified action. As the agency tasked with policy formulation for the Medicaid program, DHCF could facilitate these efforts between these agencies.  

Planning and Capacity

With many changes to Medicaid presented by the ACA, it is important that Health Care Finance have the capacity to both write state plan amendments needed for immediate functionality of Medicaid and plan for coming changes to regulations, programing, and federal funding levels. I applaud the policy staff at DHCF for their dedication in completing SPA’s over such a short period of time, while maintaining foresight on many of the issues coming in future years. For example, staff are already performing analyses to determine how best to cover our childless adult waiver population once the waiver expires at the end of 2015. Both the Exchange and Health Care Finance staff have identified that undocumented residents with incomes just above the Alliance eligibility threshold lack health insurance options in DC after 2014, and are working on potential solutions.  

Issues of coverage are important, but DHCF also needs capacity in planning for and evaluating reforms that address quality issues and rising Medicaid costs — including new payment and delivery models. Combined with improved coordination with other health reform agencies, DHCF can drive innovative reforms that improve the quality of care residents receive. The agency has already added a staff member who will focus on this work, and I hope they continue to build capacity in these areas. 

Information Sharing

Health Care Finance made some progress this year in increasing the transparency of the Medicaid Managed Care program by publicly releasing the MCO Quarterly Performance Report. The document helped the agency and community stakeholders better understand areas in need of improvement, such as MCO spending on behavioral health services and low admission into care coordination and management programs. 

However, data and program transparency of this nature is not present in all aspects of the Medicaid and Alliance programs. For example, after several inquiries, Health Care Finance has not made public the numbers of Medicaid and Alliance enrollees who attempted to recertify, successfully recertified, or were terminated during the eligibility and enrollment system transition in the last quarter of 2013. These figures could have aided stakeholders and the agency better address application issues cited before. Another example is budgetary information on historical local spending levels for Medicaid and factors that contribute to growth in annual current services funding levels. As MCAC Chair, I look forward to working with Health Care Finance to increase the transparency of data and program information, and I hope we can work together to make agency information more accessible and digestible for consumers.      

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