All right, good morning.

I'm at large councilmember Christina Henderson, Chair of the Committee on Health.

Today is Wednesday, May 6, 2026.

The time is 9 31 a.m.

We are in room 123 of the John A.

Wilson building.

This is a hybrid hearing with uh government witnesses testifying in person, and we'll hear from public witnesses on both in person and online.

This hearing is being broadcast live on Cable Channel 13 as well as on my YouTube page at CMC Henderson.

I'm calling to order this meeting of the committee on health for the proposed FY27 budget for the health benefit exchange.

We'll hear testimony from both again today.

Let me tell you a little bit about health benefit exchange.

So DC Health Benefit Exchange Authority or HBX is a quasi-governmental agency of the District of Columbia government charged with implementing and operating the district's health benefit exchange.

The exchange operates DC HealthLink, an online insurance marketplace for district residents and small businesses.

DC HealthLink fosters competition and transparency in private health insurance market, enabling individual small businesses to compare health insurance prices and benefits and to purchase affordable quality health insurance.

The health benefit exchange has expanded their scope of services available in the last year by developing the basic health plan, also known as the Healthy DC Plan, which is a coverage option for individuals between one hundred and thirty-eight and two hundred percent of the FPL who lost Medicaid coverage this past year.

HBX works closely with the Department of Healthcare Finance to make this transition as smooth as possible.

And I want to commend Director Kaufman and her team for their quick and effective work.

If you're here in person, there are timers here.

If you're virtual, if you go to gallery view, you'll be able to see the timer there in the box.

Patricia Quinn.

Okay, Jacob, when you're ready.

Thank you to the chair for the opportunity to testify today.

My name is Jacob Spidel, and I'm a staff attorney at LegalAid DC.

First off, we strongly support the proposal to add dental and vision benefits for basic health plan enrollees.

And we urge the council to approve the five point seven million dollars the mayor proposed to support basic health plan dental and vision benefits.

The loss of dental coverage and vision coverage have been devastating for those who are transitioned from Medicaid to Healthy DC, which currently does not cover dental care except in mental medical emergencies.

The cost for restoring dental and vision coverage to the healthy DC population is a fraction of the district's annual budget, but will have an outsized positive impact on those individuals who have been moved from Medicaid to Health E DC.

Next up, we urge the council to increase the income limit for healthy DC from 200% of FPL up to what was the Medicaid limit.

215% of FPL for childless adults and 221% of FPL for parents or caretaker relatives.

When healthy DC was created, the lower income limit meant that about over 1,500 people previously enrolled in Medicaid did not qualify for healthy DC, even though their income had qualified them for Medicaid.

More broadly, the council should ensure that everyone losing Medicaid coverage due to cuts in that program can qualify for healthy DC if at all possible.

Similarly, the district should support healthy DC enrollment for DC residents who lose their affordable health coverage due to changes in federal law and do not qualify for alternative coverage.

Healthy DC has become an essential last resort to DC residents whose affordable health insurance is stripped away through cuts to Medicare, Medicaid, and the health care exchange.

Under the one big beautiful bill act, many DC residents will lose their Medicaid coverage on October 1st, 2026.

More will lose coverage January 4th, 2027, and others will lose access to affordable plans under the Affordable Care Act in January 2027.

When DC residents lose access to health insurance due to these changes, DC should have funding allocated to allow them to enroll in healthy DC to the greatest extent allowed by federal law.

Last, we encourage healthy DC to use continuous enrollment beyond the first year.

Healthy DC is using continuous enrollment for the first year, allowing people to enroll as soon as they're eligible.

After the first year, however, Healthy DC plans to switch to an open and special enrollment process that will force people to wait for certain enrollment periods, even if they're eligible.

This has higher administrative costs and is a difference from Medicaid, which has continuous enrollments.

Thank you for the opportunity to testify.

Thank you.

Anne?

Chair President Henderson, thank you for the opportunity to testify.

My name is Ann Gunderson, and I'm a senior policy analyst at DC FPI and member of the Under 3 DC coalition.

My verbal testimony focuses on the importance of preserving the investment in health care for child care.

And my written testimony provides feedback on the new healthy DC plan.

These programs ensure that district residents and workers maintain access to low-cost health care so they can thrive and meaningfully contribute to the district's economy.

To continue supporting health care in DC, lawmakers should maintain the mayor's proposed investment of 12 million dollars annually in health care for child care and maintain her proposed investment of 5.7 million dollars annually for restoring dental and vision benefits to healthy DC.

To date, more than 3,500 child care employees and their families have benefited from health care for child care, many of whom are receiving employment-based health care for the first time.

Many educators have testified before the council about how life-changing this program has been for them in every dollar DC invests in health care for child care, and that's over a dollar in premium value, making it a beneficial program for the entire district.

