Good morning.

I'm at large Council Member Christina Henderson, Chair of the Committee on Health today is April 27th, 2026.

The time is nine thirty-four AM.

We are in room four twelve of the John A.

Wilson building.

I'm going to describe each of the agencies before we turn to the public witnesses.

So first, the Office of the Deputy Mayor for Health and Human Services supports the mayor in coordinating a comprehensive system of benefits, goods, and services across agencies to ensure that children, youth, and adults with and without disabilities can lead healthy, meaningful, and productive lives.

DMHHS provides leadership and policy planning, government relations and community and communications for agencies under its jurisdiction, including CFSA, the Department of Behavioral Health, the Department of Disability Services, DC Health, Department of Health Care Finance, Department of Human Services, and the Department of Aging and Community Living.

The Department of Health Care Finance provides health care services to low-income children, adults, and elderly persons with disabilities with nearly 290,000 district residents.

That's approximately 40% off of all DC residents who receive health care services of some sort through Department of Health Care Finance, Medicaid and Alliance programs.

Healthcare finance strives to provide these services in the most appropriate and cost-effective settings possible.

I don't see any of my council colleagues here, but we have a long hearing ahead of us, so we're going to get it go ahead and get started.

I just want to confirm for folks that each of our public witnesses will have three minutes to testify.

It's not because we don't want to hear from you, that it is just that we have a very long witness list today, and we'd like to hear from everyone.

If anyone, I know that there are some witnesses who require translation services, and you had to let us know beforehand.

We'll get to those individuals once they arrive, but I'm going to call the first panel of witnesses for those who are here in public in person.

Did the doctor just leave?

Okay.

Okay.

He just walked out.

I can send a message.

All right.

Um.

Okay.

So we're gonna go with who is good, Lord.

All right.

Uh Patricia Quinn.

Not at all.

Uh Patricia here.

Chris Gamble, he's here.

Who else is here?

I'm gonna have a lot of people who CEOs are very soon.

It's okay.

Liz Davis.

Is Jackie the one who's testifying?

Lord have mercy.

Jesus.

Okay, guys.

Um I know it's Monday.

I do try to start on time.

Okay, doctor, come to the table.

Let's let's let's go.

Yep.

All right.

Patricia, when you're ready.

I would be ready in about two hours.

No.

Good morning.

Thank you for the opportunity to testify.

Um, thank you, Councilmember Member Henderson, committee staff.

Um, Patricia Quinn.

I am the senior director of government affairs and policy for the DC Primary Care Association.

And we are here to discuss the FY27 budget for the Department of Health Care Finance.

As the district prepares to implement Medicaid work requirements, we urge a thoughtful approach that prioritizes continuity of care.

We are concerned about proposed reductions in Medicaid funding for childless adults, those most likely to be impacted by new requirements.

We ask to partner with DHCF on beneficiary communications and reiterate our request for presumptive eligibility authority to help keep eligible residents enrolled.

We also recommend a no-wrongdoor verification approach, low barrier documentation, such as self-attestation, and a clear and inclusive definition of medical frailty to help protect vulnerable patients.

Additionally, we asked the committee to lift the moratorium on DC Alliance adult enrollment as it effectively reduces access despite stated commitments to maintaining coverage.

We are already seeing early warning signs.

Preliminary data from the first six months of recent eligibility changes shows declines in Medicaid and Alliance visit volume across some health centers.

These losses are not fully offset by gains in other coverage categories.

This translates directly into reduced access to care and growing financial strain on providers.

Community health centers operate on thin margins and reinvest every dollar into patient care.

Decline in covered visits and subsequent revenue loss threaten day-to-day operations and long-term capacity.

The direction is clear.

Maintaining and restoring coverage is essential in preserving access and stabilizing the safety net system.

We urge the council to take immediate, concrete steps to stabilize the safety net, lift the moratorium on DC Alliance adult enrollment, protect coverage for childless adults, ensure Medicaid work requirements are implemented in a way that minimizes administrative burden and prioritizes continuity of care.

These steps are critical to preserving access for patients and sustaining health centers that serve as the backbone to care in the district.

To steal a quote from a national advocate for community health centers, primary care is the best part of the health system, and health centers are the best part of the best part.

Thank you for your leadership, and I welcome any questions.

Thank you.

Mr.

Gamble.

Good morning, Chairperson Henderson and members of the Committee on Health.

My name is Chris Gamble, and I'm a behavioral health policy analyst at Children's Law Center.

Thank you for the opportunity to testify today about the proposed FY27 budget for the Department of Healthcare Finance.

After an incredibly challenging year for the Medicaid program, it was good to see some stability maintained by preventing some of the expected changes to Medicaid and Alliance eligibility for the time being.

We know, however, that upcoming federal work requirements and new redetermination cycles will add to the likelihood of people losing coverage.

There are many cuts across the health sector's budget that concern us about how our clients will be able to receive quality services going forward.

We see the system pulling away from families by divesting from critical areas like school-based services and crisis response teams.

We need to take advantage of the opportunities available to invest strategically in the health system and create long-term benefits to care quality and health outcomes while also addressing some of the most pressing financial issues in the system.

We have been consistent in our advocacy for the carve-in of behavioral health services and to manage care because the complexities of the current financing system create too many unnecessary hurdles to quality whole person care.

Right now, the procedural web that payments for MHRS and SUD services have to go through leads to data gaps that keep MCOs from fulfilling their obligations to their members and ultimately make getting integrated care harder for DC residents.

Streamlining financing through the carve in will simplify payments and improve care coordination.

Through quality care coordination, overall health care costs can be decreased by reducing duplicative tests, medication errors, and use of emergency care.

It also improves the care experience itself and the treatment progress made on patients' physical and behavioral health conditions.

Within the current carved-out structure, the key function of responding to suspected billing fraud is partially taken on by DBH through a lengthy multi-step process of decertification.

From investigation through potential appeals and final adjudication, taking a bad provider out of the network takes too long.

Conversely, while DBH would still have decertification authority under the CARVIN, MCOs can simply choose to stop doing business with bad providers by depaneling them when investigations confirm fraudulent billing.

Earlier this year, Children's Law Center reviewed all of these known benefits in meetings with Budget Director Jenny Reed and Deputy Mayor Wayne Turnage and determined viable next steps for a path forward.

The last estimate given for the annual cost of the carve in was in early 2024, stated to be 13.7 million dollars.

While this cost may have changed in the past couple years, we propose that to initiate the carve-in, a quarter of the funding be provided as needed across DHCF and DBH for a July 1st, 2027 start date.

This will allow for implementation processes to begin and push the bulk of initial funding into the outyears.

Over the course of encountering several roadblocks since the initial carv-in start date of October 1st, 2022, the same problems persist, so the solution should still be pursued.

Thank you for the opportunity to testify, and I welcome any questions you have.

Thank you.

Alison.

Gotta hit the button in front of you.

Thank you.

Good morning.

My name is Alison Miles-Lee.

I'm a managing attorney at Bradford City.

I supervise Brad's public benefits practice.

We advocate for clients who encounter problems accessing public health insurance, among other things.

We are also a federally qualified health center, providing primary care to patients living with low incomes.

At the intersection of our legal and medical programs, I have witnessed firsthand the chaos that alliance cuts have caused.

We're relieved to see that the mayor's proposed budget restores dental envision coverage to alliance recipients, and that further anticipated cuts in the fall of 2026 will not happen.

But we remain concerned about the reduction in income limits from 215% of the federal poverty line to 138% and the moratorium on new applications for DC residents over 26 years old.

Due to the moratorium on new applications, we now have a fragmented alliance coverage landscape where individuals in similar circumstances are inconsistently either included or excluded.

I want to share the story of Pablo, a Bread for the City client, to demonstrate the profound karm caused by the moratorium on new alliance applications.

Pablo was brought to the US as a child and has lived in DC for most of his life.

He's a DACA recipient.

Pablo previously had alliance coverage, but it was terminated in October 2025 because his earnings were slightly over the new 138% federal poverty line cutoff.

In January 20 2026, shortly after he turned 26, Pablo developed severe upper gastrointestinal bleeding, which rapidly led to pneumonia and sepsis.

Though he was a relatively healthy young man, he was suddenly hospitalized, intubated, and fighting for his life without alliance coverage.

We're working with the hospital to ensure that they apply for emergency Medicaid for Pablo.

However, he desperately needs health insurance for follow-up care.

As a DACA recipient, he's ineligible for both Medicaid and the Healthy DC plan.

While Bredford the City can provide him with primary care as an outpatient, we do not offer specialized care.

Pablo's only option for receiving the specialized follow-up care he needs is through alliance.

Without the ability to obtain this critical care, we're deeply concerned about his future health and life outcomes.

This current health insurance system creates illogical distinctions.

For example, a 26-year-old like Pablo, who grew up in DC but was born here rather than brought here as a child, would be eligible for Medicaid.

A person in Pablo's exact situation who is 25 years old would qualify for alliance and would be able to re-enroll.

And if Pablo himself had become ill and lost his job before October 2025, he would still have alliance coverage today.

This lack of consistency is unacceptable if a health insurance system should not operate this way.

Maintaining alliance coverage allows individuals like Pablo to continue thriving in our community, contributing their work, and enriching DC's vibrant culture.

We urge you to remove the age moratorium, enabling Pablo and other qualified individuals to re-enroll in the Alliance program.

Councilmember Henderson and members of the committee, thank you for the opportunity to present my testimony.

We're grateful for your continued consideration of these important matters, and we do feel that you're listening and you're concerned about the clients that we serve.

Thank you.

All right, Dr.

Omar Joey.

Thank you.

Um, Chairperson Henderson and members of the council.

Good morning and happy Monday.

A little bit sleepy.

Um, thank you for the opportunity to speak today.

Um, my name is Dr.

Omar Tawe.

I'm a Lebanese American and queer resident physician at the George Washington Emergency Medicine Residency Program.

And I'm a proud right regional vice president of the Union Committee of Interns and Residents.

I'm reading off my phone, I apologize in advance.

I'm here today to urge you very directly in my limited free time to restore full funding to the health care alliance to ensure meaningful access to this program.

I also urge you to do a number of things that my colleagues have already mentioned.

One is return the income eligibility to 215% of the federal poverty level, as we know, and to remove the age moratorium for all Washingtonians who meet the income requirements so that they can receive care when they need it.

So these cuts aren't like an abstract budget decision, to us at least.

There are real barriers that leave people sicker, families destabilized, and our people already stretched, including our health care system, even more strained.

From where my nursing colleagues and I stand in the emergency department, the impact on patients is real, and it can literally be life or death, as in Pablo's story.

When Washingtonians lose coverage, they don't just stop needing coverage or care.

Instead, they delay treatment until their conditions become life-threatening, and I have seen it firsthand.

I've seen patients with uncontrolled diabetes, like myself, type one diabetic, going months without medications necessary to take care of them, suddenly arriving in the emergency department requiring ICU level care because they weren't able to access their medications.

I've care for patients juggling multiple jobs, avoiding seeking care for chest pain and a simple EKG out of fear for the cost of the EKG, coming in with heart attacks.

I've also delivered cancer diagnoses to people who have continued to ignore symptoms for months on years simply because they were afraid of what the cost of seeing a doctor like myself in the emergency department would be.

This is not rare.

This is a daily occurrence.

And data backs up what we see in the emergency department.

Uninsured adults are 25% more likely to die prematurely than those with coverage.

And I'll say that again.

Uninsured adults are 25% more likely to die prematurely than those without coverage.

When Medicaid coverage expands, mortality drops by up to six percent.

That's not an insignificant number when we're talking about the lives of people and lives of fellow Washingtonians.

We can intubate, we can resuscitate, but we cannot undo months of delayed care caused by loss of access to insurance.

The DC Healthcare Alliance is a lifeline for tens of thousands of low-income DC residents who are not eligible for Medicaid, many of whom are immigrants, which I know you stand for the care very strongly of.

I Googled you right before this.

As the federal government turns its back on the death or on the health of millions of Americans, DC has the choice to either step up and allow our community members to get care or to suffer.

If we know that the lack of coverage leads to delayed care, worse care, and higher mortality, then restoring access is not optional.

It is essential.

I urge the council to reverse these uh cuts and continue safeguarding the health of our people who call this city home.

Thank you for your time.

Thank you.

Um thank you so much to this panel of witnesses.

Um of you I've seen already uh in this budget cycle.

I just have a couple of follow-up questions.

Ums Quinn.

Uh what conversations, if any, has the Primary Care Association had with Department of Health Care Finance about different payment mechanisms for managing the care of individuals who used to qualify for alliance.

Um we've gotten very robust data from the department about the Alliance population, the historic Alliance population, been able to begin to assess that data and identify opportunities with the department for FQHC-led care management that we think can significantly save dollars within the Alliance program.

Historically, the alliance does not have a good track record of care management that leads to those kinds of cost reductions.

Very, very low percentages of alliance beneficiaries who were hospitalized, were reconnected back to primary care, like in the single digits.

Um there's lots of studies and lots of data that says when you center that kind of care management in the hands of the primary care provider, the results, both in health outcomes and in cost savings, are robust.

And we are in the midst of those conversations with DHCF.

I think they're supportive of conceptually how do we lean in on provider-led care management.

But we're pushing for this lift of the moratorium because absent a viable alliance program, it doesn't make sense for the health centers to sort of shift into a different way of providing care to beneficiaries when that program is kind of collapsing in terms of the numbers.

Um we're hoping that you, between all of us, can we can get some good uh fiscal numbers for what would it take to reopen the program to adults?

Um I don't think the cost is going to be that high looking at data they provided last year.

Um we believe we can contain costs very effectively in that program, and we have the data to show it.

Yeah, I think um some of the challenges that we had.

There were multi-layered.

Um a document that some what were the credentials that someone could use to prove that they were actually a district resident, which was a little um it was very open.

Um and then, you know, we we know from some of the claims data around prescription drugs that there were individuals not in DC, very far away from DC who were submitting claims for prescriptions, but were part of the alliance program, if that makes sense.

Like, and you can sort of deduce you you are not actually living here because you're going every two weeks to this particular pharmacy that is almost an hour away.

Um so I think the question for us is um would any financial number be a solid one given uh we've already seen so many drops and and also not even yes, you're still eligible, but folks who are voluntarily taking themselves out or not no longer participating.

So I think in terms of where we are right now in the alliance, I think that attrition, we've seen that kind of disappear both from the income eligibility changes and other factors that are leading to people leaving the uh the alliance program.

So I think we could come up with a good estimate of how many people would re-enroll given the opportunity.

And if we don't do that, we're gonna continue.

The purpose is that you continually see the number of people who are covered shrink.

And that's just not a sustainable approach for the health centers.

Right.

They can dive in and do this work, but they need a stable program.

Okay.

Um, and just curious, uh in past testimony you guys have talked a lot about the connected care network and the work that you guys were doing with Wellpoint.

Uh is in past testimony you guys have talked a lot about the connected care network and the work that you guys were doing with Wellpoint.

What's the status of that?

So we have the contract with Wellpoint and Medicaid.

We have a contract with HSCSN, a value-based contract.

We are very anxious and interested in pursuing those contracts across the Medicaid program.

So including Ameri Health, including Med Star and even some work with United for the duels.

So we we're we think we are ready.

We've proven that we can manage um care and that we can reduce costs and uh you know your support for pushing forward with those approaches with the Medicaid MCOs is really helpful.

Okay, great.

Well uh I'm gonna try to be good on my own time clock as well.

So I don't have any further questions for the rest of the panel.

If you could make sure you can provide your testimony for us for the record if you haven't already done so.

Thank you so much for being here.

Okay, we're gonna go back.

Hope I've got some folks here.

No problem.

All right, uh Sonia Cruz are Aeroseli Gillian Salinas.

Of whose behalf, which great uh Zulima Ulo Jennifer Lopez and um Petra Reyes also meeting the public.

Okay.

Um Isis Osorio.

Okay.

Uh Sonia, when you ready?

You just gotta uh turn your mic on.

