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 here today to urge the Committee and the Department of Health Care Finance to reexamine recertification rules for the Healthcare Alliance program and to limit funding reductions for the program in FY 2014. The current rules ‘ which aim to protect the program from fraudulent use ‘ correspond with rapid enrollment decline, far more than anticipated when the recertification changes were implemented. We believe the rules are discouraging eligible residents from enrolling and staying on the Alliance, and we hope DHCF can align the Alliance eligibility process with other health programs on the new DC Access System. The Alliance program serves a particularly vulnerable population in the District and is in line with the city’s commitment to providing all of our residents with affordable health care.
For Fiscal Year (FY) 2014, DHCF’s proposed budget funds Alliance provider payments at $40 million, a cut of $2 million or 5 percent , over the FY 2013 budget after adjusting for inflation. This marks the second consecutive funding decrease to the program and correlates to a steady decline in enrollment, from 24,000 in September 2011 to 15,400 in November. The enrollment decline started when a new recertification policy was implemented, in FY 2012, that requires in-person interviews every six-months to maintain eligibility. Prior to that, Alliance recertification worked much like Medicaid, with annual renewals that do not require an interview.
The new rules were put in place to limit fraudulent use among people who were ineligible for the program ‘ particularly non-District residents. Yet it appears that the recertification process is also limiting participation among DC residents who are eligible.
Health Care Finance originally projected that the policy would decrease enrollment by 5,000 people. However, actual enrollment decline has been 8,600 people, more than two-thirds higher than expected. DCFPI is concerned that the policy is affecting eligible residents’ ability to enroll and maintain coverage. Frequent in-person recertification presents significant obstacles for many residents, particularly working families under strict time constraints. National research suggests that when application or re-certification processes become more challenging, participation among eligible participants can drop sharply. Both providers and DHCF report that office visit wait times have increased at service centers where the majority of Alliance enrollees recertify. Moreover, community-based organizations report that there is a limited number of staff handling recertification and there are even fewer with needed foreign language competency.
DC Fiscal Policy Institute calls on DC Council to consider three mechanisms that may help eligible residents enroll and maintain coverage, while also preventing abuse by non-District residents. First, if the six-month recertification policy is to continue, we ask the Council to reallocate a portion of the proposed $2 million cut from Alliance provider payments to fund more recertification staff at the Department of Human Services. This will help eligible enrollees get through the recertification process with greater ease and help working families maintain coverage under tight time constraints.
Second, we ask that the District use existing community-based assisters to help clients through the recertification process. DHCF already funds community outreach workers, and some health care providers employ public benefit application assisters who help residents get through the Medicaid application process. Allowing these types of community organizations to assist with eligibility and recertification can help with staff shortages at service centers and address language and cultural competency issues.
Third, we ask the District to consider moving Alliance’s recertification to an annual basis like other programs on the DC Access System (DCAS) ‘ including Medicaid and Qualified Health Plans. The Alliance will be added to the integrated eligibility system in October of 2014, and DCAS will have the capability of verifying residency though multiple local data hubs. The data system will limit the ability of non-residents to access the program, reduce the number of times eligible enrollees need to visit the service centers, and free up staff resources for more complicated eligibility determinations.
Thank you for the opportunity to offer testimony. I am happy to answer any questions you may have.