The exchange's commitment to creating a well-designed health care program is likely one reason why the pay equity funds has been so effective at attracting more educators to early childhood classrooms, increasing the retention of qualified educators, and expanding access to high-quality affordable care to district families.

As a result, health care for child care has become a national model that other states are studying and helping to implement for their child care sectors.

For example, North Carolina is exploring creating its own workforce compensation program for early educators, including a health care component, modeled after health care for child care.

Ensuring that child care workers have access to health care is central to closing persistent staffing shortages and building the workforce needed to provide families with accessible, affordable, high-quality care.

While the mayor's proposed budget for health care for child care is sufficient for fiscal year 27, if health care rates go up significantly, 12 million dollars may not be enough to cover everyone currently enrolled.

And it certainly will not be enough to eliminate the need for the wait list for this program.

There are also additional child care employers in the districts who are not currently enrolled in health care for child care group group coverage who would benefit from it.

But the exchange's outreach to new child care providers has stopped because there is not enough funding to cover new employers.

As the pay equity fund and subsidy program face real threats in this budget cycle, it's critical to protect every penny currently dedicated to health care for child care and anticipate how the cost of the program will grow in future years.

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

Thank you.

Rolf.

Just gotta turn your mic on.

Thank you.

Thank you.

My name is Raúl Echavaria, and I am the co-founder of Communicates Preschool, a multilingual early childhood education organization serving families across the district.

And I want to thank you for the opportunity to testify today in support of the DC Health Benefit Exchange Authority and the vital work it does to ensure that child care workers have access to affordable health insurance through the Health Care for Child Care program.

And I want to take a moment to thank you, Councilmember Henderson, for the help that you provided in ensuring that this pro this very important program continues to be funded.

So thank you.

I come before you as a child care provider, an employer, and someone who sees every day how deeply interconnected child care is with workforce stability and the economic growth of our city.

If we are serious about building a thriving economy, we must recognize that child care is essential infrastructure.

I often describe our system as a three-legged stool.

The first leg is peak, the second leg is the pay equity fund, which includes health care for child care.

And the third leg is a child care subsidy program.

Each leg is necessary.

Together they create stability.

If we weaken one, the entire system is at risk.

I want to focus on what happens if we weaken or eliminate the pay equity fund and the health care for child care program.

At its core, the program supports health and well-being of the child care workforce.

In order to educate and care for our youngest children, teachers must be healthy.

That will allow them to be present and supported.

The health care for childcare has made it possible for providers like communicates to offer access to affordable health care.

Something that is essential for attracting and retaining highly qualified educators.

If we don't have that, we face a very real challenge.

We will struggle to hire, we will struggle to retain.

And when that happens, the consequences are immediate.

We may be forced to close classrooms, not before not because families do not need care, but because we do not have enough qualified healthy staff members to safely operate.

When classrooms close, supply shrinks, but the cost of running a center does not shrink with it.

Childcare is a high fixed cost model.

Rent, staffing structures, compliance, all of these costs remain.

And families are already carrying an extraordinary budget.

Right now, the cost for infant care in DC, just the cost is around $31,000 per year, more than many families pay for in-state college tuition.

So when these classrooms close, the supply tightens, those costs don't stay the same, they actually rise.

So how this is how quickly affordability moves from difficult to be completely out of reach.

The impact then doesn't just stop with families.

When childcare becomes unavailable or unaffordable, parents are forced to make impossible choices.

They reduce hours, they turn down opportunities, and they work leave the workforce entirely.

So the question before us is not simply about maintaining a program.

It's about whether we're willing to sustain a workforce that makes child care and our economy possible.

Thank you very much for your leadership and your commitment to the children and families and educators of the District of Columbia.

I welcome any questions.

Thank you.

Patricia Quinn.

Good morning, Chairperson Henderson.

I'm Patricia Quinn, Senior Director of Government Affairs and Policy at the DC Primary Care Association.

And I'm providing testimony on behalf of Ruth Pollard, our president and CEO and executive director of the DC Connected Care Network.

Thank you for the opportunity to testify on HBX's FY27 budget.

HBX plays a critical role in maintaining high rates of health insurance coverage in the district, and it increasingly plays that role for low-income individuals and families who are over income or otherwise ineligible for Medicaid.

We are grateful to the HBX team for their commitment to maximizing opportunities for coverage for the broadest population possible.

HBX effectively stood up the basic health plan for DC residents, 138% of federal poverty level to 200%, and establish this program with all the essential health benefits, no premiums and no co-pays.

In particular, for the FY27 budget, we support and are grateful for the inclusion of dental and vision in the basic health plan.

Federal policy changes contained in HR 1, specifically the new restrictions on ACA marketplace subsidies and access to Medicaid and the basic health plan for lawfully present non-citizens will impact district residents formally eligible for these programs.

Without proactive action from the council, these changes threaten to destabilize health coverage for lawfully present immigrant Washingtonians.

