Last week, the mayor hosted the Virtual 2021 Budget Engagement Forums, an opportunity for DC residents to tell the mayor’s office what values they want to see reflected in this year’s budget. Bread for the City, as a member of the DC Healthcare Alliance Coalition, called on the mayor to fund a simple but essential improvement to DC’s low-income immigrant health insurance program. We want the mayor to change the DC Healthcare Alliance recertification period from six months to one year.

The DC Healthcare Alliance program is a locally funded program that provides health insurance to low-income immigrant residents of DC who are ineligible for Medicaid. DC Healthcare Alliance – often just called “Alliance” – resembles Medicaid in many ways. The income limit is roughly 200% of the federal poverty level, the program is administered through managed care organizations, and people apply for it through the DC Department of Human Services. Some important differences stand out, however, DC Healthcare Alliance recipients need to recertify for their health insurance in person every six months. Established in 2011 as a cost-saving measure, this requirement is far more restrictive than Medicaid recertifications, which are annual or are even conducted automatically. While the Department of Health Care Finance has suspended the recertification requirement for public health insurance programs during the COVID-19 Public Health Emergency, now is the time to fund the transition from a six month to an annual recertification for Alliance.

An annual recertification would drastically reduce barriers low-income immigrant residents face accessing health insurance in DC. The six-month recertification for Alliance is an example of an “administrative burden” – a policy that heaps more paperwork onto the shoulders of individuals and local agencies in the name of means-testing. The burden manifests in many ways. Alliance recipients may need to take off work twice a year, find childcare, and prepare to wait for hours in a line stretching around the block. (1) Other people who are eligible for Alliance may forgo recertifications. In years past, less than 60% of Alliance recipients due for renewal ended up re-certifying, leaving eligible residents uninsured when unexpected medical expenses arose. (2) The six-month recertification also leaves the DC Department of Human Services with organization burden. Service center workers need to process twice as many recertifications for Alliance with the six-month recertification as opposed to the proposed 12-month recertification. This additional interfacing between Alliance recipients and the agency leaves more room for error, bad service, and language access mishaps. The burden of a six-month recertification likely hinders DHS administering other public benefits as well – including SNAP, TANF, and Medicaid.

Mayor Muriel Bowser has chosen the hashtag #FairShot for her 2021 budget and has committed to “Give Every Washingtonian a Fair Shot.” Aligning the DC Healthcare Alliance recertification period with Medicaid by changing it to an annual recertification would be a concrete step to giving low-income immigrant residents of DC a Fair Shot at health insurance, which is so vitally important during a public health emergency. The DC Council has taken major steps to improve the DC Healthcare Alliance recertification process. In the fall of 2020, the Council passed a bill providing for Alliance annual recertification but has not had the opportunity to fund the change yet. The Mayor has the opportunity to collaborate with the Council to show that she means business when it comes to the health of DC’s immigrant residents. Investing in essential changes to health insurance programs like Alliance and addressing social determinants of health like housing, food access, and a clean environment shows that DC’s leaders value the health of its residents.  Mayor Bowser, let’s fund annual recertifications for Alliance!

(1) See page 3 of Legal Aid Society of DC’s March 29, 2019 testimony at the Budget Oversight Hearing Regarding the Department of Health Care Finance at https://www.legalaiddc.org/wp-content/uploads/2019/03/Legal-Aid-FY20-DHCF-Budget-Testimony-FINAL.pdf

(2) See https://www.dcfpi.org/all/no-way-to-run-a-healthcare-program-dcs-access-barriers-for-immigrants-contribute-to-poor-outcomes-and-higher-costs/#_edn1