To: The Honorable Christina Henderson, Chair, DC Council Committee on Health

Members of the Committee on Health

From: Patricia Quinn, VP of Policy and Partnerships, DC Primary Care Association

Re: Budget Oversight Hearing for DC Department of Health Care Finance

Date: April 5, 2023

The DC Primary Care Association (DCPCA) works to build a healthier DC by sustaining community health centers, transforming DC care delivery, and advancing racial and health equity. Our collaborators in this work include community health centers, serving almost 1 in 4 District residents in every ward of the city; District government agencies including the Department of Health Care Finance (DHCF), DC Department of Behavioral Health and DC Health; as well as other providers in the DC health ecosystem. Thank you for the opportunity to provide testimony regarding the budget for the District of Columbia Department of Health Care Finance (DHCF.)

DCPCA’s greatest concern for community health centers and the patients they serve in 2023 and 2024 is the impact of the end of the Medicaid continuous coverage provisions implemented at the start of the COVID-19 pandemic. Using data from the US Health Resources and Services Administration (HRSA) 2021 Uniform Data System (UDS),[1] the Geiger Gibson Program in Community Health at George Washington University estimates the revenue losses for the District’s community health centers as between $12.9M and $24.2M. As a result of the revenue decline, health centers will lose capacity to serve between 6,500 and 12,300 patients. The lower bound estimates account for the fact that some of those who lose Medicaid coverage may gain other insurance.[2]

The projected coverage and revenue losses will have significant impact on the District’s drive for health equity. Seventy percent of people served by our members identify as Black; 36% identify as Hispanic or Latino/a, and 67% of our patients have incomes below 100% of the Federal Poverty Level; 87% below 200% FPL. Thirteen percent of health center patients identify as lesbian, gay, or bisexual, and 2% are transgender. Over 11,000 health center patients are homeless. DC’s community health centers are the cornerstone to reaching and serving the highest priority populations in the quest to give every District resident a fair shot at a full healthy life.

A second area of fiscal pressure on the District’s community health centers is the loss of an enhanced rate for their fee-for-service patients put in place to mitigate pandemic impacts. This rate will revert to a utilization-based rate.

DCPCA urges the Committee on Health to support the following actions to mitigate the impact of Medicaid coverage losses and ensure that every District resident eligible for Medicaid retains coverage, and that those no longer eligible find safe harbor through Alliance coverage or affordable commercial insurance:

1. Create direct, fast-track access between health center staff supporting patients through the enrollment/redetermination process and the District staff who can assist them in addressing system issues. This maximizes the human capital we are collectively investing in making sure our residents maintain coverage.

2. Co-locate District employees responsible for managing Alliance and Medicaid redeterminations at community health centers. This was often utilized pre-pandemic to increase efficiency and improve service.

3. Monitor rates of coverage losses, subsequent health center revenue declines, and impacts on health center capacity, and be prepared to put holds on removals from the Alliance and Medicaid rolls if redetermination/enrollment system issues are at fault.

As we confront the potential loss of significant revenue and the subsequent loss in patient care capacity, timely payment of existing Medicaid Managed Care claims becomes even more critical. DHCF has the power to hold MCOs accountable to improve the functioning and sustainability of a comprehensive, coordinated system prepared to meet the needs of high priority District residents. Additionally, DHCF can support standardization of processes such as billing, credentialing, and prior authorization to reduce provider burden and delays in patient care. We can work together to improve payment and credentialing systems so we can all fully focus on ending persistent, pervasive inequities that drive disparate health and well-being in the District.

DCPCA believes we have strong DHCF support to utilize tools that maximize capacity and efficiency, and we look forward to the Department’s partnership to protect health center patients and maintain health center stability.

1 https://data.hrsa.gov/tools/data-reporting/program-data/state/DC/table?tableName=Full

2 The Potential Effect of Medicaid Unwinding on Community Health Centers | Geiger Gibson Program in Community Health | Milken Institute School of Public Health | The George Washington University (gwu.edu)