We urge council to identify additional resources for HBX to serve residents who will soon lose coverage due to federal policy changes.

The HBX team is one of solution seekers.

They developed a short-term solution to cover lawfully present residents under 100% of FPL and ineligible for Medicaid due to immigration status for the remainder of 26.

HR1 eliminates Medicaid and chip coverage for some legal immigrants, including including refugees, asylumes, parolees, certain abused spouses and children, and certain victims of trafficking.

It restricts access to ACA marketplace subsidies, the premium tax credits, to U.S.

citizens and a narrow set of lawful permanent residents.

Approximately 400 residents will be impacted by the loss of subsidies for BHP.

We recommend that council appropriate funds to maintain subsidized coverage for immigrants who lose federal eligibility.

Thank you for your time and consideration, and I welcome any questions.

Thank you.

Sorry.

Thank you all for your testimony.

You know, Patricia, when you're sort of going through all of the various things that HR1 did.

Just in sort of this agency, it sort of brings me back to earlier this week with DC Health, where I'm we're literally cutting teen pregnancy prevention, HIV stuff.

Like there are so many things that the federal government has essentially abandoned in terms of it coming to public health.

But what I think is incredibly cruel is well, all of it is cruel, but even more so is for the individuals who are here lawfully present, don't qualify for Medicaid, and now we're saying they can't get any subsidy off the exchange and XYZ.

And there's a degree of cruelty to that that I find difficult that that these are are folks who did the right thing, came the right way, right way.

You know, that is a different, a different hearing.

Um, but still we're going to deny them access to health coverage.

And the thing is, I mean, we're you're hearing this all during the hearing season.

People don't stop needing health care ever.

So we eliminate coverage, we don't eliminate health care need, and it has its downstream impacts across the board.

We eliminate coverage, but we don't eliminate the need.

Yeah.

Thank you.

Thank you for being here.

Um, Raul and Ann, thank you for being here and for your continued advocacy.

Um, I think Anne, as you sort of said, healthcare for child care, I think is probably one of the more innovative things that this government has done in a long time.

Um, and as Roel said, right, it's helping to sustain a workforce.

Um we have some questions for health uh benefit exchange Authority.

Um, when we spoke to them during performance oversight, there wasn't a wait list for healthcare for child care with the current amount of money that they had.

So hopefully that is still the case today.

But I think Patricia, as you sort of said, HBX have been solution seekers.

And so it's actually been a really great agency to work with around some of our more challenging issues.

Again, we gotta go back to the feds.

We cannot.

Yeah, in January of 2027, when the Medicaid work requirements start, we will have a population of individuals who might lose their Medicaid coverage then.

There is no safety net under that safety net that exists, if that makes sense.

I can't move you to Healthy DC because Healthy DC actually requires you to have income.

And if you had income, then you were working.

And then if you were working, you would still qualify for your Medicaid.

So it is one of those um things that I think we as a government are gonna have to get sort of creative about.

But I feel like in terms of healthy DC, we have stretched this.

Um we have stretched it as far as we can at this um particular stage.

And frankly, without a change in the administration, I don't see how we move a little bit further on that.

But we will ask some questions about the continuous enrollment piece, um, which we had a meeting with Health Benefit Exchange.

I can't remember if she told me that requires a waiver, but nonetheless, we'll get that on the record.

But thank you so much uh for being here, and um if we don't have your testimony, key please be sure to submit it for the record.

Thank you.

Thanks everyone.

Okay.

Uh Neil, Christie.

All right.

Um, okay.

Neil is the last person that I had for in-person.

So I'm gonna go back through the people who I uh called who weren't here and let's see if they arrived.

Okay, Jen's still not here.

Adrian.

No?

Okay.

Uh Rosalina.

No.

Melissa Hall.

Okay.

All right.

Is there anyone who's here in person who is expecting to testify today?

Who I didn't call their name?

Okay.

Okay.

Neil, when you're ready.

Oh, some.

Neil, now.

Oh, just turn your mic on.

There you go.

All right, thank you.

Uh good morning.

Uh, Chairperson Henderson, members of the Committee on Health and Council staff.

My name is Neil Christie.

I'm a proud resident of Ward One.

I've lived and worked in the district for more than 30 years as an advocate for international human rights and as a leader within the United Methodist Church.

My wife Lois is a clinical social worker.

We've raised two wonderful children through DCPS.

Our younger son is currently an undergraduate student at UDC.

Thank you for the opportunity to speak today about my family's experience with DC Health Link and to express my strong support for this essential program for all efforts to make it affordable, keep it affordable, health care insurance is a reality for every district resident.

As a longtime resident, I believe it's worth noting that every one of my interactions with DC Health Link has been a positive one.

I wish I could say the same for all agencies where my experience with housing and sanitation have been mixed.

