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 to testify in support of the Department of Health Care Finance’s (DHCF) efforts to obtain stakeholder feedback when defining Medicaid eligibility and enrollment processes under the new DC Access System. I would also like to urge the importance of streamlining the DC Healthcare Alliance program’s enrollment and recertification processes into this system, so eligible residents can get the health services they need.
The DC Access System is a District health reform initiative that coordinates Medicaid eligibility and enrollment with the DC Health Benefits Exchange and other social programs such as food stamps and Temporary Assistance for Needy Families. The system creates a “no wrong door” approach to our health and safety-net programs, using federal and local data hubs to verify eligibility for multiple programs at a single point of entry.
DCFPI supports Health Care Finance’s efforts in obtaining community-based organizations’ feedback to design the system and develop new Medicaid eligibility rules. In particular, as we streamline and coordinate eligibility and enrollment processes for our health programs, DCFPI urges DHCF and the Council to consider aligning Healthcare Alliance’s recertification rules with those of other programs in the DC Access System. As it stands now, Alliance will be included in the DC Access System in October of 2014, but will still have a six-month face-to-face recertification ‘instead of the annual renewal required my Medicaid. The recertification rules were put in place to deter non-DC residents from taking advantage of the program, but enrollment declines have been far more significant than what DHCF originally projected ‘ with 2012 enrollment dropping by nearly 8,000 cases or one third of the caseload. This trend suggests that frequent recertification is creating barriers to participation among eligible residents, many of whom are working and unable to leave work for frequent in-person interviews.
Community-based organizations also report that their clients have difficulty because there are only a limited number of staff members handling recertification. DHCF reports that office visits and wait times have increased at service centers, especially at the Taylor Street and H Street centers that serve a majority of the Alliance caseload. The limited staff and frequent verifications strain the ability of eligible residents to maintain coverage. Moreover, missing a recertification prevents providers from receiving reimbursement for services rendered, making it more difficult for those providers to offer services needed by this population.
DCFPI supports two mechanisms that can help eligible residents enroll and maintain Alliance coverage, while also preventing non-DC residents from taking advantage of the program. First, the District should use existing community-based assistance to help verify residency and eligibility for the Alliance. DHCF already funds community outreach workers who help residents get through the applications process, and the Health Exchange will soon fund assister organizations to do similar work. DHCF can use such community assistance workers to verify District residency and eligibility, as they already have access to the population and the needed cultural and linguistic competency.
Secondly, Alliance recertification should be done on an annual basis, aligning with other annual renewals on the DC Access System. Not only will this reduce barriers for eligible residents to enroll, it also will relieve strain now faced by intake staff. Fewer visits and shorter wait times will help working residents maintain services under time constraints and free staff to focus on more complicated cases. Furthermore, the coordinated eligibility system will reduce the number of non-residents accessing the program because it can pull from existing local data hubs to verify residency.
DCFPI thanks DHCF for their leadership in aggressively implementing our streamlined eligibility and enrollment system, and we look forward to working with staff and Council to ensure that the Alliance Program fits with our coordinated health and human service delivery.
Thank you for the opportunity to testify and I am happy to answer any questions.