Sonia conduct.

This is the interpreter uh I just want to let them know and you know ask them to speak slowly and in short sentences so I can interpret everything completely.

No problem.

Okay, primero que todo bueno dias.

Hi, good morning.

My name is Sonia Cruz.

I am a mother of two daughters and a long time DC resident.

Aki in established.

I have raised my children here in this great city.

And we all benefit from the various supports and good schools that the city offers.

My children go to DCPS and I attend BRIA Public Charter School.

I can do many things in my life because I am in good health when I can attend school.

public charter school puedo hacer muchas cosas en mi vida porque tengo buenas salud cuando puedo asister asistir a la escuela i can do many things in my life because I am in good health when I can at a school puedo trabajar con mi compañeros que están aprendiendo inglés esto me permite my peers who are learning inglish this allows me sobre lo que está sucediendo en mi ciudad como ser a otros otros recursos y compartir mi propio recursos con los demás italos me to learn about what is happening in my city learn about other resources and share my own resources with others much de mis compañeros que asisten a brilla ptc también a dc alianza health alianza escucho sus historias sobre su hijo many of my peers who at also acces healthcare aliance i hear the stories about their children que están vanos y gracias a la atención médica gratuita ser recuperada se recuperaron se recuperan yo también me beneficio de ese alianza antes y me ha ayudado enorme enorme enormemente thanks to the free medical care they were nursed back to health i too benefit from this alien before and it has helped me tremendously alianza se aseguró de que tuviera un barazo saludable y mi hija ahora también ha que sido una quiere ser pedir pedir la pediatras y a la otras es una profesional en formación formación mesure that I healthy pregnancy and my daughters are now also grown up one wants to be a pedician and another one is an aspiring professional la atención médica es importante ayuda a que nuestro sueño se hagan realidad estoy aquí hoy en solidaridad con mi compañeros y mis comunidad health care is important it helps our dreams come true I am here today in solidarity with my peers and my community por eso respet respetuosamente respetuosamente les pido al consejo que eliminen el que el límite de edad para adultos mayores de veintiún años restablecen restablezcan el límite de ingresos al doscientos quince de nivel federal de pobreza pobreza restauren los servicios que existen ante el uno de octubre de veinte veinticinco pausa cualquier cambio adicional al programa alianza muchas gracias y gracias por la paciencia respectfully ask the council to remove the age limit for adults over twenty one restore the income limit to two hundred fifteen percent of the federal poverty level

That is why I respect respectfully asked the council to remove the age limit for adults over 21, restore the income limit to 215% of the federal poverty level, restore the services that existed before October 1st, 2025, post any additional changes to the alliance program.

Thank you, and thank you so much for your patience as well.

Thank you.

Okay.

For RSL.

Thank you so much.

Good morning.

I'm gonna read it in Spanish.

Is that okay?

Sure.

Okay.

Or you prefer in English.

I'm sorry to just save this some time.

In English is fine.

Either one.

Both will be submitted for the record, so either one.

Thank you.

Good morning.

Hello, my name is Araceli Guillén Salinas.

My daughter, my daughter and I both benefit are beneficiaries of DC Healthcare Alliance.

I am grateful for the health care benefit that also ensures that my daughter can access therapies for her special need without DC Alliance.

I do not know how to ensure I do not know how she can continue to progress in her development.

She attends DCPS and I am an English language learner at Bria Public Charter School.

Health insurance is a part of my life because when I have had emergencies and pneumonias, it has saved me.

And it is essential because in the case of an emergency, such as a chronic disease last like bronchius bronchiactasis, I need medical care.

Without DC Alliance, I would not be able to access this life-saving care and support.

I was hospitalized for Gallston in my bladder, and I couldn't have my surgery because I had pneumonia.

So I remained hospitalized until my pneumonia was under control while managing my gallstone pain.

While they were taking my blood pressure, my pulse was very low to be able to undergo surgery because to proceed with surgery, they would have to give me anesthesia, and it would lower it even more.

And if I start a treatment, the gallstone surgery would be postponed due to my pneumonia.

Every time I get the flu or some virus, the first thing that is affected is my lungs, because I already have one lung damage.

So the Golston surgery was postponed.

Everything was very complicated for the doctors.

Then three months later I had another colleague from same goldstone and I was hospitalized again, but this time I did not have the flu or cold, and I proceeded to have surgery.

Currently I have a future surgery for that lung, and we are only monitoring it for that reason.

For me, it is essential to have it so that I can take care of myself and take care of my girls.

It is our lifeline for our families with low income and some with chronic illnesses.

We are parent of child parents of children who needs us to be present to care for them and watch them grow healthy.

Thank you very much for having us today.

All right, Jennifer Lopez.

I'll be reading on behalf of Jennifer Lopez, but in Spanish because she wants to watch her her story online.

Can you please repeat the name?

Jennifer Lopez.

I have endobronchial lymphomas.

Which are benign uh long tumors that are not uh very common.

Due to the age limit of the DC Care Alliance, I do not qualify to apply.

This means that I do not have access to an affordable health insurance and I am worried about how am I going to receive the care that I need.

And to pause any additional change to the Alliance program.

I know what it's like to not have coverage when you are sick.

And we did go.

Such as death.

That is why I respectfully ask you to remove the age limit for adults over 21, resort the income limit to 500% of the federal poverty level, restore the services that existed before October 1st, 2025, and pass any additional changes to the alliance program.

Durante el día de mis hijos y yo vamos a la escuela para trabajar haciendo el creation de un futuro mejor.

During the day, my children and I go to school to work towards creating a better future for our family.

So los días.

Then I go to school to learn.

El Seguro de Salud.

Compartir me historia sobre DC Alliance.

DC Alliance.

I want to share my story about how DC Alliance has saved my life.

Soy diabetica contuviera seguro de salud.

Because I'm a diabetic, and if I didn't have health insurance, I wouldn't have insulin.

Because I'm a diabetic and if I didn't have health insurance, I wouldn't have insulin me ayuda a seguir contralando mi veles de azúcar my insulin helps me to continue to control my blood sugar levels in la sangre para poder y poder continuar cuidando de mis hijos and be able to continue caring for my children si salven mi vida la ball medico hoy no sería estaría aquí without this life saving medications and doctors visits I would not be here today todos de todos de veremos tener seguro para que nuestros salud sea buena para todos los communidad and see we almost have insurance so that our health is good for the entire community in DC nuestro nuestra salud is muy nuestra nuestra salud nuestra salud rique nuestra riqueza our health is our wealth por eso por eso repetimos respetosamente que eline el límite de para los de un años 21 años that is why respectfully ask you to remove the age limit for adults over twenty one respetosa restrable el número de límite de límite al doscientos quince de nivel federal de parta de pobreza restore the income limit to two hundred and fifty lostable los restaurant restaurar se servicio que existan antes de primero de octobre del dos mil veinticinco restore the services that existed before october first twenty twenty five pausing con qualquer qualquer cosa cambio de addicional a program alianza post any additional changes to the alliance program y muchísima gracias thank you very much to the span of witnesses um I think the I feel like we're gonna get I'm gonna be able to recite the last paragraph of everybody's testimony here uh by the next uh ten people that we get to but the repetition is good and your point is certainly getting across this creo que mos repetido el último parapho and las últimas personas pero es utile para saberlo um all right I don't have any specific questions for you all but thank you so much if you make sure you give us your testimony for the record no más preguntas para ninguno de vosotros pero asegura os que nos da os nos da is vuestro testimonio para el registro we're gonna go to the next panel thank you continuamos con el siguiente panel gracias gustavo anglo gloria chias or chicas maria vigillo serrara cabrera sorry and uh mercedes chami oh hold on who's who oh uh okay mercedes you have to go to the next one okay hola mi nombre es gustavo javier angulo olivero you gotta move the mic closer okay okay hola mi nombre es gustavo javier angulo livero hello my name is gustavo javier angulo olivero

Gustavo, you gotta move the mic closer.

Okay.

Hello, my name is Gustavo Javier Angulo Olivero.

I am 47 years old.

I'm a DC resident.

I'm an English language student at Bria Public Charter School.

I moved to the United States to escape violence from my home country.

Gracias, memorable for permit.

Thank you, Council members for allowing me to speak today in front of you.

I'm very happy to arrive to Washington DC.

It's a new life for me.

I also found out that there are so many helpful organizations to support me.

I was recovering from a physical trauma that I experienced prior to arriving here.

And even less the medication I needed.

I was very happy when I received my DC health insurance.

And I would like to encourage you to continue to find fund health care to ensure that everyone lives a healthy life in DC.

From my experience with insurance companies.

In spite of all these challenges.

And have a better independence.

Durante DC Health Care Alliance.

During the last years the DC Healthcare Alliance program.

That we faced.

Without this program, I don't know how we would have been able to receive the support that we needed.

That's why I would like to request you.

Families like mine depend on this support.

These changes would help to ensure de nuestra salud.

That mother such as myself would take care of our health.

And eventually to achieve economical stability to our families.

Sorry.

To be a good provider, and most of all to be a positive role mother to them.

All this can be achieved when I'm healthy and strong enough to speak for them when needed.

Healthy enough to share with them my culture that enriches our lives.

That's why I respectfully ask you to remove the age limit for adults over 26 years old.

Thank you very much.

Okay.

Mercedes.

Myrna Pedia.

Panita.

And uh Yadera Ramirez.

Okay.

Mercedes when you're ready.

The interpreter is virtual.

Mercedes con Felicia el interprete por Via Virtual.

Buenos días.

Mercedes Chocami, soy estudiante adulta in Villa Publica Church School y Madre de Dos Hijas.

Good morning.

My name is Mercedes Chigna.

I'm an adult student at Charter School.

I am the mother of two daughters.

One of them is 20 years.

They are my main motivation to keep on going.

I currently work half time.

Pero quiero trabajar tiempo completo para mejorar la situación economica de mi familia.

But I want to work full time in order to improve my family's financial situation.

However, I am concerned about losing my health insurance due to the age limit.

And losing my coverage would mean to put at risk my health and the health of my family.

And this is forcing me to choose between improving myself and try to maintain the health insurance.

And to stop any additional cut to the alliance program.

For me it is very important because I have hypothyroidism.

And this is a dangerous health issue that I will have for the rest of my life.

Soy Madre, Sposa E Studiante de Inglés in Bria Public Charlest School.

I am a mother, a wife and an English language student at Brigitte Public Charter School.

Every day I am grateful for the DC Alliance benefit that we can access.

Such as doctor care, speciality care and medications.

According to my doctor, if the gland called the thyroid does not work, all my organs will deteriorate within a maximum of one month.

My kidneys, liver, pancreas and other organs may suffer as well.

Thank you for listening.

Thank you.

My name is Myrna Torres Pineda.

I have two daughters that I am responsible for.

I want to make sure that I will be here to guide my daughters in their lives.

DC Alianza Vido Ami Familia Garantizar Kepueda Medica continua.

DC Alliance has served my family by ensuring that I can have continuous medical care and allows me to study at Briet Public Charter School.

I spent my days learning.

I spent my days learning English and hope to find employment someday.

When I am at home, I take care of my daughters and I share with them my hopes and dreams.

I believe that we all deserve a healthy life as human beings.

As you know, if we are not healthy, we will not be able to work.

When I arrived here, I needed many doctor visits to make sure that I was healthy.

My son Dennis needs his eyes check, dental care, and urine checkup.

As you know, then something as simple as an earache can cost hundreds of dollars for a visit.

I do not have the means to pay for it.

With DC Alliance, that would mean that I will be healthy and I will be able to go to school to learn English, learn to read and write better.

When I am healthy, I can help my son and pick him up from school.

I could help my mom with health work.

She is supporting us.

Thank you for letting me know that I matter and that my health is a priority for this community.

Thank you.

Thank you.

Thank you so much to this panel of witnesses.

If you can make sure you please provide your testimony for the record.

Oh, you can tell you my card, sorry.

Victor Lopez, Dina Gonzalez and Maria Hernandez.

If you're joining us virtually, you'll need to affirmatively accept our invitation to become a panelist.

There'll be a little box that pops up.

Yes.

Okay.

Okay, we see Victor.

So Victor, when you're ready.

Victoristo.

Yes, I'm ready.

Okay.

Uh good morning, council member, and thank you for the opportunity to testify.

My name is Victor Lopez, and I am an adult learner at Brias Public High School.

I am husband.

I am father of the two elementary age children.

And the primary provider for my family.

Every day I work hard to support my household.

And well, a better future for my children.

Being healthy is very important to me because my family depends on me.

If I'm not well, I cannot work.

And that puts everything at risk.

Programs like the DC Healthcare Alliance are critical for families like mine.

Without Alliance, I will not be able to afford perfect health insurance for my family.

The cost is simple too high.

And losing this coverage will create a serious artist for us.

But I need access to health care to do that.

That is why I respectful as the council to remove the age cap of adults 26 and older.

Restore the income limit to 250% of federal power level.

Restore the services that were available before October 1, 2025.

Those changes in your help to show that families like mine can stay healthy, keep working and continue contributing to our community.

Thank you for your time and for supporting families like mine.

Oh Dina, sorry.

Thank you for your attention and for providing us with a space to share our experience.

My name is Dina Actun.

So mad.

To have the DC Healthcare Alliance is a very important for my family because it's also important for the human life.

Enabling us to go to our annual checkups as well as a specialized screenings, as this was the case for me.

For problems, I underwent an endoscopy, a colonoscopy and an ultrasound.

Followed by surgery to remove my girl brother.

Without health insurance, I would not have been able to undergo all those diagnosis diagnostic tests, as I do not possess sufficient financial resources to do so.

I am deeply grateful for everything.

And I honestly hope that you our health coverage is not taken away, so that may continue with my prenatal checkups and to care for my baby.

During my previous pregnancy, I contracted Cito Megalovirus, a virus that's that possessed a serious risk.

Since it can adversely affect a baby in many ways.

And thanks to that health coverage, my son has been able to undergo hearing and vision screenings every six months.

Thank you for your attention.

Thank you.

Maria.

Maria?

Yes.

Buenos días.

Good morning, my name is Maria Hernandez.

I live in DC in zone number four.

And I'm someone who had many benefits.

I perform my job.

My deepest happiness is to take care of all the people in the city.

Ah, pero tenido muchos riesgos de salud.

But I went under several health risks.

Because I take care of other families and children.

Pero no tengo un segundo medicament.

But unfortunately, excuse me, I have no insurance for my job does not provide a health insurance.

And after I went to the hospital.

And I was concerned of not being able to pay the hospital costs.

And to see your loved one suffer.

And that's not easy because I experienced that myself as a mother.

You seriously esteuro volviera a la normalidad comante.

Muchas gracias.

And I would like the members of the council to put themselves in my place and see how would they react if they will see some loved ones suffering.

And that's why I would like to ask you this favor to have the conditions as they used to be before.

Thank you.

Thank you.

Thank you to this panel of witnesses I want to mention for Tina but I think she left already that um under the proposed budget prenatal care is covered for pregnant women.

For the entire pregnancy and then um two months postpartum are they must meses postparto okay all right we're gonna go to our next panel of witnesses thank you to the folks online.

Okay.

Uh troopd patel I saw true D oh okay Chioma and then online we have Nadia Casey Reginald Black Catalina Quintero and Sandy Carbal are you Sandy oh your Kentuck okay in person okay and you're Sandy okay great okay okay Chioma when you're ready okay good morning Chair Person Henderson and other members of the committee they may observe this later my name is Chio Mo Rue and I'm the Health Justice Project Director at Advocates for Justice and Education.

These are the families most directly impacted by the decisions before you today I am here representing the interests of these families of children with disabilities with many residing in wards one, four, five, seven and eight we have one of our ambassadors observing today and we have some questions that we hope that you address and others that may be observing online now or later.

Mayor Bowser's proposed budget reflects a city under strain roughly 700 million in reduced resources and over 450 million in rising costs including 172 in Medicaid pressures and the fracturing the entire DC health and human services infrastructure but the response cannot be to shift the burden onto families as cost rise, job stability declines and youth face increase in surveillance reducing investments in health and human services does not solve problems.

