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: Performance Oversight Hearing for DC Department of Health Care Finance

Date: February 16, 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 work of the District of Columbia Department of Health Care Finance (DHCF.)

DCPCA’s partnership with DHCF is robust and effective. DC Primary Care Association is grateful for the work of DHCF to support health center sustainability throughout the COVID-19 pandemic and beyond. Their actions on payment models and telehealth remain central to health centers’ ability to meet patient needs despite unprecedented workforce challenges. From our long-standing alliance to develop the DC HIE (health information exchange) and ever-advance its capabilities, to new collaborations to advance health equity and amplify beneficiary voice, DHCF is a committed, transparent, and valued partner.

As the District further invests in a managed care organization (MCO) approach, and as the carve-in of new behavioral health services brings new providers into MCO systems, the need for DHCF oversight of MCOs grows. 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. We encourage DHCF to support standardization of processes such as 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.

Without a doubt, DHCF plays a central role in the District’s push toward health equity, but health equity will not be achieved through clinical care alone. Recognizing this, DHCF is leading the nation in leveraging CMS dollars to build capacity for robust social needs screening and community referral. DHCF should build upon this work and lean in to new opportunities offered by CMS to explicitly address health-related social needs via 1115 demonstration waivers or through the use of “in lieu of services” (ILOS) options. We fully support this effort and encourage DHCF to pursue this funding opportunity.

When we address the opportunities to build a health system that has equity as its foundation, we must consider how we invest in the providers serving our highest priority residents. Since at least 2009, providers serving Alliance patients have not had any increase in the MCO per visit payment rate of $95. Our health centers are not willing to hold beneficiary care hostage to negotiate higher payment rates with the MCOs. We need support from the Council and DHCF to fund and establish a rate that comes closer to costs, and acknowledges changes since 2009.

As DCPCA supports health centers and their patients emerging from three years of the COVID-19 pandemic, we are particularly concerned about the restart of recertification requirements for beneficiaries of Alliance and Medicaid. Since the Alliance program began redeterminations, the number of those insured by the program has declined precipitously. We know the ESA has struggled to keep pace with the paperwork to complete recertifications. We appreciate ESA’s efforts to increase staffing, but we may need DHCF to halt disenrollment if the backlog cannot be cleared. The exponentially larger Medicaid population begins recertifications this spring. Coverage losses due to delays could have devastating impact on community health centers and their patients. Additionally, beneficiaries who are no longer eligible for Medicaid will require significant support to find new coverage options through the Alliance or on the Health Benefits Exchange. We will need additional allocation of resources to respond to community enrollment support needs and a transparent view into system capacity and challenges to ensure District residents can access the health care benefits for which they are eligible. This will enable the District to maintain its high rate of health insurance coverage that is an example for the entire country.

DCPCA and our member health centers are grateful for the partnership of DHCF Director Wayne Turnage, Senior Deputy Director and Medicaid Director Melisa Byrd, Deputy Director of Finance Angelique Martin, and Director of the Health Care Delivery Management Administration Lisa Truitt, and their dedicated teams. We believe in our collective capacity to build an anti-racist health system that gives every District resident a fair shot a full, healthy life, and we stand ready to support the DC Council Committee on Health to engage in that effort.