But I can say that with DC Health Link, I have never ever had a single negative experience.

Not once.

Whether I had a question on a Saturday morning or a Sunday afternoon, knowledgeable staff have always made me feel heard, understood.

Not once have they left me feeling like I was to be shuffled along.

This matters because I believe that DC HealthLink serves as a critical buffer between insurance companies and ordinary citizens.

DC Health Link ensures that people are not dropped, overlooked, or left behind without complete answers and a range of solutions to their questions.

The greatest challenge, as you know, remains the high premiums, but that responsibility lies with insurance companies and not with this agency.

When I transitioned from employer sponsored insurance plans after several decades, I was relieved to discover the range of options available through DC Health Link.

And my hope is that all residents in the district, especially younger adults, will understand the options available to them and take advantage of it through DC Health Link.

In my early career, I served as within the only faith-based office, non-governmental agency and building located on Capitol Hill.

And that agency, along with my church, has been dedicated to educating and organizing United Methodists and other people of faith, frequently people of no faith, on the critical issues of human dignity and social justice.

And from that vantage point, I've met thousands of people across our country, and I've listened to countless stories of human and civil rights struggles.

Far too many of these stories include a crisis caused by disparities in health care.

Disparities that we have the power, we have the ethical responsibility to address.

A responsibility the government ignores at its own peril.

And like police or fire protection, health care is best funded through government's ability to tax each person equitably equitably and equally.

We believe it is the government's responsibility to provide all citizens with health care.

We also say that health care is a human right, and treating it as such is one of the most effective ways to advance racial equity and social justice in our society.

DC Health Link plays a vital role in this work.

So I thank you, Chairperson Henderson.

I thank you, members of the committee, for your leadership, for your support for health care for all, and I thank the DC Health Link program, all of its staff.

I thank them for the mission of the Health Benefit Exchange Authority, and I welcome any questions you may have.

Thank you.

Thank you.

Uh Jazelin.

Oh, you gotta hit the button right in front of you.

Turn your mic on.

There you go.

Perfect.

Thank you so much.

Uh good morning, council.

Uh, my name is Jaslin Lindsay, and I'm the executive director for Anyamekua Farm Collective.

We are an agricultural education nonprofit, and I am a fifth generation Washingtonian, and I'm here to speak about the Office of Food Policy and a the funding of the Office of Food Policy.

Hold on, one second.

Um, Jaslin, that is uh this is the wrong hearing.

So the food policy is I don't know which room they're in, but that would be Office of Planning.

Okay.

Thank you so much.

No, no, no.

Hold on, hold on one second, and I want you to get further down.

We're gonna find out where.

Yeah, that will be in room 412.

Thank you so much.

Oh, okay.

I want to go take them in, too, but that's actually what I was doing.

Okay, yep.

That 412.

And also, yay.

Thank you for testifying on that.

Thank you.

Okay.

All right, so Nigel, you're here for okay, great.

All right.

Uh when you're ready.

All right.

Yeah, you're on.

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

I appreciate your time.

Uh my name's Nigel Warren.

I'm a resident of Ward 6 and a parent.

I'm here today to just share the challenges that young families at mind face when it comes to health care and why I support DC Health Link and the DC Health Benefit Exchange Authority.

Uh my partner Trisha and I have always relied on employer uh employer sponsored insurance.

But a few years ago, I left my job to look after our two young children.

And then more recently, my partner Trisha was made redundant by her NGO.

So I've been job hunting.

Trisha decided to build her own business here in the district uh as a birth and postpartum doula.

And both these things involve a certain amount of stress, but healthcare uncertainty takes that stress to the next level, as I'm sure many people can relate.

Um at one point we were paying for COBRA insurance, and our premiums jumped by hundreds of dollars uh from one year to the next.

We did some budgeting, decided to drop dental coverage to bring down our costs.

Um it's not a fun gamble to make with kids when you're gambling on health insurance and what may or may not happen.

When it came to navigating the ACA marketplace, health ink is the reason that I was able to understand what my options were.

Uh like Mr.

Christie, is it here?

Every interaction I had with uh people that were working there was incredibly helpful.

I used the website, I called up people, people were proactively calling back.

Very impressed, very helpful.

And because of that help, I was able to get a marketplace plan as well as a tax credit to help with costs, which I'm grateful for.

On top of that, DC Health Link highlighted that Trisha and our kids are eligible for DC Medicaid coverage.

So the help and the services have all been a massive relief.

Uh it made our health care more affordable, and it's given us some stability.

I don't take any of the resources for granted, and I came here to let you know how important they are.

We're proud to be active members of Ward 6.

It's a wonderful, diverse community.

We love raising our family there.

Thank you for your leadership and your support of policies that are vital to families like ours.

Happy to answer any questions you may have.

Thank you.

Um, Miss Hubbard, I've called you twice.