It compounds them our parents ambassadors are living this reality we meet weekly to unpack the challenges affecting their households in the critically unanswered questions from the Deputy Mayor and you know co also um the director of health care finance these must be addressed for alliance recipients requiring CAC level care what other pathways to home based services wrap around supports including medications especially for behavioral health regarding Medicaid work requirements for so called childless adults how will DHCF protect child parents of adult children with disabilities who are full-time caregivers but may not be recognized as such in eligibility systems is there a caregiver exemption and if so how will that be implemented for caregivers who are not designated as primary often fathers and again parents of adults with disabilities but are actively involved what are the work requirements for them for transition age youth over 21 who are not SSI eligible but have I high needs what are their care pathways and exemptions what happens when they age out at 22 or 27 and for immigrant families including undocumented caregivers, asylum seekers and new green card holders who haven't resided in DC for up to five years what are the pathways to coverage for those with disabilities especially as federal restrictions tighten and DC lacks a clear plan to fill these gaps.

And for immigrant families, including undocumented caregivers, asylum seekers, and new green card holders who haven't resided in DC for up to five years.

What are the pathways to coverage for those with disabilities, especially as federal restrictions tighten and DC lacks a clear plan to fill these gaps?

In the absence of clear answers, families are left navigating crises alone.

And where caregivers that are supported, our policy guided systems unfortunately default to the most expensive and harmless harmful responses hospitalization, child welfare involvement, and incarceration.

Because when DC fails to invest in the needs of caregivers, it's not just it's not just families who bear the cost, it's the entire system of which the proposed fiscal year 2027 budget makes no demand on the wealthiest of us and puts all the burden on the most vulnerable of us.

Thank you.

Thank you.

Lavia.

Okay.

Nadia, you didn't accept our panelists.

Um we're gonna have to go to the next person.

Uh Reginald Black.

Okay.

If you're online and your uh display name is not your actual name, it's a nickname, a user, an iPhone.

We we we can't promote you.

Um so if you could change that.

Uh well, they get that worked out.

Uh Catalina.

Yes.

Good morning, Ms.

Anderson and council members.

My name is Catalina Quinteros, and I am adult learning Abrilla Public Charger School and a mother.

I care deeply about my community, my community and the well-being of the families around me.

Abriya, I see every day how many of my classmates depend on the C Healthcare Alliance.

I have witnessed how important this program is for families who are working hard, raising children, and trying to be better futures through education.

Alliance is essential.

Medical bills can be because medical bills can be overwhelming.

Without this support, many families will not be able to afford care, the care they need.

This creates stress and uncertainty that make it harder for people to focus on their education, their work, and their families.

Alliance provides stability and peace of mind.

They allow families to stay healthy and continue moving forward with the without the constant fear of non-affordable medical cost.

That is why I am respectfully asked the council to remove the age cap for adults over 26, restore the income limit to 250% of the federal poverty level, restores the services that were available before October 1st, 2025, and stop any further cuts to the alliance programs.

Please continue to support programs that make a real difference in the lives of families and communities like mine.

Thank you for your time and consideration.

Thank you.

Sandy.

Oh, hold on.

There are too many mics on.

Chairman, can you train?

Okay.

Good morning, council members, and thank you for the opportunity to testify.

My name is Cindy Carbal.

Uh I was a I am a former educator for District of Columbia Public School.

I work until August for nine years teaching French.

But due to a situation with my visa, I had to stop working.

So I've been surviving all this situation with all the changes.

Right now, I decided to continue my studies in English to improve.

So that's why I'm attending BRIA school.

I'm an adult learner.

So my family is composed by three children.

One is in university right now.

She's on her second year here in the district as well.

And my two kids who attend public schools as well, second grade and kindergarten.

My house goes my husband is the only one working independently at the moment.

But what he gets in the morning is not enough to pay a private insurance.

So that's what I try to apply to alliance.

But due to the limit of the age of 26, I was not able to apply.

So I don't qualify.

And my kids as well, they don't have insurance.

I'm working very hard to get them the Medicaid as well because they were born in this country.

But my daughter as well, she is also waiting for an insurance.

So we are waiting for alliance, but we need alliance to please remove the age limit.

So my husband, my daughter, and me can afford to have it in the mid time.

We transition this situation and we get all our paperwork on back and track.

So it's difficult times.

It's been more than seven months with no insurance.

And I had to take some exams last month and mammogram with not very good results.

So it's like I need to be monitored, but I don't have insurance to be doing like ruffles and stuff to get the money to pay those exams.

So it's very sad because I'm not the only one.

I know many people like me are suffering the lack of insurance.

So this moment I am here respectfully asking the council to restore the income limit to 215% of the federal poverty level, remove the age limit for adults over 26, restore the services that existed before October the 1st, 2025, and is and please pause any additional changes to the alliance program.

These changes would help ensure the working families like me are not left without options and can access the health care.

We need to stay healthy and stable.

Thank you for your time and considering my testimony.

Thank you.

Did Nadia or Reginald join?

Okay.

All right.

Well, thank you so much to this panel.

I thought it was gonna be virtual, but you're right here in person.

Um if you could make sure you please provide your written testimony for the record.

Thank you so much.

Councilman, would you happen to have any answers to the questions posed in my testimony?

I don't at this time.

Okay, thank you.

Yeah, thank you.

Uh Nadia Casey.

Yeah, I know.

Yeah, I know Nadia.

Um, Hilary Caseur, Joshua Drumming, Jakia Carroll, and Jamila White.

These are folks all online.

Okay.

Um, so uh for our folks online, again, you have to affirmatively accept our invitation to become a panelist.

There'll be a little box that pops up on your screen that says, Do you want to be promoted?

And uh you gotta say yes.

And also, if you could change your name, please, so that we can at least send you an invitation to be promoted.

Okay, uh, we see Joshua, Mr.

Drumming.

If you're speaking, you're on mute.

Apologies, my videos acting up.

Uh, I'm sorry, could you circle back to me?

Um, you are the only one on this panel uh who appears to be here, so well uh I can speak and hopefully my video comes.

Or I mean I can go to uh a group of in-person folks and we can come back.

That works.

Okay, all right.

Um, Nancy Bann, Nasima Shafi, Benjamin Oldfield.

I know all of you guys are here, so like and Carlos Plazas.

Okay, Nancy, when you're ready.

Good morning, and thank you for the opportunity to testify on the fiscal year 27 DHCF budget.

I'm here today as CEO of Mary Center and a board member of the DC Primary Care Association and the DC Connected Care Network.

DCPCA represents community health centers serving one in five district residents across every ward, and the CCN is our clinically integrated network focused on aligning outcomes and containing costs.

For more than three decades, Mary Center has supported the health and well-being of tens of thousands of our neighbors.

Community health centers are the strong partner to Medicaid and represent one of the best values in the health care system.

In DC, health centers consistently outperform broader Medicaid benchmarks on measures like hypertension and diabetes control, as well as cancer screening.

This reflects a model built on access, prevention, and addressing the drivers of health before they become more costly problems.

If we want to build on the outcomes we're seeing today, we should take a closer look at how primary care is supported and paid for.

Alternative payment models can create the space for health centers to focus less on volume and more on outcomes, giving teams the flexibility to coordinate care, address social drivers, and spend more time where it matters most.

Other states like Oregon have begun to demonstrate how these models can support stronger primary care and reduce reliance on higher cost services over time.

A practical next step is ensuring that health center rates are appropriately rebased to reflect the current cost of delivering high quality primary care.

This will require adequate resourcing for DHCF, including the staff and technical support needed to do this work in partnership with providers.

Our outcomes are strong, our model is working, and the opportunity ahead is meaningful.

With the right alignment, we can continue to strengthen the system for Medicaid and Alliance patients and deliver more coordinated, high quality care for the district.

Thank you for your partnership.

Thank you.

Nasima.

Good morning.

Thank you for the opportunity to share a testimony on the FY27 budget for the Department of Health Care Finance.

My name is Nasima Shafi, and I'm the CEO of Whitman Walker Health.

I serve on the board of the DC Primary Care Association and also as chair of the DC Connected Care Network.

Our FQHCs deliver high-quality whole-person primary care to more than 150,000 patients, one in five residents across the District of Columbia.

Yet the care we provide represents a small share of the Medicaid investment in district and federal partners that district and federal partners make in health care for DC residents.

FQHCs and the CCN generate significant value by improving outcomes, strengthening care coordination, and reducing avoidable emergency use and hospitalizations.

We appreciate policymakers' continued focus on health care amid current unemployment and federal spending pressures that threaten access.

Through partnerships with the DC Connected Care Network, the district has an opportunity to address the long-standing challenges of cost growth while advancing a stronger primary care-centered system.

Realizing these gains will require greater alignment across payers and reduced administrative fragmentation that continues to burden primary care delivery.

As a Department of Healthcare Finance continues to advance coverage and payment strategy, we urge a stronger focus on managed care contracting as a key lever for scaling value-based care.

Progress has been made, but current managed care plan contracting structures remain inconsistent and do not fully support sustainable participation by FQHCs and the CCN.

We recommend the following.

Strengthen managed care plan contracting requirements to ensure consistent and meaningful participation and value-based payment arrangements with FQHCs and primary care providers, including clearer minimum expectations for alternative payment methods.

Second, explore payment innovations that support population-based care delivery, including prospective per-member per month approaches that allow flexibility for non-visit-based care, as we've seen in other states such as California.

And last, continue efforts to modernize value-based contracting standards, including reducing barriers to accountable care organization participation and improving risk arrangements to support sustainable provider accountability.

FQHCs are the strongest investments the district can make.

Thank you.

Thank you.

Dr.

Ofield.

Good morning, Chair Henderson and members of the Committee on Health.

I'm Dr.

Benjamin Oldfield, the Chief Medical Officer at Unity Healthcare, a member of the CMO Council of the DC Connected Care Network or CCN, and a practicing primary care physician.

The CCN is a clinically integrated network focused on aligning outcomes and containing costs across seven community health centers.

Building on alliance claims data from 2022 through 2025 that DCF shared with the CCN in February, we identified key population insights that could assist with the development of a value-based payment strategy.

I'd like to share four such insights.

First, across all age groups, alliance beneficiaries not seen by CCN health centers show monthly costs substantially higher than those of CCN members, with a gap primarily driven by inpatient facility spend.

Benefit redesign in the Alliance program to assist an FQHC medical home thus could yield real savings.

Two, members not seen by CCN health centers exhibited consistently higher ER and inpatient utilization and had higher disease prevalences, representing the largest potential opportunity for quality improvement and savings under a potential value-based arrangement.

Three, data indicates that the 2% highest cost members under age 21 account for 63% of program cost for that age group, strongly suggesting that prospectively identifying beneficiaries likely to have higher costs through centralized care management may help contain costs.

And finally, less than 1% of members with inpatient admissions had a follow-up PCP visit within 30 days of discharge, while almost 20% of admissions were readmitted within 30 days.

We've identified significant opportunities to improve member outcomes and reduce costs with better processes around transitions of care.

We're collaborating closely as a network to facilitate a path toward a health center-led care management program.

Through a shared model of care, we can provide robust primary care that improves outcomes and contains costs in the alliance program.

Key to the success and sustainability of our effort is a viable alliance program that is not subject to the erosion that follows any moratorium on enrollment.

We urge this committee to identify resources to lift the moratorium on adult enrollment and afford the DCCCN health centers and alliance beneficiaries the opportunity to realize the improvements and cost savings our analysis shows are clearly within our reach.

I'm grateful for the opportunity to testify here today and happy to answer any questions.

Thank you.

Thank you.

Carlos Good morning, Chairpit.

Chairperson Henderson, Council members, Council staff.

My name is Carlos Plazas.

I'm the CEO of La Clinica del Pueblo.

La Clinica de Pueblo is a federal qualified health center providing comprehensive primary and behavioral care in DC.

Funded in 1983, La Clinica is a trusted leader advancing health care equity and expanding access to care for underserved communities.

We are grateful that the mega proposed budget did not include further reductions to Medicaid or lion eligibility.

However, we remain deeply concerned about ongoing alliance enrollment moratorium, particularly the age restrictions for adults 21 and over, and the income limits that create a coverage clift for residents between 138 and 200% of the federal poverty level.

As of January 1st, 2026, the alliance enrollment declined more than 20% in just three months, which is consistent with the coverage losses we saw at La Clinica.

This is a chart loss of coverage, not a reduction in need.

As an FQ, as a federal qualified health center, La Clinica is legally admission-driven to continue pro continue serving patients regardless of insurance status ability to pay.

However, the sustainability of this model depends on a balanced payer mix, which has been significantly disrupted.

La Clinica Burs burns a disproportionate burden of 43% of our patients are uninsured compared to an average of 16% of other federal qualified health centers.

The systemic issues have real human impact.

One of our patients, Maria, has relied on La Clinica for over a decade.

While she still access primary care with us, she has lost access to specialty care and hospital-based care.

She's monitoring a BRISMAS and experience in wars and vision, but cannot afford tests that she needs.

She has told us that she fears what will happen if she faces faces another medical emergency.

Equally concerned is amidst the districts facing one of the highest overdose death rates in the country.

DBH has decided to mirror DHCF's eligibility restrictions.

This has resulted in an approximately 35% of sustenance disorder services provided at La Clinica going unrembers.

We encourage DHCF to work with the Department of Behavioral Health to ensure the local dollars support behavioral health access, specifically sustenance use order services for uninsured residents.

Taken together, this impacts the aim and urgent action.

We urge the Department of Health Care Finance and Council to restore and redesign the DC Healthcare Alliance and collaboration with federal qualified health centers.

And for fiscal year 27, we ask council to leave the monetarium on adult enrollees.

As labor shortage grow nationwide, a healthier workforce will be key to supporting local business and economic vitality, making access to health care both a human right and in smart investment decision.

Access to health coverage should be considered a baseline expectation of what it means to be a Washington DC resident.

As a nation capital, DC has both the responsibility and the opportunity to set an example for the country.

Thank you for the opportunity to be in front of you.

Thank you.

Okay, we're gonna try our folks online.

Uh Joshua, are you good now?

Okay.

Sorry about that earlier.

It's okay.

This is among the most dangerous and tumultuous times encampment residents have faced.

DC encampment residents are beset by local and federal agencies that are targeting them on the streets in a mayoral budget that does nothing to mitigate the harm.

As we've testified to on multiple occasions, DMHHS has decreased their notice period from 14 to 7 days.

However, following both an executive and mayoral order, DMHHS oftentimes bypasses the notice altogether through its use of the immediate disposition protocol.

Immediate dispositions allow DMHS to remove encampments without notice if DMHS claims they pose immediate risk to public health and safety.

Under the current purposefully vague standards, anything could qualify the public health and safety risk.

Justifications for determinations aren't shared, encampments no different than any other that pose no actual risk are often swiftly dismantled and their residents are dispossessed.

Many immediate dispositions are used for single persons.

Those encampment residents often receive little to no outreach before removals and posted signage may not even be visible.

Once removals begin, all or nearly all belongs if you're thrown away, despite DMH's mandate to store non-trash items.

The seizure andor destruction of belongings through immediate dispositions without notice or adequate notice, due process or post-deprivation proceedings are likely unconstitutional.

Increased encamping evictions and immediate dispositions have worsened in already dangerous situations.

DMHS removed 36 incampes in FY24 and 2025.

DMHS removed 128, a 355% increase.

Despite a massive increase in displacement efforts, there's no increase in availability of housing resources.

This indicates a clear policy choice of priorities, erasing the visibility of homelessness rather than ending homelessness.

Well, DMH tests used to conduct site clearings, cleanings.

USC leadership has recently admitted their current policy is to dismantle or remove all encampments.

If DC has austerity budget, encampment site removals should be eliminated.

Last year, DC spent considerable money to displace its unhealth residents through encampment evictions.

Those funds could have been better spent permanently and stably housing them.

When people have safe stable housing options, encampments decrease.

