In 2017, the D.C. Council passed two pieces of legislation to address longstanding problems in the D.C. Healthcare Alliance program. The program provides health insurance to some of the District’s most vulnerable residents but its burdensome process for renewing enrollment means that, each month, people in the program get dropped from their health coverage. Despite the Council recognizing the need to change the Alliance program and passing legislative solutions without a single “no” vote, the Mayor’s FY19 Budget does not include any funding for either piece of legislation, allowing needless losses of coverage to continue. This budget season, Legal Aid has testified at the budget hearings for both the Department of Human Services and the Department of Health Care Finance to urge the Council to do what the Mayor failed to do: work together to fund changes that Alliance program enrollees need.
The Alliance program provides health insurance to low-income residents of the District who are not eligible for Medicaid due to strict federal rules on eligibility for immigrants, including those who have Temporary Protected Status (TPS) or are in the Deferred Action for Childhood Arrivals (DACA) program. Although Alliance provides vital, life-saving services, the Department of Health Care Finance (DHCF) adopted a harmful policy in 2011 requiring all beneficiaries to complete an in-person, face-to-face interview every six months in order to keep their coverage. The Department of Human Services (DHS) is charged with implementing this requirement through its five ESA Service Centers, but Service Centers are plagued by long lines that prevent individuals from obtaining, and maintaining, public benefits. In January 2018, Legal Aid visited the Service Centers on ten different occasions and spoke with people waiting in line. We found that the earliest the first person lined up was 2:40 in the morning, and the latest the first person lined up was 4:12 in the morning. The shortest line when the Service Center doors opened was 26 people, and the longest line was 84 people. People have to line up early because they are often turned away due to Service Centers reaching capacity. The Service Centers’ failure to serve people who need support has been a problem for a number of years.
Extremely long lines and wait times at the Service Centers cause District residents who are eligible for Alliance to lose, or go without, coverage because the strict recertification requirements every six months are overly burdensome. DHCF’s data shows that 31% of Alliance enrollees who were terminated in FY17 re-enrolled within a year, thus proving that many eligible individuals are likely cycling on and off the program.
In December 2017, the Council passed the D.C. Healthcare Alliance Re-Enrollment Reform Act of 2017, which would repeal the current recertification requirement and replace it with an annual recertification schedule similar to what is already in place for Medicaid enrollees. The law would allow enrollees who need to recertify to complete the process at community health centers rather than going to Service Centers. Legal Aid believes that this law offers the most effective solution. Allowing beneficiaries to recertify once a year and complete interviews at community health centers would reduce barriers to coverage for consumers and ease the burden on service center resources (make service centers more responsive for everyone).
In October 2017, the Council also enacted the D.C. Healthcare Alliance Recertification Amendment Act of 2017, which would allow Alliance recipients to complete one bi-annual recertification interview by phone rather than in-person at the Service Center. Both bills were passed by the Council unanimously. The Council heard extensive testimony on both bills from the agencies, residents, and advocates in the District, and decided to act to protect Alliance participants from arbitrary coverage cut-offs.
The Mayor did not veto either law, but instead, simply proposed a Fiscal Year 2019 budget that includes no funding to implement them. The Mayor’s failure to fund the elimination or even modification of these burdensome requirements ignores the will of the Council and continues to place additional burdens on the District’s immigrant population, a population that is already marginalized and at risk under the current administration.
The District deservedly takes great pride in providing access to health insurance for the vast majority of its citizens, causing us to have one of the lowest uninsured rate in the country. Funding the Alliance bills would send a clear message that the District believes that all of its residents deserve access to healthcare, regardless of their immigration status, and that District residents should not lose that access because of bureaucratic obstacles. It is time to ensure that we live up to our goals of ensuring healthcare for all.