No, it's okay.

Come on.

Okay.

Good morning, Chiron.

Good morning, Anderson.

You turned your mic off.

There you go.

And staff.

Uh my name is Chiniati Hubbard, president and CEO of the DC Chamber of Commerce.

And I'm pleased to testify today on behalf of over one thousand members of the DC Chamber.

Businesses, both large and small, and from all eight wards across the city on the proposed FY 2027 budget for the District of Columbia Health Benefit Exchange Authority.

Before turning to the DC Health Exchange budget, I would like to raise the broader fiscal conditions shaping this budget proposal.

The challenges that we face are not cyclical or short-term, they are structural conditions with lasting implications for the district's financial position.

And in recent years, the district has balanced its budget by drawing down fund balance and enacting tax increases to support new spending.

Repeating this approach will only reinforce the downward pressures the district faces.

The path forward is to make DC a city that works by strengthening core systems, removing barriers to housing and economic activity, and delivering services reliably.

Which brings me to my comments on the DC Health Link.

We are pleased to support the DC Health Benefit Exchange's FY2027 budget as proposed.

And we ask that you and members of the committee maintain this funding as you move through the council's budget process.

There are an estimated 75,000 small businesses in DC.

Together they make up more than 98% of all businesses in our city.

Studies show that businesses with between one and 50 employees can create more than 90% of all jobs across the country, and D.C.

is no exception.

Facing our current economic and fiscal headwinds, our small businesses need all the support that small health coverage provides to thousands of our business small business employees.

And it's more important than ever to these small businesses and district residents who are enrolled in DC Health Link.

Throughout the year, the chamber has continuously partnered with DC Health Link through virtual and in-person interactions and web-based information sessions designed to educate the small business community about their critical health coverage options.

These initiatives promote our joint small business health insurance enrollment campaign during open enrollment session, including direct outreach to DC Chamber members to inform them of the benefits offered by DC Health Link.

Within the past year, we've sent more than 35 unique email campaigns and over 100,000 emails distributed marketing and promotional emails and social media messages to our small businesses and partners.

Made over 600 phone calls and 750 in-person connections and referred more than 200 businesses.

For greater exposure, the DC Chamber newsletters and virtual convening announcements feature the DC Health Link banner as a tagline, directing businesses to the DC Health Link website.

We're also proud to note that two of our three carriers, CareFirst, Blue Cross Blue Shield, and Kaiser Permanente are members of the DC Chamber.

Each of them works with us to inform small businesses of the changing commercial health insurance landscape and accompanying market trends.

Every month, the chamber hosts new member orientation, providing an opportunity for DC Health Link representatives to address our nearly 190 new chamber members during last fiscal year alone.

The chamber hosted a series of employer advocacy program webinars, during which the DC Health Link educated dozens of attendees about the benefits of providing health coverage to employees.

We also hosted the DC Health Link at our business after business networking in September of 2025.

The DC Chamber's ongoing small business partnership with DC Health Link includes outreach and enrollment campaigns designed to inform these small business owners with the array of high value plans, enhanced employee benefits from which to choose.

The DC Health Link is also conducting targeted small business outreach to help former small business employees who lose their jobs to bridge the gap as they transition from employer-sponsored health coverage to individual or DC Medicaid coverage.

Among other roles and responsibilities, we partner with DC Health Link assisters to reach out to small businesses to support DC resident employees who are going through difficult transitions, as we've already heard this morning.

The DC Chamber is committed to continuing our partnership with DC HealthLink to promote the adoption and maintenance of robust health insurance coverage for small business employees through DC Health Link.

As the committee reviews the budget priorities of agencies under its purview, we seek to underscore the importance of ensuring that there continue to be a variety of plan choices for our local businesses that are exclusively offered on DC Health Link.

For small employers, stability and affordability are paramount considerations.

We ask that you and the members of the committee work to ensure that the exchange has the funding required to support its outreach, education, and enrollment initiatives for individual residents and the district's job creators.

We look forward to continuing to work with the DC Health Benefit Exchange Authority to maintain an affordable health insurance program for the district's businesses.

Thank you.

Thank you.

Okay.

Thank you so much to this panel of witnesses.

Mr.

Christie and Mr.

Warren, thank you so much for being here.

It's always good to hear positive feedback in terms of customer service experiences, particularly when sometimes when folks are coming to the health benefit exchange or coming to the exchange in general, sometimes it's under positive circumstances, and other times it's under life circumstances have changed one way or the other.

And folks are still looking for continuous coverage.

And so it's good to hear that you guys were able to one find a product that works for you all, but two were able to navigate the system seamlessly.

And Miss Hubbard, it's always good to hear that you know the exchange is working for our small businesses.

Or there's a lot of focus in terms of individual coverage, which is super important.

But there's so many individuals across the country, and particularly here in DC, who are receiving their health insurance through employer-based programs.