Council should suspend all encampment clearings.

Instead, these should conduct trash-only cleanings, provide additional trash cans that encampments maintain portable bathrooms and hand washing stations.

Further, council should reallocate encampment eviction funds through investment housing resources that in homelessness create legislative policies that standardize requirements and definitions required related to encampment evictions, adoption due process for encampment residents and minimizing opportunity for random andor politicized encampment evictions.

The mayor's proposed budget does nothing to provide stable housing.

Mayor Bowser has funded zero vouchers in this budget.

Last year we testified to the harm that would come from funding zero vouchers for individuals.

We've seen since seen the subsequent trauma and harm.

Now council has received a budget much worse than the FY26 one.

The mayor has proposed a budget that excludes housing resources for unhealth individuals and families.

Unsheltered residents are being evicted from the homes they've made and often displaced from DC.

It's deeply troubling that DC is removing encampments while defunding housing resources.

Um council must increase funding for all permanent vouchers, increase DHS and DMHS budget transparency and increase investment outreach services.

This budget comes at a time of height and local federal cooperation.

And over the next few months, the U.S.

will be celebrating its 250th anniversary, and DC will be hosting the America 250 events.

Many advocates and community members are concerned that events may prompt renewed efforts to displace unhouse residents.

Time is of the essence.

DC Council must ensure there are adequate shelter and housing resources and appropriate legislative policies and place it ensure resident safety.

Council should also suspend DC efforts to direct or cooperate with any federal government targeting of encampments for evictions and displacement.

Council must ensure that a resident's housing status, income, andor race do not determine whether they are including the vision for DC's future.

The vision for DC must include a plan to meet the needs of all residents, and council must be willing to fight for all of them.

Thank you.

Thank you.

Jamila.

Thank you, Councilmember Henderson.

And uh oh, let me close my little messy background.

Nobody noticed until you mentioned it.

Okay.

Oh no, I gotta move it.

I usually have it on blur, but okay.

Anyway, y'all are just see it.

It's just my books and stuff.

No, your camera, you you turned your camera off completely now.

Yeah, I'd rather like do the messy background because my cat's gonna come in, but y'all will see it.

I'm a teacher, so there's my um books and stuff for school.

But go for it, Carol.

Um, Councilmember Henderson.

Um, it's good to see you, and thank you for the opportunity to testify today.

I am Jimmy Louis.

I am the commissioner, ANC commissioner for AAO5 and the chair of ANCAA.

This is probably my fourth year that I've come before the council to advocate for the same thing, urgent action to address the long-standing crisis along Mary and Barry and Minnesota Avenue corridor.

For more than 20 years now, this corridor has struggled with substance substance use addiction, open air drug activity, and the deep harms that come from this, where we've seen generations now entering in the same cycles of harm.

During the winter months, during this corridor, we see upward of a hundred people gathering in visible crisis.

Um, and since the pandemic, these faces have gotten younger and younger.

We are witnessing a public health emergency rooted in unmeat unmet needs and years of disinvestment.

And it's really time that we act differently.

Residents, businesses, students, and families, and those struggling with addiction and substance abuse all live with the daily impacts of this crisis.

There are regular overdoses, people in distress, public deprecation, violence, and instability along this corridor.

The burden is especially heavy for our our young people who are traveling through this corridor to get to and from schools.

Almost all of our schools within AA have to cross through this corridor.

Too many students have been assaulted, threatened, and traumatized by trying to go to school by navigating these areas.

And several years ago, building blocks identified this corridor as one of the most distressed in the district, and MPD has also identified this corridor as one of the most distressed and proposed that some changes will help bring about both public safety and public health.

For several years, AA has facilitated meetings with the Deputy Mayor for Health and Human Services and DBAs, DBH to call for both to call for solutions that address the long-term structural um challenges as well as some short-term interventions that can be had.

Some of these interventions really concentrated around two solutions that have come out.

One, a relocation of the BHG Methodome Clinic located at 1320 Murraybury Avenue, and the second solution for an 18 to 24 month integrated public health plan for this corridor, right?

And I'll start with our first call for relocating uh the clinic, which you're aware of, council member, because we brought it up to you all.

Um, most recently, the deputy mayor for health and human services and director Basron did attend our ANC meeting.

During that meeting, we were told that the administration has concerns about moving the clinic because it will cost a few million dollars.

I think about five million dollars to move the clinic.

The deputy mayor did note that if it was up to him, he would move the clinic to a medical campus.

We're asking for the council to be creative to help move this forward, this solution forward.

We have seen how the district has invested millions of dollars in other efforts, but for some reason will not do it for our community.

There are ways that we can move this clinic without taxpayers covering the entire burden, including low cost or zero finances and other incentives that can help them move.

The clinic is open to moving as long as there is some support provided with it because they just spent a couple of million dollars upgrading um their current location.

We understand that recloning relocating the clinic alone will not solve everything, but it will significantly reduce activity in this corridor and also the concentration in this corridor and provide the patients with higher quality treatment in a setting that's designed for healing for people who need care and dignity.

As you know, the lines for the clinic start two to three hours in the morning before they open.

And during this time, it's very undignifying for anyone who needs the services.

There's not access to bathroom services, therefore we see the public deprecation.

And some people don't even wait in line long enough because other folks selling them other treatments start to come up.

So it's created this concentration also to supply and demand, right?

And so we want the we need the council to act.

Because the administration doesn't want to do it, it's a responsibility council to fully provide that investment to our community.

Commissioner.

In addition, we've talked about there are about 10 organizations providing some type of addiction or substance support in our ANC.

Yet when we talk to these service providers, they tell us that they don't have funding to do actually outreach to the neighbors who are right outside their doors who need that help.

So we have all of these organizations providing services, but they can't do outreach to the people out in front of them that need support.

And there has to be a change in that.

And so what we've asked for is that these organizations I'm over time.

Yep.

About two minutes over.

Can I just have one more minute?

Commissioner, I have I have like 40 people after you.

Can you just wrap it up?

Yes, wrap it up.

So because they don't have the funding to do outreach, we've asked the district for two years now for an integrated 18 month plan that's with DHS, uh uh DH, HS, uh DBH for our community to start addressing some of the immediate needs right now and a sobering station.

These recall requests for support has had no action over the last four years.

And so we are urging you, begging you, advocating for you to make sure that there is some interventions for the Marion Barry and Minnesota Avenue Corridor.

And I will submit my testimony so you can have the complete um solutions.

Thank you.

Thank you.

All right.

Thank you so much to this panel of witnesses.

I have a couple of follow-up questions.

Um it says that you are the board chair for the DC Connected Care Network, so maybe I'll ask this.

Um, what have the conversations been like with the other MCOs around trying to get more value-based care arrangements?

We have two contracts with two of the MCOs successfully negotiated and executed.

Two of the MCOs haven't been able to give us the level of data that we need in order to uh create a population focused proposal.

Um I would say that the conversations continue to not move forward.

We're just not getting the data that we need.

Okay, so the data is sort of the catalyst, I guess, to move forward.

Yeah.

Um what happens if one of the MCOs goes away?

We will continue to take care of the patients as we have, but the network itself will be at risk.

And so we would look to health care finance and others to ensure that we can support the patients with the kind of population health value-based programs that we have in place that we we've already seen great improvements um in a couple of the quality indicators and the cost control indicators that we've worked on.

Okay.

I mean, what you all have been describing, uh Nancy, Dr.

Oldfield, etc.

It sounds as though it's like a mini MCO within the MCO, kind of like a mini Kaiser, if you will, come to us, just us.

We're connected.

Is that a accurate metaphor for the vision?

Um, I would say yes.

It's a closed network that allows us to take care of the patients and follow them throughout their uh lives.

And so right now, um, as was just presented, those that are not connected to us have higher costs.

And so if we are able to connect to those that are not currently in our care, we're able to use care coordination and other social driver methodologies that we already have to make sure that we are keeping people healthy.

What's the maximum patient capacity that you all could handle at this particular stage?

I think some of the health centers have capacity currently and don't need to do additional recruiting or building in order to meet it.

And if you don't, um, I would say overall we could probably take, I feel very on the spot here, but I I think we could probably take I mean you can follow up.

I'm just curious.

Yeah, let us follow up.

I think it's 20 to 30,000 more patients among the health centers that we could absorb pretty quickly.

Okay.

Um Mr.

Drummond, thank you for being here.

Um we have some follow-up questions for DMH just about um encampment clearings, although we did talk to them quite a bit about it at um our performance oversight hearing um in terms of the change to immediate disposition.

Um but as you rightly pointed out, in terms of things that are going on this summer, we just want to understand better what the protocols are.

Um, Commissioner White, um, thank you for being here.

We've talked a lot about the Mary and Barry Avenue corridor.

Um, you know this conversation around moving this clinic.

There are twofold.

So, number one, I don't want to set up a perverse incentive where now clinics want to set up an area and and and then they want the government to pay to move them.

Um, and not just pay for their costs, because I feel like they added a little extra to the side of like pain and suffering and cost for moving.

Um, but also um move them where is a big question.

Um we're about to uh we just had a conversation with the city administrator last week.

Um, they're gonna demo United Medical Center, so that's not an option.

Um Cedar Hill has more than enough going on that they don't need any additional things uh there now.

And so um, I don't know, just witman walker want it.

I put her on the spot.

That was just uh uh that was a joke.

Um so we're gonna we're gonna have keep having conversations.

We did have money in the budget for the substance um the targeted substance abuse outreach grants, um, which had a which has a location in ward eight that's currently active.

This is a department of behavioral health, not a health care finance program.

Um we just passed legislation to make this program permanent.

Um, so we're really excited about that.

We're still in a uh strong disagreement with the Department of Behavioral Health because they're saying in order to make a pilot program that they have been running for the last two years permanent, they need like two additional FTEs to do the work that they've just been doing for the last two years without any additional people.

So we're still trying to work on that.

But um I hear you.

I'm just trying to, I don't I don't know how we get to that next step in terms of action amongst the agencies.

Yeah, can I can I respond, Councilmember?

Can you hear me?

Yep, I can hear you.

There has not been an actual task force set up to my knowledge to just look at this issue in terms of the impact that in terms of the public health crisis that's impacting Mary and Barry Avenue and Minnesota Avenue corridor, both long-term and short term, and actually come up with solutions that can come out of that.

And that's a that's something the ANC has called for for numerous years to actually have an integrated task force that set up you have one year, this is what you're supposed to do.

The community will be engaged, the people receiving the services will be engaged so that we can come up with options that are valuable, viable, and options that are gonna um help reflect the needs of the community, but also the people that need those services.

And that's just something that has not been done.

It's really been the ANC trying to coordinate all of these different agencies, all of these different residences and people to come up with a solution.

And that's one thing that could be done right now to look at the overall um corridor because if we don't address it now, think about what it's gonna look like in five years from now.

Yeah, right?

Think about all the young people who are gonna be pulled into that corridor and be pulled into sex work, pulled into uh uh substance use, pulled into substance sales, and think about their lives.

So we have a 20 billion dollar budget.

We just gave two billion or however much to the RAM scans or the commanders, whatever the new name is.

It cannot be told to us that this cannot be resolved.

There is a clinic on George Washington's campus.

Parents who were paying 100,000 of how much they're paying for their kids to get an education there, they're not calling and complaining about that methadone clinic because of the way it's maintained, because of the entire environment around there.

And so if we're able to have communities um have resources for people who need it and communities that are wealthier and quite frankly, wider, why can't we have that same equity here in Ward 8 and in AA?

No, I why can't we have a clinic that serves our community?

You know, this clinic council member has told us that their staff is afraid to come to our community, that their own staff is afraid to come here.

They go through directors over and over.

Grandma and my grandma said, I'd like to wash your drawers.

You know, just keep flipping over staff and directors.

So this narrative, and I know it's not you, I know you've been an advocate for us, but think about how it makes us feel like we are truly an underclass, second class citizens, and we don't even have the same rights for our government opportunity to go.

Commissioner, let me just start with first off, just for the public who is not familiar.

Like this is a private clinic.

It is not a government-run clinic.

They do receive Medicaid services, et cetera.

But in terms of how they do their operations, we have had DC Health out there.

We have had Department of Favoral Health Health out there, they've done the inspections.

How the clinic then goes forward in terms of their operations, that is in terms of the leadership piece of that.

And unfortunately, um, at not unfortunately, unfortunately, but like uh citations can be made in terms of service, but they haven't broken the law yet.

And so asking us to pay them to move or pay them to be better as a private entity, that's the hard part.

And I also hear you in terms of the task force piece, and I could have this conversation with the Deputy Mayor for Health and Human Services because this is frankly what the DMHHS office is supposed to be doing, these types of coordinated things.

I don't like to legislate task force, because when I have to legislate task force, it takes six months for somebody to appoint the other person to have the conversation, and then I have to babysit the agencies to actually do the work in an ideal sense.

Two years ago, DMHHS would have handled this.

They would have pulled together their relevant agencies to be able to have this conversation around what are we doing on this particular corridor?

Because as you pointed out, uh the public health implications also uh has implications for public safety as implications for education and the other things that are going on from economic development standpoint at that particular quarter.

So I'm I'm I'm gonna follow up again with DMHHS.

This is the hard part because I feel like half this administration got senioritis.

So I need them to lock in for the next six months that they with us.

Um, longer than that.

I think seven, I don't know.

Nine, maybe fine.

Okay, whatever, the rest of the year that you're here.

Um and so we'll have that conversation with them because I think they're their appropriate ones.

And I think it would be sad if I have to legislate a task force to get agencies to come together for a problem.

I think that's embarrassing, actually.

So um I'll I'll follow up.

Thank you so much for being here.

Thank you so much to this panel of witnesses.

If you don't have your if we don't have your testimony, please provide the testimony for the record.

Thank you.

Thank you.

Thank you, Councilmember.

Okay.

Uh Jacqueline Bowens from the Hospital Association, Andrew Patterson, Legal Aid, DC.

Eric Engel or Angel from DC Greens.

Oh, Eric's online.

Okay.

Let him in.

Uh let her in.

Uh okay, Claudia Sosa.

Come on in.

And uh Gabby Salado.

Okay.

Jackie, when you're ready.

Uh it's good afternoon, right?

Good afternoon, Chairperson Henderson, uh, members of the committee.

I appreciate the opportunity to present testimony at the FY27 Department of Healthcare Finance budget oversight hearing.

We recognize that this year's budget was developed under significant financial pressures and appreciate the mayor's commitment to maintaining Medicaid eligibility levels for childless adults at 138% of the federal poverty level throughout the financial plan.

This policy decision keeps people covered and allows emergency Medicaid to cover individuals not eligible for Medicaid up to 138% of the federal poverty level, which is positive.

We continue to be concerned with the reduced eligibility for the alliance program because it erodes access to primary care and pharmaceuticals to manage chronic conditions and increases the likelihood of more expensive hospitalizations.

While minimizing coverage losses and increasing access to dental envisioned services are truly welcome, additions to this budget.

We're concerned about the proposed 48 million dollar reduction for direct medical education.

This funding is critical, sustaining the district's physician workforce pipeline.

Our hospitals depend on this funding not only to train residents, but also to ensure an adequate supply of physicians are available in critical specialty areas where demand is high and access is often limited.

Without this funding, hospitals would be forced to absorb significant unreimbursed training costs at a time when margins are already under pressure.

While Howard University Hospital and Med Star Washington Hospital Center will take the steepest reductions, all our teaching hospitals will share in the burden of this reduction.

Driving our concern is that this is on top of roughly 46 million dollars reduction in outpatient services this year in fiscal year 26 that hospitals are already scrambling to absorb.

We're already seeing from one safety net hospital measurable increases in uncompensated care and self-pay volume.

This trend is not isolated but reflects a broader and accelerating shift in payer mix that place sustained financial pressure on safety net providers across the system.

We are aware that state directed payments are often views as a way to blunt these reductions, but the approval process by CMS is taking so long that this is not a reliable source of stabilizing funds that we had hoped for, especially for our dish hospitals.

More concerning is that in FY28, these payments will start being reduced until they disappear.

This volatility, together with the impact of rate reductions imposed by health care finance in 2026 and proposed funding cuts this year and future years, is why we're so concerned with the unknown impact of the scope of the medical debt mitigation amendment of 2025.

As I've said before, DCHA and our hospitals can uh support the concept of this legislation, but we're concerned about the hospital's ability to remain strong anchors of the district's health care safety net.

It is critical that the council the council fully consider the cumulative impact of these changes, including the nearly $95 million in reductions across fiscal year 26 and 27.

Thank you for the opportunity to testify, and I'm happy to answer any questions.

Thank you.

Andrew.

Good morning, Chairperson Henderson and uh members of the committee on health.

Thank you for the opportunity to testify at this budget hearing.

Uh legal aid is DC is one of many organizations that works on health justice with the Fair Budget Coalition.

The mayor's proposed budget fails to fully restore the alliance cuts that were implemented last year, which resulted in thousands of district residents losing their health insurance.

Although the council partially reversed several of the worst proposed changes in the mayor's FY26 budget, more must be done to ensure that all district residents have access to the health services they need and deserve.

We urge the council to remove the new applicant age cap for adults over 21 years of age, restore the income limit to 215 percent of the federal poverty level, and restore the full list of covered services for alliance enrollees as it was prior to October 1st, 2025.

These steps are crucial to repair the damage caused by the mayor's efforts to fully eliminate the alliance program.

Throughout the past year, at budget hearings, oversight hearings, and other meetings and roundtables, the council has heard testimony from a wide range of stakeholders urging full restoration of the alliance program.

LegalAid DC has worked with multiple clients whose health and lives depend on access to alliance health coverage, and yet have either been threatened with termination or actually been terminated from that coverage.

Although a small number of individuals have been transitioned to healthy DC coverage, the vast majority of individuals who lost alliance have no other option for affordable health coverage.

Additionally, the one big beautiful Federal Bill Act contains further restrictions on access to Medicaid and Medicare that are set to go into effect either later this year or early next year.

Under the Act, many D.C.

residents who currently qualify for Medicare and Medicaid will lose coverage over the next few years.

If the alliance enrollment cap is not lifted and the income limit is not restored, all DC residents losing their other sources of coverage will have no affordable, no other affordable health care options available to them.

We also urge the council to include legislative fixes to the DC Healthcare Alliance Reform Amendment Act of 2025.

Although we support the mayor's proposal in the FY27 budget to add dental envision coverage to alliance and maintain eligibility at 138 percent of the federal poverty level, those fixes and any other changes the council adds must be codified legislatively in order to take effect.

Additional positive changes made by the council last year, such as eliminating the six-month certification period and in-person recertification requirements should also be codified.

And I just want to briefly mention that we support fully funding the Certified Nurse Amendment Act of 2024, and that we also urge the committee to fully fund and implement the Medicaid buy-in program.

Legally uh, excuse me.

This act would, for the first time, create a Medicaid buy-in program for those who are disabled but whose income puts them above the Medicaid income limit.

Medicaid beneficiaries risk losing their Medicaid due to small increases in income, and those folks are put in the difficult position of having to choose between an increase in their income or keeping the health insurance they desperately need to maintain their health and ability to work.

A buy-in program would remove a significant portion of the incentive for workers with disabilities to turn down additional earned income.

And I'll just submit the rest of my testimony for the record and happy to answer any questions.

Thank you.

Thank you.

Troop D Patel.

No, she's online.

Hi, Councilwoman.

Uh I had to work today.

I'm actually in the middle of lunch service, so I'm gonna go ahead and testify, and then I'm gonna ask the excuse since I'm in the middle of lunch service.

No, go ahead.

Uh oh.

Good afternoon, Councilwoman.

Um, my name is Tripty Patel.

I represent single member district two A03 in historic Flocky Bottom, and I serve as the chairperson of advisory neighborhood commission 2A.

I am here to speak about two issues with direct impact on my community encampment clearings and the Aston.

Washington, D.C.'s first high barrier bridge housing facility in War II in the context of the fiscal year 2027 budget for the Department of Human Services.

As if a former colleague, Commissioner Yannica Mickton authored an ANC resolution raising concerns about how the East Street encampment was cleared by the Deputy Mayor for Health and Human Services.

The resolution reflected a core principle the city claims to uphold housing first.

Clearing encampments without individual, individualized housing plans is not housing first.

It is displacement.

This approach does not end homelessness.

It moves it.

It is inefficient, costly, and poor stewardship of taxpayer dollars.

We also know how many individuals in encampments already have housing vouchers and are waiting for placement.

Clearing encampments without fixing that bottleneck delays permanent housing and worsens instability.

It also deepens traumatic it also is deeply traumatic.

People lose medications, IDs, and personal belongings, and trust in government erodes, making outreach harder not easier.

This issue is amplified in the fiscal year 2027 budget, which reflects reduced overall resources of a at a time when housing needs are growing.

When DHS is operating under constrained funding, the district cannot afford strategies that produce movement without outcomes.

Encampment spending must be tied to measurable housing outcomes, verified placements, bousing out utilization, and continuity of care, not just site clearings.

By contrast, the ASTIN shows what works.

In 2023, the George Washington University sold the property to the district to serve medically vulnerable adults, families, and couples experiencing homelessness.

The project faced intense scrutiny, including litigation, but through transparency in the community advisory team process, it became a model of accountability with leadership from DHS that asked the met and exceeded benchmarks, resolved issues quickly, and build community trust.

After one year, it is operating successfully.

The CAD has now formally supported lifting the cap alongside ANC2A.

As the council reviews the fiscal year 27, first DHS encampment spending must be conditioned on housing outcomes.

Second, the district should prioritize full utilization of proven assets like the ASN before expanding temporary capacity.

Third, the community advisory team model should be institutionalized and modestly funded as a standard accountability tool.

I close with three requests.

End encampment clearings without guaranteed housing pathways, institutionalize the community advisory team citywide model, and lift the cap on the ASTIN so it can operate at full capacity.

The fiscal year 2027 budget is not a spending document.

It is a policy choice.

Right now, it risk measuring activity instead of outcomes.

The ASTIN shows what alignment looks like when funding, oversight, and accountability work together.

Thank you.

Have a great day, Councilwoman.

Thank you.

Thanks, Tripti.

Thank you.

Eric Good afternoon.

I'm Eric Angel, the executive director of DC Greens, where we work to advance health equity by building a just and resilient food system.

At DC Greens, we believe that food is health, food is medicine, food is a human right.

I'm testifying today really about three things.

One, in strong support of the 500,000 in the DCHF budget that funds the Produce RX program administered by DC Greens.

Two, in strong support of the budget request of the Fair Food for All DC coalition.

And three, in strong support of the Food Policy Council, which has unfortunately been eliminated in the mayor's budget proposal.

I'll say just a bit about all three.

First, Produce RX.

DC's produce prescription program as part of the national food is medicine movement, recognizing that especially for certain medical conditions, access to healthy nutritious food is key to preventing treating and managing diet-related illnesses, reducing health care costs.

Our produce prescription program is the oldest and largest in DC.

It's really an amazing food is medicine intervention in which medical providers literally prescribe fresh fruit and vegetables to qualify Medicaid or Alliance patients.

The qualifications are set forth in my written testimony, but are essentially diagnosis of hypertension, prediabetes, diabetes, obesity, and having the capacity to visit per participating growth earth stores.

That's essentially it.

Assuming the doctor provides the rights the prescription, we send a debit card loaded with 80 to 120 dollars based on family size on a monthly basis.

These ever cards can only be used for fresh fruit and vegetables at a variety of markets.

The remark results have been remarkable, reducing food insecurity, ameliorating depression.

Latest leadership change.

So to the Howard people, to the representatives who are watching.

No, no.

Our safety net hospitals are extremely vulnerable.

So absolutely.

Okay.

All right.

Um I thank Commissioner Patel for her testimony, even though I know she had to go back to work for some questions.

Maybe not to GMHS, but to GHS.

We've raised this question about the Ashton.

Um and the cap and we're gonna have to work through it.

There are a lot of people who are like, yes, the building is not full, and there are more people where they need to come in.

Um we definitely have some questions to ask questions to the deputy mayor for uh Sandra Hiruca.

I'll be speaking on behalf of Sandra Rodriguez.

Okay.

Uh good afternoon, council member.

My name is Sandra Rodriguez, and I am an adult learner at Bria Public Charter School.

While I was covered by the DC Healthcare Alliance, I was able to receive a surgery that I am very grateful for because the cost would have been extremely expensive without insurance.

That coverage made a critical difference in my health and well-being.

Unfortunately, I lost my alliance coverage due to income limits.

I went in person to a service center to explain my situation and submit proof of my income.

But despite my efforts, I still lost coverage.

Since October 2025, I have had to pay more than $500 out of pocket for dental visits.

I am now skipping medical care because I simply cannot afford it.

This puts my health at risk and creates constant stress and uncertainty.

No one should have to go without necessary care because they are trying to work and improve their situation.

That is why I respectfully ask the council to remove the age cap for adults over 26, restore the income limit to 215% of the federal poverty level, restore the services that were available before October 1st, 2025, and stop any further cuts to the alliance program.

Please consider the impact these policies have on people like me who are working hard but still cannot afford basic health care without support.

Thank you for your time and consideration.

Thank you.

Flora.

Good afternoon, Council members, and thank you for the opportunity to testify.

My name is Flor Buruca and I am a uh adults learn at Bria Public School.

I am a mother of four children.

My oldest child is currently in university studying to become a doctor because she believes our community deserts more great doctors, has a mother that makes me very proud.

I am also continuing my own education.

I will be graduating from UDC next month with my child development associate.

My goal has always been to grow embryo has been a vital part of that year.

Programs like the DC Healthcare Alliance have also played an important role in supporting my family.

Alliance has helped us many times.

It is a program that's work, and I am very grateful for it.

Every emergency room visit my family has needed, has been covered by alliance, giving us peace of mind during difficult moments.

Having access to health care has allowed me to stay focused on my education and continue supporting my children's brains.

That is why I respectful as the council counsel to remove the A limit for adults over 26.

Restore the income limit to 215% of the federal poverty level.

Remove the service that exists before October 1st to 2025.

Pause any additional changes to alliance programs.

Those changes will help families like mine stay healthy, continue growing growing, and give back to our communities.

Thank you for your time and for and for considering my testimony.

Thank you.

Thank you.

Francesco.

Thank you.

Good afternoon, Council members.

My name is Francisco Hernandez.

And I am an adult learning at Brea Public Charter School and a single father of two teenagers.

I am currently working part-time while I study to build a better future for my family.

Balancing work, school, and parenting is not easy, but I am committed to improving our lives.

The DC Healthcare Alliance has been essential for me during this time.

Alliance has covered all medical appointments, and I am very grateful for that support.

Without it, I would not be able to afford private health insurance of my health.

For families like mine, alliance is not just health coverage.

Stay healthy and become more self-sufficient.

That is why I respect you as the consul too.

First, remove the age cap for adults over 26.

Two.

And for stop any future goods to the Alliance program.

Please continue to support parents and students like me who are working hard to create a better future.

Thank you for your time and consideration.

Thank you.

Rosa.

Good afternoon consumer members.

My name is Rosa Cruz.

And I am adult learner at Briya Public Charter School.

I am also the mother of the preschool each song, who is truly a miracle after many years of try to conceive.

My pregnancy was very high risk.

And the DC Haircare Alliance was a lifeline for me.

It allowed me to receive the care I needed to safely bring my son into this world and to recover after giving birth.

Today, my husband is the only one working in this financially responsible for our households.

However, he recently lost his alliance cover due to income limits.

Even so, he's our sole provider.

Without alliance, the cost of post-part and ongoing medical needs will be impossible for us to afford all a single income.

This program has not only support my health, but it has only given me the opportunity to continue my education and work toward a better future for my family.

Alliance changes lives.

That is why I respectfully ask the council too.

Remove the age cut for adults over 26, restore the income limit to 215% of the federal poverty level, restore the service that we available before October 1, 2025.

Stop any food that could the alliance programs.

I know this question has been repetitive, but I want you to know how important it is for us that the benefits be re to.

Please continue to support families like mine who rely on this program for their health and well-being.

Thank you for your time and consideration.

Thank you.

Thank you to this panel of witnesses for your testimony and for sharing your stories.

It's a big deal, even though people try to minimize the work of our early childhood educators.

I'm really excited for this next step for you.

So congratulations.

I don't have any specific questions for this panel, but thank you so much for being here and make sure you provide your testimony for the record.

Thank you.

Okay.

We're gonna go to uh Lorena Gutierrez, Sandra Custa, Cindy Carbal.

Not here.

Oh, she went already.

Oh god, good, okay.

Okay.

All right.

Piera Martinez.

And uh Yennifer Castro.

Okay, Lorena, when you're ready.

Thank you, Council.

Um, good afternoon, council members.

My name is Jennifer Lorena Gutierrez and Student Services Coordinator at Brea Public School and students and families as they work to build better opportunities for themselves and their children.

Work and care police.

These are families who are committed to improving their lives even when the resources are limited.

Part of my role is helping them navigated access to have insurance.

And for many of the families, size support alliance is the main option they can access.

It allows them to take care of their health while continuing their education and supporting their families.

Since October 2025, I have goodness firsthand the impact of using changes to the DC Healthcare Alliance.

More than 43 families at my site alone have had at least one member of their household lose coverage due to the income restrictions.

In many of these families, there is only one working adult supporting two or more people.

As a result, daily life becomes more harder when access to health care is not consistent.

Families often have to wait to get care, worry about unexpected medical costs and make difficult decisions with very limited income.

This adds even more pressure on families who are already trying their best every day.

Health insurance is not an extra support for our students.

It is essential for their ability to keep moving forward.

That is why I respectfully ask the council to remove the age limit for adults over 21, restore the income limited to 150 percentage of the federal property level.

Restore the services that existed before October 1st, 2025.

Keep in mind when families have access to health care, they are better able to stay in school, keep up with their goals and care for their families.

I ask you to protect and restore the alliance program so that families in our community can continue building a better future.

Thank you for your time and listen to my testimony.

Thank you.

Sandra.

Good afternoon, Councilmember.

My name is Annie McKeel, and I am testifying on behalf of Sandra Costa.

My name is Sandra Costa, and I serve as a student services coordinator at BRIA Public Charter School.

In my role, I work closely with adult learners and families who are doing everything they can to build stable lives in Washington, D.C.

Many of the individuals I support are balancing school, parenting, and multiple jobs just to make ends meet.

Too often I meet families who make the difficult decision to pick up extra shifts or additional work to cover rent, child care, or basic needs.

Instead of being supported for their effort, they find themselves at risk of losing critical health coverage due to strict income limitations.

This creates a heartbreaking cycle where doing more to support one's family can unintentionally lead to losing access to healthcare services that are essential for stability and well-being.

These policy barriers place unnecessary stress on families who are already working hard to move forward.

Healthcare should not become inaccessible precisely when individuals are trying to improve their economic situation.

That is why I respectfully ask the council to remove the age limit for adults over 26, restore the income limit to 215% of the federal poverty level, restore the services that existed before October 1st, 2025, stop any additional changes to the alliance program.

Thank you for your time and for your consideration of the families and students who depend on these vital services to continue their education, support their children, and build a more stable future.

Thank you.

Thank you.

Ms.

Martinez.

Good afternoon, Council members, and thank you for the opportunity to testify.

I am Lydia, and today I'm testifying on behalf of my friend Kira.

My name is Kara Martinez, and I am an adult learner at Brea Public Charter School and a single mother.

I was taken off the DC Healthcare Alliance due to income at the at the time of my renewal.

When I was working more hours, however, my work schedule has never been stable.

And now I am only working part-time and would qualify again based on my income.

Unfortunately, because of the age cap, uh, I am no longer able to reapply for coverage.

Losing my insurance has made it very difficult to take care of my health.