And they there were lots of small businesses who didn't have the opportunity before the ACA to afford or be able to provide coverage to their small businesses.

I don't know if you want to speak about that a little bit more around the smaller companies.

Oh, sorry.

That is the case.

Many businesses suffered and weren't able to provide coverage to them or their employees.

And so we're grateful that this program has been successful and be able to sustain a lot of our small businesses.

And that is one of the uh components that Director Mila Kaufman will talk about at a small business summit we're hosting on Monday morning at the convention center.

Great, great.

Okay, well, I don't have any further questions for you all.

Um if you haven't provided your written testimony for the record, please just go online and make sure you upload it.

Thank you so much for being here.

Okay, so we're gonna turn to our virtual witnesses.

Um so for our virtual participants, again, you have to um there'll be a little box that pops up that says, Hey, do you want to become a panelist?

And you actually have to affirmatively say yes in order to be able to testify.

Uh we're gonna do panels of six or start there and kind of see where we go.

Uh Veronica Hernandez from Mary Center, Floyd May from the Leadership Council for Healthy Communities, Kimberly Clispy, Gustavo Ali, Marcelo Barris, Violeta Chirino.

And just as a reminder, everybody has three minutes to testify.

I know some folks went over a bit, but I just want to underscore that again, three minutes.

Okay.

Oh, and also uh for our virtual folks, um, if on Zoom your username is like user 5234 or iPhone 2 or something to that effect, um, we won't be able to promote you.

So if you could please um change your username so that we can promote you.

Axel, do you want to go now?

You could join this panel if you take a seat.

Hang on one second, we're trying to get some more folks in.

Hold on one second.

Okay, um, we're gonna call a couple more uh just to try to get a fuller panel.

Uh Alem Koserari, Marcelina Romero, and Maria Gomez.

Okay.

Alright, we do have one person uh in person.

So um Axel, when you're ready.

Good morning.

Thank you so much for having me here.

Uh, my name is Axel Martin Del Campo.

Okay, and I am a Ward 4 resident.

Uh I live with HHT, which is a rare genetic disease, uh, that affects roughly one in 4,000 people.

At present, there are no treatment centers for DC for this rare disease.

And I also have experience uh as a transgender uh gender-affirming surgical care navigator uh supporting bilingual patients through Whitman Walker Clinic at another point in my life.

I am also an advocate for food justice through Redelicious, uh having been a co-director of the cooperative helping people get access to healthy food that would otherwise be bound for food waste.

Um all of these things uh are small and large parts of how I show up in the world and in the District of Columbia every day.

Uh I'm in here to insist on the protection and expansion of DC Health Link.

For me, access to health care is an absolute necessity, and I have supported hundreds of people that without programs like DC Health Link would not be here with us.

Um I cannot understate how an uh severe uh even a brief gap in access to health care can be.

For someone like myself, it can be life and death.

Um, I with I just even um so HHT means that I am uh I have a hemorrhagic disorder and I have actually already had two bleeds today with access to some of the best health care that one can get.

I am incredibly fortunate in the way that this disease impacts me.

Um last month when I did an advocacy day, I met a 12-year-old that had already had a double lung and liver replacement, and that could be anyone.

Most people that have the disease are are not diagnosed and have no access to providers that have even heard of the rare disease that I have.

Um, so I'm just here to to advocate for how true of a necessity is to have access to to good health care that can support the people of the community so we can show up better for our community and continue to uplift as a rising tide lifts all boats.

Um I'm open to any questions should you have any.

Thank you so much.

Thank you.

Uh Veronica.

Good morning, Chair Person Henderson, members of the committee.

My name is Veronica Hernandez.

I'm an entitlement manager at Mary Center, a federally qualified health center serving the metropolitan area.

For nearly 11 years, Mary Center has partnered with DC Health Link Benefits Exchange Authority to help these residents access affordable health coverage.

At Mary Center, with witness firsthand the impact of the DC Health Link program has in our community.

Our in-person assist our health individuals and families enroll into coverage through the DC Health Link.

Our team is well prepared and the DC Health Health Benefits Exchange Authority provides a strong consistent training to ensure we can effectively respond to the community involving insurance enrollment needs.

In fiscal year 2025, ours to assist our support, 3,801 DC residents.

Overall two thousand nine two thousand and two hundred and ninety residents were successfully enrolled into medical coverage programs.

Beyond enrollments, the team provide 1,511 consultations focused on health literacy, benefit status checks, and troubleshooting complex cases involving renewables, eligibility changes, and coverage transitions.

Our team continues to play an important role in reducing the number of insured residents.

However, recent changes to the C Alliance program, the implementation of the health based plan through DC Health Link and the transition process for individuals no longer eligible for Medicaid who are automatically transferred to the new basic health plan, have introduced challenges.