I have been putting off my ophthalmist appointment because I do not have enough money to pay out of pocket.

This is not a choice I want to make, but I simply cannot afford the cost without coverage.

As a single mother, I am doing everything I can to support my family, but these policies make it harder to stay healthy and move forward.

No one should lose access to care because their income changes or because of their age.

That is why I respectfully ask that council to remove the age cap for adults over over 26, restore the income limit to 215% of the federal poverty level, restore the services that were available before October 1st, 2025, stop any further cuts to the alliance program.

Please consider families like mine who are working hard but still need access to affordable health care.

Thank you for your time and consideration.

Thank you.

And uh Jennifer.

Hi, and good afternoon, council members.

My name is Jennifer Castro, and I'm in Adult Learning IB approach.

So every day I am working hard to build a very fruitful for my family through my education.

My goal is to become a medical assistant because health and medicine are very important to me, and I want to be able to help other in my community.

And also um also um working sorry in also I working to create a stable and security life for my family in my education is an important step toward that wall.

I currently have DC Healthcare Alliance.

It has been essential for me, even though I work.

Having alliance allows me to take a get to take care of my health, stay in school, and continue working toward my career.

Without discovery, I will face very difficult chose between paying for my medical care and my family's bicep need.

No one who is working hard and trying to improve their life, have should have to make that shows.

Alliance gave me the opportunity to stay health, keep moving for aware.

It supports not only my health, but also my ability to succeed in school and eventually give back to my community as a healthcare professional.

That is why I respectfully ask the council to remove the edge cap for adults over 26, restore the income limit to 20, 50% of that federal propellant level, restore the survey that were available before October 1st, 2025, stop any future cop to the alliance programs.

Please continue to support students and families like my like my who are working hard to build a better future, and thank you for your consideration.

Thank you.

Thank you so much to us, panel of witnesses.

Um again, the reputation reputation.

Repetition, excuse me.

I know the last paragraph of all of your testimonies.

Um so thank you so much for being here.

And if you could please provide your written testimony for the record if you haven't done so already.

Thank you.

Um, all right, uh Sheila Escamila.

Mark Miller.

I can see Mark.

Kathy Hudson.

Sophia Ballman Spencer.

And Ray Rachel Neito.

Okay, Sheila, when you're ready.

Thank you, Mrs.

Henderson, and I'm so grateful to be able to sit here and share with all of you.

I'm so happy.

I am grateful for the opportunity to share with you today the successes and continued support needed for many DC residents.

My name is Sheila Escamilla.

I am a student services coordinator for Brea PCS, a former early childhood educator, a community advocate, and a parent to three boys.

Many years ago, I lived here in DC and went to school at a local high school.

This means that my immigrant mother and I also have access the public health system.

In my current role, I have been able to support our families with a DC Healthcare Alliance so they too will have health care.

I want to share with you because some of the families who did not qualify for DC Alliance when the income level was at 215%, battles, medical bills from 10,000 to 15,000 for an emergency care.

We spent many hours calling the hospital billing agency to apply for assistance or to lower the charges prior to creating a payment plan that lasted for many years.

Because the family can only afford to pay 100 a month, this becomes a stressor for many years ahead.

This payment plan was elected because that is all they have left after after paying for their everyday needs.

I work with parents who are currently unhoused, who arrived here in DC with prior injury from their journey to their better tomorrow.

Unbeknownst to him, the previous injury is causing arterial occlusion, which could eventually cause this person to be paralyzed on one side of his body.

He's grateful to the DC Healthcare Alliance for the medical attention that he was able to access, discounted medication, and continued access to health care.

They are two of the many lives depending on the DC Alliance.

As I mentioned earlier, I also immigrated here and accessed the public health system many years ago, like the families I now serve.

I decided to become an educator and recognize that it is my duty to return to my community and contribute to the best of my ability.

The parents that I work with also have the same dreams of success for their children, and their success lies in their good health.

I am I am fortunate to have access to good education for myself, be able to encourage my children to pursue their dreams, to have this opportunity today to urge you to continue to fund DC Healthcare Alliance.

Please continue to walk with people who need your support to share the gift of liberty given to many of us.

Our mothers, fathers, and children who walk through the door Sabrea every day are members of this community.

They also reserve the right in pursuit of the happiness according to our constitution, which means they too will have the right to a good education to pursue a profession that they wish equal rights, including legal rights and other opportunities.

Health care plus education is a bright future for all.

Thank you very much.

Thank you.

Kathy.

Good afternoon.

My name is Kathy Hudson, and I am a Ward 3 resident and the director of health programs at Miriam's Kitchen, where we work to end chronic homelessness in the District of Columbia.

I'm here today to share our plans for building a new medical respite program in the District of Columbia to meet critical needs for people experiencing homelessness while advancing the district's care transitions priority.

Today, DC lacks adequate safe discharge hospital options for people experiencing homelessness.

Unhoused patients are often medically cleared for discharge, but are too ill or frail to recover in shelter or on the street.

As a result, they stay in hospitals longer, cycle through the emergency room, and are frequently readmitted.

This hospital to street to hospital cycle is expensive, inefficient, and inhumane.

It strains the entire health system.

A proven solution is medical respite.

It provides short-term post-acute care for people experiencing homelessness who are discharged from the hospital but not well enough to recover without support.

It combines room and board, clinical services, care coordination, and housing case management.

DC currently only has 94 medical respite beds, of which just 22 are for women.

That is far short of the need.

Miriam's Kitchen is planning a new medical respite program at the E Street Bridge Housing Site that would add 24 beds and serve approximately 175 patients a year.

In the FY 2025 budget, the council identified hospital discharge planning and care transitions as a top community priority.

Medical respite is a clear and effective way to advance that goal.

The district has already laid the foundation by funding the E Street Bridge Housing Facility, making it making respite an efficient and ready to implement solution.

With timely action, the E Street Medical Respite program could open an early FY27.

In addition to the DHS investment at E Street, Medicaid and Medicare will cover significant portions of medical respite clinical services.

The community priority funding for care transitions could fill the remaining gap.

E Street Medical Respite will deliver a strong return on investment through shorter hospital stays, fewer emergency department visits, fewer readmissions, and stronger connections to primary care and housing.

We urge the council to ensure that the community priority funding is used to support the E Street Medical Respirate Program as a core component of the district's care transitions infrastructure.

Thank you for your time and consideration.

Thank you.

Sophia.

Good afternoon, Chairperson Henderson and staff.

My name is Sophia Belemian Spencer, and I serve as the employment policy attorney at National Domestic Workers Alliance.

NDWA advocates for approximately 9,000 domestic workers in the district, a workforce that's 92% women and 71% immigrants.

I'm here with a singular urgent demand.

The council must legislatively and financially restore the DC Healthcare Alliance to its 20 September 2025 standards.

In the domestic worker industry, employer provided insurance is almost non-existent because household employers rarely reach the STI thresholds required to provide insurance.

The alliance is not a supplemental benefit.

It's the primary pathway to care for this workforce.

Recent cuts have decoupled the program from the economic reality of low-wage work in DC.

Since October 1st, 2025, a new moratorium has blocked any resident age 21 or older from enrolling.

In an industry where the median age is 45, this policy functions as a near total exclusion for our members.

Furthermore, the drop in eligibility is roughly 1,800 per month, excludes the very workers who are the backbone of the district's care economy.

These workers are losing eligibility not because they can cannot they can afford private care, but because the program's floor is now lower than a full-time minimum wage paycheck.

To stabilize the district's safety net, we urge the committee to include a budget support act subtitle that codifies these three essential restorations.

One, remove the age moratorium to ensure that DC residents of any age can enroll in and receive health care coverage.

Two, restore the income threshold by returning the eligibility limit to 215% of the federal polity level to align with the district's economic reality, and three, reinstate essential services to fully restore the scope of services covered by the alliance prior to October 2025.

Domestic workers keep the district running and they depend on alliance for their survival.

We asked the council to decisive to act decisively to return the program to the thresholds that worked for our community six months ago.

Thank you for the opportunity to testify, and I will be submitting my written testimony later today.

Thank you.

Rachel.

Good afternoon, Chairperson Henderson and members of the committee.

My name is Rochelle Nieto, and I am a senior bilingual case manager at Ayuda.

Thank you for the opportunity to testify in Ayuda's behalf and call on the council to restore alliance and keep D.C.

residents, all DC residents safe and healthy.

For over 50 years, Ayuda's legal, social, and language access programs have served low-income immigrants in DC, many of whom depend on alliance as their only access to care.

The impact of last year's cuts remained devastating.

It has left many to choose between their health and financial stability, while others remain unaware their coverage has changed, only to later face serious health and financial consequences.

Across our work, we have seen the serious long-term and often irreversible harm caused by the cuts to alliance.

For example, one client of mine suffered a miscarriage and sought care for a DNC procedure.

Unfortunately, the procedure was performed incorrectly and she went into septic shock.

She required life-saving care, including an ambulance and blood transfusions.

But because of the post-October first changes to Alliance, she no longer had coverage and was left with a $25,000 bill for a medical emergency care that would have been covered before the cuts.

Another client of mine was hospitalized for nearly a month after breaking his leg in a motor vehicle accident while working as a DoorDash driver.

After his surgeries, he learned that due to the cuts to the services covered under Alliance, his insurance did not cover his rehabilitation for physical therapy, meaning that not only would his recovery be tremendously delayed, but he would also have to find a way to pay out of pocket for his medical treatment.

The district's failure to clearly communicate the changes to Alliance has left thousands without coverage, often learning only after the fact.

Many of my clients are showing up to renew their insurance or access care, only to be told that they are no longer covered or that their essential medication and specialist visits are no longer included.

The confusion and poor communication have had harmful consequences of their own.

However, the real physical and financial harm already caused to my clients demonstrates the need to fully restore alliance.

Protecting the health and safety of the city must come first.

Inaction will deepen harm for some of our most vulnerable residents in place, further strain on an already overextended emergency system.

Putting the health and safety of all DC residents at risk.

Ayuda urges the council to truly hear all of today's testimonies and restore alliance by ending the age vest moratorium and fully restoring income eligibility standards to 250% of the poverty line.

These steps would stabilize care for thousands and reaffirm that DC does not abandon its residents.

Thank you for the opportunity to testify today.

Thank you.

Thank you so much to this panel of witnesses.

The BSA subtitle for Alliance was inadvertently missing.

So there will be a subtitle.

I don't know the details of said subtitle.

I know that it was being drafted last week.

And we'll have to see in terms of the considerations of the various components, but there will need to be some sort of subtitle.

So we know that that will happen.

Kathy, can I ask just for clarification?

Is your program going to be within the E Street Bridge Housing Program?

Did I get that right?

Yeah.

So we've been working with DHS, and they are very supportive of devoting one floor of the E Street Bridge Housing facility to be a medical respite.

And so we need to, so they're covering the how the housing case management and the room and board.

So that's a huge investment that we can leverage.

And now we need to fill in the blank.

So with clinical care and care coordination.

Okay.

I'm trying to remember.

No, that's um nope, that's Bradford City.

Miriam's good.

You guys don't operate a clinic currently.

We do not operate a clinic.

We do have a unity outreach.

We are a unity outreach site.

Okay.

And we run a patient navigation program where we help connect our guests to primary care and then help them get out to specialty care.

And really seeing dramatic results.

One of the first guys that I navigated, he had been in the emergency room 17 times in the year before I started navigating him.

And in the 18 months now that he's been navigated, he's been to the ED once.

And it was for a good reason.

So we're having a tremendous impact and respite is sort of that in spades.

Yeah.

Well, and I mean just even sort of the statistic around like we have 94 respite beds across the city, but only 22 are for women.

Which I know in some cases speaks to the population in terms of the gender disparity breakdown, if you will, in terms of our unhouse population, but 22 is is is small.

Um in terms of the You didn't tell us how much are you need are you looking for money?

Mm-hmm.

Okay, you didn't say how much.

Sometimes people just got to be like we're we're like, I don't know, three weeks before this is done, so just gotta be very specific.

How much do you need?

Right.

So we are specifically looking for funding out of the community priorities funding that was provided in the FY25 bill.

Okay.

So there was a fee that was applied in a way that I don't completely understand, but others do.

Okay.

Um, and some of that is being administered by the DC hospital association.

Oh, yes, yes, yes.

Okay, from the um commercial rate.

Yes.

Yes, okay.

It is one of the four.

Yes, and it is one of the four priorities.

And that was in FY25, and here we are heading into FY27.

None of those monies have been.

Because um Jackie just testified.

None of those monies have been because um Jackie just testified I don't know if you saw that the money's late.

Yeah.

That's part of it.

Part of it.

And apparently there's $15 million for community priorities for this fiscal year lap FY25.

Yep.

And then question mark for FY26.

So there's money available and this seems like a perfect match and you asked me how much.

So we are still doing some due diligence on the unreimbursed clinical care costs.

And then we know what the care coordination cost would be.

And so to serve 175 patients over the course of a year we're looking at probably 850 and the return on investment is high so there's tons of published research that shows that medical respite has a huge return on investment by reducing hospitalizations, EV use, and connecting people to care.

Okay.

All right.

We may follow up with some additional questions.

Thank you.

But I don't have any further questions for this panel.

Thank you so much.

Thank you all for being here.

And Sheila thank you for your work earlier.

Yep.

Okay I'm just gonna telegraph for the remaining in-person folks because I have one, two, three, four, five I have five I have four seats let's see if everybody's here but um I've been sitting here since 9 30 and I really really need to take a five minute break.

So I'm gonna do the next panel and then I'm gonna take a break and then we're gonna do finish up on the virtual.

All right.

Uh Kate Coventry who's been here Myrna Padita look at that I guess correctly okay Lindsay Niles.

Oh okay Jacqueline Ed's here at Lazier and uh Felicia Nelson.

Look at that four seats exactly although is there somebody else out in this audience who was hoping to speak today.

All right look at that okay great all right so for the virtual people Dr.

Sugarman please be patient after we finish with these four we're just gonna take a five minute break.

Okay go ahead Kate Chairperson Henderson thank you for the opportunity to testify today my name's Kate Coventry I'm the director of legislative strategy at the DC Fiscal Policy Institute.

DC FPI is a nonprofit that shapes racially just tax budget and policy decisions by centering black and brown communities in our research and analysis community partnerships and advocacy efforts to advance an anti-racist equitable future health insurance plays a pivotal role in improving health outcomes and ensuring broader quality of life despite that fact in DC's longtime commitment to near universal health coverage in the district thousands fewer immigrants in DC have access to affordable health insurance under drastic changes that district's lawmakers approved to the DC Alliance program.

Nearly 25 years ago DC leaders created the alliance a program that has served around 23,000 residents per month in fiscal year 2024 with the belief that everyone should have access to health care regardless of immigration or economic status and that widespread coverage is good for residents' health and less costly than the alternative but facing a very tight FY2026 budget district lawmakers halted new enrollment in the alliance for adults over 25 and ended entirely for all adults over 20 in October 2027.

Lawmakers also reduced covered benefits my testimony focuses on the harm caused by these changes the changes in Mayor Bowser's proposed 2027 budget and the actions that the council can take to reduce harm.

One point I definitely want to make is that the alliance cuts will primarily harm Hispanic and black residents including those who are documented as well as undocumented.

In FY2020 50% of alliance recipients were Hispanic 20 were black and just over 2% were white.

And the current federal policy shift on immigration and local changes alliance are part of a long racist history of restrictions on immigrant access to public benefits.

Prior 1965 immigrants primarily were coming from the northern and European countries and federal law did not exclude them but as immigrate the number of immigrants from Latin America and Asia grew there were um increasing calls to um drop uh Medicaid coverage for immigrants so we know this is going to have a lot of bad effects and my written testimony goes into a lot of it so I'm just gonna hit the highlights um increasing reliance on costly emergency room visits that also don't um well serve people who need to manage chronic conditions like diabetes or hypertension um increased medical debt um for residents with low incomes um there while there are some uh programs for people who are low income in hospitals they're not often informed of this availability don't know how to access it and um hospitals are not spending the same amount on on compensated care that they should and um loss of coverage for pregnant people just two months after delivery um we will be insuring people through CHIP which unfortunately is not as robust as our local Medicaid um you know uh people can have postpartum complications up to 365 days after birth so having a longer period is helpful um so the DC council should just reserve reverse this harmful cuts as much as possible and if possible it'll definitely restore vision and dental for FY26 if there's any additional money in the supplemental budget.

We will be insuring people through CHIP, which unfortunately is not as robust as our local Medicaid.

You know, people can have postpartum complications up to 365 days after birth, so having a longer period is helpful.

Um, so the DC council should just reserve reverse this harmful cuts as much as possible.

And if possible, it'll definitely restore vision and dental for FY26 if there's any additional money in the supplemental budget.

Thank you for the opportunity to testify.

And I'm happy to answer questions.

Thank you.

Jacqueline.

Good afternoon, Chairperson Henderson.

Thank you for this opportunity to testify.

My name is Jacqueline Verner, and I am an attorney at Disability Rights DC at University Legal Services, the designated protection and advocacy program for the District of Columbia.

We advocate on behalf of district residents with disabilities to promote their rights to live in the community under the integration mandate of the ADA as interpreted by the Supreme Court in Olmsted.

My testimony today focused on the fiscal year 27's budget, budget's impact on long-term care services and supports for district residents with disabilities.

In a challenging budget year, we appreciate that DHCF's proposed budget maintains Medicaid eligibility and does not directly cut long-term care services.

However, it reduces and constrains the Medicaid funding streams that support long-term care services, particularly through cuts to provider payments and an ongoing lack of investment in the direct care workforce.

DRDC remains concerned about DHCF's continued use of an unspecified quality-based bundled provider payment structure for long-term care services to reduce costs.

DHCF states that this payment structure is designed to promote the efficient use of local dollars and represents a $2 million cut in this budget.

This approach carries significant risks to service access if not carefully designed and implemented.

A bundled payment structure could lead to a cross-the-board pressure to reduce personal care aid service hours and reassess beneficiary PCA hours downward, particularly for beneficiaries with the highest need whose care could exceed the bundled payment.

Accordingly, the bundled payment must reflect the acuity of this population with complex needs.

At the April 22nd DC MCAC meeting, DHCF stated that it is implementing a bundled payment because of inefficiencies in the long-term care system because PCA services are the most utilized service, and other EPD waiver services like homemaker and chore aid services are underutilized.

DHCF explained that while it is still working out the details of its bundled payment structure, the goal of the bundled payments is to give providers greater flexibility to deliver the full range of EPD waiver services and to encourage more beneficiaries to use those services that are currently underutilized.

However, in our experience, the underuse of services reflects a system design failure and is not caused by beneficiaries' overuse of PCA services or a fee-for-service payment structure.

Instead, low utilization can mean that a beneficiary does not know that those other waiver services exist, that the case manager or provider does not offer or educate the beneficiary about those services, and or the services are difficult to access.

We are also troubled by the mayor's proposal to only fund the direct support professional wage enhancements at current levels.

The district should fully fund the Certified Nurse Aid Amendment Act.

According to the DC Coalition on Long-Term Care, as of June 2024, the district had about 11,500 direct care employees, yet 36,000 district residents with disabilities needed their care.

Without significant investments to fully fund enhanced wages for this workforce, vacancies are going to remain, workers will continue to exit the workforce, and providers will be unable to retain quality staff.

I know I'm out of time, so I'm gonna end there, but I will also point you to our written testimony that also discusses that we urge that the council to enact and fully fund the Judith Human Memorial Workers with Disabilities Act of 2025, also commonly known as the Medicaid Buy In Act.

Thank you.

Take a deep breath.

You're not allowed in.

All right, Ed.

Chairperson Henderson, thank you for the opportunity to testify.

My name's Ed Lazier and I'm the director of legislative advocacy at United Planning Organization or UPO.

We are the district's community action agency and have been working since 1962 to improve the economic security of DC residents with low incomes.

It's a rare moment when I can testify before the DC Council and be thankful that only 10,000 DC residents lost health insurance over the last year, because that is what happened with the alliance.

But of course, I'm thankful that the 2027 budget stops further eligibility reductions in the alliance and restores dental and vision coverage.

But to be clear, that is not enough.

Under the budget, eligibility and other service cuts adopted last year would not be restored, and not a single person over age 26 could join the alliance.

To me, DC abandoned its commitment to near universal health insurance coverage last year, something that affects not just individuals but our entire health system.

So UPO is asking you, as so many others have done today, and the full council to bring back near universal health coverage in DC to restore the alliance to where it was in September 2025.

I also want to use this as an opportunity to you to urge you as a member of the full council to address the wide range of safety net cuts reflected in FY26 and in the FY27 proposed budget.

You know I've been watching the budget for a long time.

This is the largest retrenchment in the DC safety net that I have seen in at least a generation, perhaps since the beginning of home rule.

When we look at 26 and 27, we see that no family will be able to get child care subsidy for the foreseeable future due to those cuts.

Yet the budget also fully eliminates TANF cash assistance for 20,000 unemployed parents and their children over the next two years, with the expectation that we'll find jobs that will require child care.

The budget shrinks rapid rehousing for families without funding other housing options, meaning more families were under the shelter system at a time when evictions at our historic high, jumping one-third in just the last year.

Residents needing income when they take time from work due to illness or injury will be out of luck.

So just imagine one scenario of a parent needing to take time from work following surgery only to be ineligible for paid medical leave or for TANF, and then unable to get a child care subsidy when they're ready to return to work.

Facing eviction due to inability to pay rent, they couldn't access emergency rental assistance and instead would enter the shelter system because there are no housing options.

All of that scenario is entirely the result of local budget decisions in the last two years.

And of course, on top of that, we have SNAP and Medicaid cuts that are coming in the next year.

So I reject the notion that the council can only tinker with the budget once the mayor has submitted it.

The council has the same pot of revenue to work with that the mayor had when she developed her budget.

I trust you all to make much better decisions and come up with a dramatically better budget that does not take the city's economic challenges and balance them entirely on the backs of our chorus residents.

I urge you to do better.

Thank you so much.

Thank you.

Ms.

Nelson.

Good afternoon, Chairperson Henderson and members of the committee.

My name is Felicia Nelson, and I am the vice president of payer financial relations for Children's National Hospital.

For more than 150 years, Children's National has served as an integral part of the health care safety net, providing essential care to children and families from the across, sorry, across the Washington DC metropolitan area.

Thank you for the opportunity to provide testimony on the 2027 budget of the Department of Healthcare Finance.

I'm testifying today to express concern about the proposed cuts for direct medical education funding.

DME funding helps offset a portion of the program's cost that Children's National occurs in support of our pediatric graduate medical education program.

In 2025, Children's National, through its 49 GME programs, trained more than 300 residents and fellows who represent the future of pediatric medicine.

Children's National also provides these residents and fellows with diverse clinical experiences across a wide range of pediatric specialties through our GME rotator program.

Through these rotations, residents and fellows can strengthen their medical knowledge and skills while gaining targeted pediatric experience.

It is also important to note that our GME trainees supply the majority of our around-the-clock in direct inpatient care at Children's National Hospital.

As frontline providers, they play a critical role in delivering high-quality care to children and families in the community.

This work is necessary to meet children's nationals' mission to educate and train the next generation of pediatric clinicians while advancing outstanding pediatric medicine to the District of Columbia.

Based on the estimates provided by DHCF, with which we concur, Children's National stands to lose approximately $3.6 million this year alone if DME funding is not restored in the FY27 budget.

This represents nearly 15% of the funding that we receive for the program.

This loss in funding would negative negatively impact a program that both nurtures and supports the career development of future pediatricians and pediatric sub-specialists and provides critical direct care for our children across the district.

Further, this reduction should also be considered in light of other changes in the health care finance landscape, including changes from HR 1, the one big beautiful bill.

While we are still assessing the full impact, we know it will negatively impact our resources and could impact the on the level and extent of care that we provide for children and adolescents in the district.

While we thank Deputy Mayor Tarnage and his team for their work on this budget and their all of their collaboration, we understand under the current landscape that this has been a difficult choice for the team to make to balance the agency's budget.

However, children's national urges the council to restore GME funding as it is essential to our GME programs and the training we provide.

Thank you.

Just through the MCAF meeting last week.

It was like pretty much the same answer they gave during last year's MCAF meeting regarding moving to these bundle payments, and they think certain services are being underutilized, like the chore and homemaker services.

And that people are mainly just wanting PCA services, which we don't think is the case.

Oh, everybody is using PCA services.

Everybody's using community support.

Everybody's using recovery support, right?

Like limits, limits, limits.

When in fact, I think PCA, a little bit different, is that it's really helping with activities of daily living.

So like if no support, then what does the person do?

Absolutely.

Yeah.

Okay.

Um and appreciate you uplifting the Judas Human bill.

And of course, um, you know, um we're gonna keep working on the CNA piece.

Um I was telling someone a couple of weeks, like we have a growing aging population in the district, and we choose to keep trying to ignore dealing with the long-term care problems and also the long-term care workforce shortage.

If I don't have CNAs, home health aids, etc.

And then I also don't have we DC don't have any nursing home slots, then what are we doing?

It's gotta be one or the other.

Either you I get to age in place in my home, or I'm going to um a long-term care facility or an assisted living facility or something else, but there also has to be space for that, and right now we haven't been building that out.

So we got to pick one from an infrastructure standpoint.

And of course, I would also just you know, echo that individuals do have the right to live in the community under the ADA's integration mandate, and so the focus should be absolutely as of course because of Brown BDC as well, that we are building out the infrastructure for people to reside in the community and focusing on the PCA services piece.

Yeah.

Okay.

Um, all right.

Ums Nelson, how many um residents do you all have at Children's?

So from an FTE uh count perspective, we have a little bit over 300.

If you were to do an individual head count, it's a little bit over a thousand residents and fellows that come to children's uh throughout the year.

Um, the number that number there is so high because sometimes there's residents that just come for one month.

Um I see yes, okay.

But the number that's factored in for reimbursement is the 300 FTEs.

The 300 FTEs, okay.

Okay.

Sorry.

They're sending me spreadsheets.

All righty.

We'll see what we can do there.

Thank you.

All right, thank you all.

Thanks so much.

Okay.

Um, as telegraphed prior uh virtual folks, we're coming back.

We just need five minutes.

If five minutes, thank you.

We'll be back in five minutes.

Okay, we're back.

Um five and five.

Uh Kate Sugarman.

Mark Lavora.

Ian Paragall.

Fernando Ruiz.

We'll see what we're doing.

Again, you'll need to affirmably accept our invitation to become a panelist.

There'll be a little box that pops up on your screen.

Um that invites you to become a panelist, and um you'll need to say yes in order to join us.

Okay.

Dr.

Sugerman, I see you.

Yes, when when you're ready.

Okay.

Uh good afternoon.

And uh thank you, Chair Henderson and the health committee.

And I am a family doctor, and I uh work at Unity Healthcare in Ward 1.

Uh so I treat uh DC patients.

I um I have many, many patients who have been benefiting uh for over 20 years uh due to the health care benefits of DC Healthcare Alliance, and that's why I'm testifying.

I have seen in real time the damage that has been caused by the cuts to DC Healthcare Alliance.

So I'm testifying to call on the council to legislatively and financially restore alliance to keep DC residents healthy, thriving, independent, working, self-sufficient, and this also protects the DC health care uh ecosystem.

So I want to give an example of a patient with insulin-dependent diabetes.

Uh her medications had previously been covered by DC Healthcare Alliance, and um the uh diabetes has also now been damaging her kidneys and damaging her vision.

And this is so critical because you know left untreated, this poor patient will end up on dialysis, she will end up blind, and these are all conditions that were controlled well by DC Healthcare Alliance.

Um the cuts do not only affect her, but they infect the entire DC community.

When uh patients can't get their chronic medications, they can't get their insulin, their blood pressure medicine, their asthma inhalers, then they end up in the emergency room.

Once they're in the emergency room, they're overcrowding the emergency room because the patients who truly have emergencies, patients with heart attacks, patients who've been in car accidents, uh, then um have increased wait time because the emergency room is so uh overcrowded by the patients uh who were previously getting their health care needs met by alliance.

So my uh my my flea, my uh my request for the members of the council is that um that um you know the DC uh healthcare alliance should be um the DC health care alliance should be uh brought back to what it originally was.

So the um income requirement should be returned to 215 percent of the federal poverty level because that truly covered people.

The age moratorium needs to be removed so DC residents of any age can receive health care, and um that the services covered by alliance before October 1st, 2025 should be restored, and make sure that all these changes are in the law as a budget support act subtitle.

And I apologize for the background noise.

I am in clinic, and um, I guess uh I'll stay on if anybody has questions.

Is that correct?

Um yes.

Uh but if you need to get back to your patients, I understand.

Okay, we're gonna go to uh Mark Lavota.

Mark.

Thanks.

Councilmember Anderson, members of the council.

Thank you for the opportunity to testify today.

My name is Mark Lavota.

I'm the executive director of the District of Columbia Behavioral Health Association and award two homeowner.

The District of Columbia Behavioral Health Association works to advance high-quality whole person care for district residents with mental illnesses, substance use disorders, or both, including the 35,000 district residents, our 35 member organizations serve annually.

The mayor's proposed FY27 budget for the Department of Healthcare Finance maintains important eligibility standards for the Medicaid and Alliance programs, but still sends troubling signals about diminishing public health insurance in the district.

My testimony will focus on public insurance coverage eligibility gaps, public insurance service gaps, and provider payment rate challenges.

District government changes to Medicaid and Alliance eligibility standards implemented in FY26 will persist into FY27, but these policies will make coverage harder for district residents when paired with upcoming federal eligibility changes.

Extending alliance eligibility for FY27 at FY26 income eligibility levels makes the moratorium on new enrollments untenable.

And the elimination of alliance coverage for adults in FY28 of the outyear budget remains deeply troubling.

The council needs to fund elimination of the enrollment moratorium.

So people who've lost alliance coverage have the opportunity to re-enroll, and people who become newly ineligible for other coverage also have the opportunity to enroll.

The council also needs to fully fund the recently passed Medicaid buy-in bill.

The district's public insurance programs also need to address service disparities across the increasing array of the district's different publicly funded insurance programs.

If the council is unprepared to restore DBH cuts to the DBH local dollar rehab service programs, alliance beneficiaries will face an effective reduction in benefit from FY26 service coverage levels, including losing access to community support and outpatient recovery support services.

We also asked the council to review the impact of prolonging the provider payment rate freeze that has been in effect for FY26 for provider types like the Department of Behavioral Health Provider Network that have neither routine rebasing cycles nor inflation index rate adjustments.

Rate freezes extend what are already often years without rate updates.

My written testimony describes important concerns regarding the lack of updates for community support services and assertive community treatment.

I also want to express our dismay at the decision to eliminate direct graduate medical education payments for hospital physician residency programs.

The district has some of the finest teaching hospitals in the country, including one of the country's few medical residencies out of historically black college and university program for behavioral health.

We're also particularly concerned about the several psychiatric residency slots that would likely face elimination while the country faces a severe psychiatric workforce shortage, and the district needs to recruit more psychiatrists into treatment roles.

Thank you for the opportunity to testify today.

I look forward to answering any questions you might have.

Thank you.

Ian.

Good afternoon, Chairperson Henderson.

I'm Ian Perigo, and I serve as exec director of the DC Coalition of Disability Service Providers.

The coalition currently represents over 50 provider agencies supporting over 2300 persons with intellectual and developmental disabilities and employing over 7,000 staff member organizations provide home health, home and community-based waiver services, as well as intermediate care facility supports to residents of the district with the IDD.

So I have a new budget impact item since it was just shared on Wednesday night.

The DC coalition is deeply concerned about the department's decision to reduce ICF support funding from 60 therapeutic and vacancy days down to 18 days as a means to save 130,000 in local funds.