These changes have created confusion, particularly among residents who were auto-enrolled into Hell Bakesed Plan in some cases without their knowledge, which left them unprepared.

We are grateful to the council and the mayor for restoring the dental envision coverage for the DC Alliance program and including that coverage for the health execution for the new fiscal year.

However, there is still work to be done to fully fund these programs long-term and provide equal access to health health care for those who have longer in who have a lower incomes and complex health needs.

Last week I received a referral from one of our mental health therapists regarding a participant who recently lost health coverage.

The participant has a valid work permit but doesn't qualify for the health basic plan because her income assist exceeds the eligible threshold.

She has an eight-year-old child who remains enrolled in Medicaid additional.

The participant is also unable to apply for the qualified health plan because she doesn't meet the criteria for a special enrollment period.

The participant is concerned about her ability to obtain coverage in the future.

This is one of many cases we encounter in which participants are left without insurance covered and must hope they don't get their experience a medical emergency while uninsured.

Unfortunately, hope is not a secure long-term healthcare plan for her to rely on while it she awaits to find out if she will be able to obtain coverage.

The participant expressed the frustration stating that she has tried to do things the right way, working, paying taxes and striving to provide a better future for her child.

Yet she feels that the efforts are not being recognized.

As a result, she shared that she felt discouraged and betrayed by a system that she has worked hard to comply with.

We respectfully you want to wrap your about for that.

Thank you so much for the time and listen.

Thank you.

All right, I don't see Floyd.

I don't see Kimberly.

Um I do see Gustavo.

When you're ready.

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

My name is Gustavo Wally, and I am a resident of World 4.

Thank you sincerely for the opportunity to share my story with you today.

I'm a professional opera singer and serve as a part-time faculty at the Rome School of Performing Arts at the Catholic University of America here in Washington DC, where I also direct the Latin American Music Center for Graduate Studies.

Music has been my life work and I have devoted my career to performance teaching and mentoring young artists.

I am also a kidney transplant patient.

Without the health insurance I received through the Affordable Care Act and the C Health Link, I would not be alive today.

In 2023, after experiencing symptoms that began to affect both my daily life and work, I was diagnosed with stage five kidney failure due to the polycystic kidney disease, which is called PKD, an inherited condition that affects more than half million Americans.

I was told I would need a kidney transplant to survive.

At that critical moment, one of my former students made the extraordinary decision to donate her kidney to me because of her generosity and because I had access to quality affordable health coverage.

I was able to receive a transplant and continue pursuing my passion and my profession.

I am also deeply grateful for the federal tax credits that make my monthly premium affordable.

As a transplant recipient, I was required lifelong immunosuppressive medication and a regular medical monitoring.

Continuous affordable coverage is not an option to me.

It is essential for my survival.

Any changes to the Affordable Care Act that threaten protections for people with pre-existing conditions will have serious consequences for district residents like me.

Without affordable coverage, I would not be able to maintain my regular checkups or access to medications that quite literally keep me alive.

So thank you for your time, your work, and your commitment to the health district's residents.

I will be honored to answer any questions you may have.

Thank you.

Thank you.

Marcelo.

Yes.

Good morning.

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

My name is Marcelo Barrows.

I live in DuPont Circle Ward 2.

Proud to share that I'm living my dream as an author.

I have a small business, an LLC, so proprietor, very small operation, but having a chance to do that in DC is great.

It's a privilege to be part of a mission-oriented community.

There are people from all over the world around me, and I do not take that for granted.

Very grateful for DC Health Link Customer.

I'm a very happy customer.

Ten years ago, like I said, I moved to DC when the ACA made it possible to leave a corporate job to pursue my career without the fear of falling into debt or becoming a burden on my family if I were to go get into an accident or get very sick.

Since then, I have relied on DC Health Link coverage, sometimes uh with tax credits, sometimes without, depending on my fluctuating income.

And at one point through shop while working for a small nonprofit.

Like many others across the country here in DC, I'm facing the impact of an economic slowdown.

My uh business is not doing well, very little revenue.

Uh my side business is uh, like I said, uh not the best right now, but I depend on it for a living.

And I've I've been greatly impacted by the general economic slowdown, as I have mentioned.

I'm now covered under the new DC Health Link Plan.

I'm able to maintain dental benefits through a separate DC link health plan.

I consider myself incredibly lucky to be uh a young worker and still uh able to afford to go to the doctor, stay healthy, continue to try to grow my business in DC.

Um over the years, uh, whenever I needed assistance from DC Health staff, it's just incredible the support.

Like one gentleman mentioned, the father of two kids.

We get calls back, people who are ready to close tickets.

Uh, most recently I was helped by Lindsay Washington, who was so thorough and professional and kind, made updates to my account.

I received my insurance cards.

I just cannot believe the kind of support I have received.

I hope every resident who qualifies for a healthy DC plan learns about it and is able to take advantage of the plan like I I have been able to.