These bed hold days are designed to be used by the ICF population when medical treatment is necessary due to illness or disease or when medical procedures are performed.

Because ICF services do not have cost constants, these days are used so the providers can continue to pay staff and meet the needs of the other persons residing in these three to six person ICFs, even though one resident may be temporarily absent.

The home operates as a unit and eliminating one person's contribution to costs impacts the entire residence.

Further, as I'm sure you're aware, these persons are residing in ICFs typically have both a developmental disability as well as some underlying medical conditions.

This is precisely why they're receiving supports in an ICF rather than residential habilitation because they require medical interventions.

The department's cost-saving measure of reducing bed hold days from 60 to 18 for the very population most likely to need medical supports in an effort to save 130,000 in local funds, which matches another $300,000 in federal funds, seems short-sighted and unduly impactful for a population of persons who are aging and likely to need additional medical care.

You may recall that many of the persons within this cohort are former Forest Haven institution members who are now in their 70s and 80s.

And for these reasons, we respectfully request that this proposed budgetary reduction be withdrawn from the budget or that council supplement this $130,000 to support this population, especially since it comes with $300,000 of federal monies.

On a far more reaching concern is the direct support wage allocations of the DSP rate payment act not being included as part of the FY27 budget or the financial plan as have been stated earlier.

I've submitted detailed written testimony about this concern.

Do testimony time constraints I urge you to review the history, the practical implications of failing to address the DSP wages and consider the need for action.

We're requesting that the funding requirements of the DSP rate payment act be reinstated and that wage funding be included so that the industry can pay our direct support and direct care workers an average of 17.6 or under the CNA Act, 20% above the minimum wage for this demanding and critical job.

Thank you for the opportunity to provide this testimony at today's budgetering, and I welcome any questions.

Thank you.

Fernanda Ruiz.

Okay.

Hi, Councilmember.

My apologies.

I was having issues with joining.

No problem.

Good afternoon to Chairperson Henderson and members of the committee.

Thank you for the opportunity to testify today.

My name is Fernanda Reese and I'm the home missing director at Mayor Center and a district resident from Ward 5.

We are grateful that funding for the Nurse Family Partnership Program is maintained at level funding in the fiscal year 27 budget.

This investment ensures continuity of care for first-time mothers and their babies across the district.

We also appreciate the HCF's ongoing collaboration and partnership in implementing this program.

At the same time, we want to highlight an ongoing challenge with the funding timeline.

Over the past two years, awards have been issued during the second quarter of the fiscal year, creating uncertainty and potential gaps in services at the start of the year.

As we have shared previously, aligning funding timelines with the fiscal year is critical to ensuring continuity of care and allowing programs to plan responsibly.

Last week, we celebrated National Home Visiting Week.

Mary Center in partnership with Changent hosted a panel where we heard from leaders across the region about the importance of sustainable funding to ensure programs can succeed long term.

Most importantly, we heard directly from two NFP mothers.

One recent graduate show uh shared how her nurse home visitor helped her feel she was not alone, supported her support her through her postponed depression and strengthen her confidence as a mother.

This is the impact of the stable sustained funding.

I would also like to briefly address the DC Healthcare Alliance program.

While we appreciate the restoration of dental envision coverage, we remain concerned about the current income limit of 138% of the federal poverty level and the age gaps for adults over 26.

We urge the council to restore the income limit to 215% of FPL and remove the age gap.

Earlier this month, one of our NFP mothers experienced a dental emergency that required three extractions.

Her nurse home visitor helped connect her to care and supported her through every step of the process, including attending appointments with her.

Despite receiving care, she was left with a 1200 bill that she had to pay out of pocket.

This is a mother that is living paycheck to paycheck.

Paying that bill meant choosing between her health and her rent.

Fortunately, we were able to secure emergency funds to support her, but without that support, she would have faced debt or delayed care.

This is why strengthening the Alliance program is so important.

Access to coverage should not depend on whether someone is connected to a program that can step in during a crisis.

In closing, we are grateful to DHCF's partnership and continued investment in home visiting.

We urge alignment and funding timelines and strengthening of the alliance programs so families can access care without disruption or hardship.

Thank you.

Thank you.

Council member.

My name is Wilsy Dubon, and I am an adult learn at Bria Public Chartered School.

And I'm a mother of an infant son.

DC Healthcare Alliance is very important, not only to me, but to many of my classmates.

Alias is a vital part of being able to live a productive life.

Without it, many of us would not be able to afford the medical care that we need.

Restore the income limit to 215% of the federal poverty label.

Restore the service that we able before October 1st, 2025.

Stop any further code of the Alliance Program.

Please continue to support programs like Aliens that make a real difference in the life of families like mine.

Thank you for your time and the consideration.

Thank you.

And Paola.

Okay.

Oh, hold on one second.

Okay.

All right.

I think Paola, we're gonna we think we see you, but um, your name is not the name on um the witness list.

So um we're gonna promote you in the next panel.

Um thank you so much to this panel of witnesses uh for all of your testimony and the issues that you've raised.

Um I don't have any specific questions right now for the record.

Um, and we haven't been joined by any of my colleagues.

So um I want to say thank you so much for being here.

If you could please provide your written testimony for the record, um we will certainly take a look and follow up.

So thank you all.

Okay, we're gonna go to our final panel.

Um so I think Mark Miller is here virtually now.

So we'll have Mark.

Um Paola if if that is you, uh Chiquita Carter, uh Roccio Cuelo, Dana Mueller, Adrian Smith, Maria Gomez, and Veronica Sharp.

So again, um there'll be a little box that pops up on the screen.

You'll ask it if you want to be promoted to be a panelist, and you do have to say yes in order to join.

Okay, all right.

Mark, uh, we'll start with you.

Thank you, Chair Henderson.

I apologize I wasn't able to join you in person today.

Uh had another commitment.

Um good afternoon.

My name is Mark Miller.

I'm the DC long-term care ombudsman with legal counsel for the elderly.

Uh, thank you for the opportunity to participate today and testify on behalf of the approximately 10,000 district residents who receive long-term care services and supports, including those that receive services under the elderly and with physical disabilities waiver DPD Medicaid waiver program.

Uh, let me first express my appreciation for the financial support which the Ombudsman program receives from DHCF, which is made possible by an agreement with the Department of Aging and Community Living.

This support is critical to our successful work resolving concerns on behalf of hundreds of EPD waiver beneficiaries and nursing home residents, historically close to 80% of the individuals that we serve and provide advocacy services for our Medicaid or dual eligible recipients.

The DCC long-term care ombudsman supports the efforts of DHCF to provide district residents with a comprehensive package of long-term care services and supports, including through the EPD waiver, allowing many individuals to remain in their own homes and maintain vital connections with their families, neighbors, and places of worship.

This high level of commitment is exemplary by comparison to other states.

Therefore, the Ombudsman Program supports a budget that provides all necessary funding for home and community-based services, including the EPD waiver, which now serves roughly 5,700 people across the district, and also a budget that acknowledges the increasing demand for this most critical part of the continuum of long-term care services and supports.

Increased funding for home and community-based services is more critical now than ever before.

Without these services, district residents will be unnecessarily forced into nursing homes and other congregate settings.

For many, that will mean leaving, having to leave the district, their families and friends in the city they love, because as we know, there are insufficient numbers of nursing home beds available.

Over the past 10 years, we've lost a significant number of beds with the closure of four nursing homes.

Therefore, the Ombudsman program also supports maintaining adequate Medicaid reimbursement rates for nursing home providers to ensure continued access to those needing that important level of care.

Thank you for the opportunity to provide this testimony today and welcome any questions you might have.

Thank you.

Paola.

Paula.

Hello, yeah.

Okay, great.

This is her.

Thank you so much, and I apologize for the tech issue.

It's okay.

Yeah, and hello, Chairperson Henderson and members of the committee.

My name is Paola, and I'm here as a DC organizer for hand in hand, the domestic employers network.

As you may know, the care economy is a broad sector in the city, consisting of 9,000 domestic uh workers and over 10,000 individual employers.

In my work, I speak with a diverse group of employers, not all, not all of whom uh can easily access and/or pay for their aging care services.

Many people in the city rely on programs such as Medicaid for access to a home health aid and the ripple effect of reducing the already limited options of our city's employers and workers have access to will have a major impact on the overall care economy, including creating a strain on the work on the workforce that is already facing ongoing shortages.

These shortages interrupt elders and people with disabilities from accessing the care they need to live independently, resulting in more institute institutions of loved ones, frequently against their wishes.

The interdependence between employer and worker is a key piece of a care world in DC.

And if a worker is unable to receive health support, it puts it puts employers at risk for not having healthy and capable workers to support them in their homes.

These impacts are felt in shortages and struggle for everyone involved.

Hand in hand would like to emphasize that the council please consider removing the age limit for enrollment, especially considering the aging population in DC, many of whom speak to us about their increasing needs as they get older.

And we also second the request regarding the restoration of income eligibility to uh to 215% above the poverty line.

Thank you so much for your time.

And um, we're happy to also respond to any questions.

Thank you.

Jaquita Carter.

Roccio Cuello.

Yes.

Hi.

Good afternoon, council members.

Thank you for the opportunity to testify today.

My name is Rocío Cuello, and I'm uh I am an abort learning abriya charter school and a mother.

In my community, many of the last ma and the parent of my son's classmates relay on the sea health alliance.

It is very important for our families.

I often hear how worried people are about losing their health coverage and how that fear affects their daily life.

I have also seen also seen some families avoid going to the doctor or delayed care because they are afraid of the cost or because they no longer have the coverage.

This is very concerning, especially for parents who are trying to stay healthy for their children.

No family should have to choose between their health and their financial stability.

Programs like Alliance provide the support a family need to stay healthy and continue moving forward.

That's why I respectfully ask the council to remove the age cap for adults over 26th, restore the income limit to 215% of the federal poverty level.

Restore the service that were every label before October 1st, 2025.

Please consider the impact this decision have on families and children in our community.

Thank you for your time and consideration.

Thank you.

Dana.

Adrian Smith.

Okay.

All right.

Um Adrian's not here, but Dana just joined.

All right, I am here.

I just had to be invited in.

Uh Dana.

When you're ready.

Okay, thank you.

Uh good afternoon.

I'm Dana Mueller.

I'm a physician, and I'm the interim chief medical officer here at Mary Center.

Uh we provide a medical home to 65,000 people every year.

And I'm here today because I'm seeing in our exam rooms what happens when our policy shifts create cuts in our health coverage.

Uh, first, I want to express my very sincere gratitude for the restoration of the dental envision coverage for Alliance and the Basic Health Plan recipients.

These services are so important to the quality of life and to keeping patients healthy as and participating in the community as parents, as workers and as people.

Um, however, I have to speak about the programs that remain in crisis, um, Alliance, the basic health plan plans, and our Medicaid for our patients, particularly those with limited incomes and complex needs.

These are not just line items, they're lifelines.

Um I heard you earlier, councilwoman, about uh how we all have the same requests, and so I'm actually not gonna repeat them because I only have three minutes, but I request the same thing that all of my colleagues are requesting regarding the poverty limit uh changes for 215% and the age cap.

Um, but I want to particularly focus on patient stories uh today.

Since January, the transition to generic only coverage has created a silent crisis.

Uh every day I see patients whose blood sugars were well controlled for the first time in their lives on new life-changing diabetes medications last summer, who have been diligently taking the generics that are covered on the current alliance formulary, and we're seeing their blood sugars climb back to uncontrolled levels.

Um, while cost containment is a logical goal, the reality is that many essential treatments, especially when it comes to diabetes, do not have true generics and that first gen meds can't be compared to newer, better, safer second medicine and third generation medications that have come later.

Uh individuals' reactions to meds are personal, and while generics work for some, they don't work for all.

And when needed, medications are inaccessible.

Individuals' health doesn't just plateau, it declines.

And so where possible, I urge uh, if not at full formulary, the opportunity to have exclusions with prior authorization.

These are hoops we are willing to jump through for our participants.

Um medicine is more than just a pill or a primary care visit.

It's also the support service that allow patients the ability to recover from the effects of illness or injury at home or in formal care environments.

We're asking for the restoration of services that were previously covered but have since been removed.

Home health, skilled nursing, podiatry, non-emergency transport.

Um, while some of these may be low utilization for the city, they are very high necessity for the patient who cannot get to their appointment or uh get to physical therapy uh uh or stay in a uh skilled nursing facility after discharge.

Um, and they will not recover uh without that services.

Um we're all better off when every member of our community, from youth to seniors has access to continuous comprehensive care and our ability to provide that care is really at the whims of the district.

And so uh we appreciate your support in expanding and defending these programs as a commitment to equity and the health of the district.

Thank you.

Thank you.

Uh Maria Gomez.

Okay.

Uh thank you so much.

Um, good afternoon, Chairman Henderson.

Um, I will be probably repeating much of what's been said, but I think it needs to be heard.

And since I happen to be probably one of the last ones, I will say that we appreciate the council support to reverse the mayor's cuts that affect first the parents of our children, second, the lower income working adults, and third, our medically fragile.

I was involved in the establishment of the alliance in 2001.

Prior to this date, some women live with their infants on their own.

Others died of cancer quietly.

With the establishment of the alliance, families can now receive early diagnosis to save lives.

In 2025, as people who are being rounded up, we took health care benefits away from them.

In that line, we also applaud the mayor for restoring dental envision coverage, which we expect the council to support 100%.

You can continue to restore people's lives by amending the DC Healthcare Alliance Reform Act of 2025 by doing the following.

One, removing the age ban to allow single adults to receive health care.

Legal A has said that in addition to the thousand people that already lost health care within a year, various existing Medicaid patients will also lose health care coverage.

Second, return the income limit to 215% of federal poverty.

And why do I say that?

Because that is a single person making $35,000 a year.

Um let's do the math.

Individuals in DC pay approximately about $28,000 of their income and rent, which leaves about for our poorest people, leaves them with about $7,000 a year.

Today, to qualify for alliance for Medicaid, my neighbors cannot earn more than $22,000 a year.

Third, restore home health care as has been said by Dr.

Mueller, the skilled nursing facility care, hospice and the other non-highly utilized services.

Families must choose between caring for disabled family members or keeping their jobs.

I'm a witness of that as I'm on a board of a hospital.

Fourth, enable health centers to perform eligibility screening and presenting eligibility for alliance coverage.

The leadership of this institution is higher.

The most knowledgeable practitioners is Dr.

Mueller, who know, and Dr.

Sugarman who know that is what is best for the patients and how important it is to deliver prompt care, as you have heard.

And last guarantee that we keep in place both mail and mail in an annual recertification for alliance and medicaid members.

In conclusion, first support our immigrant community by implementing this recommendations and codify them to take effect.

And second, secure enough funding for the Department of Healthcare Finance to respond to changes coming to the Medicaid program later this year.

Thank you for the opportunity.

Oh no, who's it?

Oh no, that's just Maria.

Okay.

All right.

Well, thank you so much to this panel of witnesses.

Um for your testimony.

Um of course your advocacy in raising these important issues.

Um we have a lot to discuss with um both DMHHS as well as Department of Healthcare Finance.

I don't have any specific questions for this panel.

I do want to thank everyone who testified today.

Um second.

Okay.

Uh for those who are unable to speak or unable to attend today's hearing, the public record will remain open until Monday, May 11th.

Uh written testimony may be submitted via the council's hearing management system site at DC Council.gov backslash hearings.

Um, the next hearing for this committee, the committee on health, will be held tomorrow, Tuesday, April um twenty-eighth at noon.

We'll hear for the public witnesses for the proposed FY27 budget for um the Department of Health.

Uh, we'll hear from the government witnesses for Department of Healthcare Finance and DMHS.

It is currently um scheduled for Wednesday, but um that date is likely to change, and we'll certainly follow up with folks um to give them more information about that.

Um we'll see everyone tomorrow, but um, there being no further business before the committee right now.

Um, this particular hearing is recessed to a later date.

Uh the time is one fifty-five PM.

Thank you.