Thank you so much for the opportunity to share my story.

Thank you.

Uh Violeta?

No, I don't see you.

Uh Elham.

Elham.

Hello.

Hi.

Hi, can you can you see me?

I can see you now, yes.

Okay.

Well, I'll there you are.

Hi.

Hi everyone.

Um, thank you so much for this opportunity.

Um, I wanted to thank Mr.

Chairperson Henderson, members of the committee on health and staff.

Uh well, my name is Alhamdulillah.

I'm uh proud residents of Ward 3.

Um, and I'm also uh founder and director of WeWorld Early Childhood Enrichment Hub.

I am actually here, we offer uh early care and education for young children, and it's also located in Ward 3.

Uh we opened in September 2025, and after being on the wait list for only one month, uh and with the tremendous help of DC Health Link team, we enrolled in HC for C CC program.

Um, and I'm so proud that we world offers uh our wonderful teachers and staff access to affordable health insurance.

I believe it's very important for everyone to understand that opening and operating an early childhood education center requires significant amount of capital, especially in the earliest stages.

This reality leaves no room to pay for health insurance premiums for staff.

But HC4CC shows us that you care about early childhood education workforce serving DC.

And we are absolutely uh we absolutely appreciate this.

As you know, young children frequently become ill, and our teachers are with them, caring and lifting them all day long.

My employees get sick more than often, more often than other workers in many other fields.

The teachers and support staff need regular access to doctors and medication in order to recover quickly and return to caring for the children.

As a business owner, my day is full from early morning through the evening.

Everyone is very busy with work and their families at home.

I would like to acknowledge that Mr.

Brian Schwartz consistently accommodated our schedule and always followed through on his promises to call us, including after business hours and on the weekends to accommodate our needs.

Well, thank you so much for that.

And uh lastly, B-Board is currently operating at one-third of the full capacity, and our early child care enrollments are growing steadily.

The availability of affordable health insurance through HC4CC help us help help us keep my current workforce stable and will attract new educators as we expand and eventually open new locations across DC.

I'm grateful for the opportunity to share my story and advocate for a program that has made such a meaningful difference in to my team and uh to my team at WeWorld and Families we serve.

I would be happy to answer any questions.

Thank you.

Marcellino.

Maria.

Gomez.

Did you call on Maria?

Yes, I did.

Good to see you.

Good morning.

Good morning.

Good morning, Chair Person Henderson.

My name is Maria Gomez, and I am at the advisory counselor of the Basic Health Plan in the DC Health Link Hispanic Advisory Council.

I work very closely as a provider for the Health Benefit Exchange for over 12 years in my capacity as a CEO of Mary Center.

I've seen their strong commitment to partner with different stakeholders, such as VHP Advisory Council, Small Businesses, Nonprofits, and Private Workers to guarantee that these residents receive concise and timely informative information to enroll in a plan that is best for them.

The exchange now serves over 115,000 people with private insurance, 5300 small businesses and nonprofits, and they partner with over 700 DC Health Link brokers to provide free assistance to customers.

They did it in under seven months.

Presently covering 2400 people and 153 employers.

Since early June 2025, we exchange health meetings with the BHP Advisory Council to adopt processes to ensure smooth transition from individuals moving from medicating to the basic health plan.

The BHP Advisory Council has been tough with requests with clarifications, and this has been great.

And their advice on what would be the best implementation with DC and ROEs.

Each step has not been perfect, but staff always lessens and takes immediate action to accelerate a better process, such as out of enrollment.

Implementing a process to make sure pregnant women did not get dropped from Medicaid was another suggestion.

They promptly committed resources to guarantee a smooth transition into Medicaid.

And presently working on the best process to transition adults over 65 from the basic health plan to prevent a gap in coverage.

Today the exchange has fully transitioned almost 15,000 individuals from Medicaid to the basic health plan and just started in January, we must know.

Your committee can rest assured that the BHP Advisory Council will continue to advise and support the work of the exchange as they implement new benefits such as the vision and dental care once funding becomes available, which we know that it will.

In addition, the exchange is working diligently with enrollees in the basic health plan to verify outstanding eligibility paperwork for over 2,800 individuals so that they don't lose coverage.

They have worked also tirelessly with carefires to get coverage for some lawfully present residents, as you have heard, who do not qualify for federal funding.

Each one of these entities needing a solution requires staff, IT infrastructure, and experts to be the most effective, efficient, and expedient agency.

I have witnessed the agency's innovation in appropriate use of your resources.

I urge you to please fully fund the health benefit exchange budget in order that not a single eligible person falls through the cracks in the District of Columbia.

Thank you, Councilmember Henderson.

Thank you.

And the committee for the opportunity.

Thank you.

Thank you so much to this panel of witnesses for your um testimony and varying experiences dealing with like HBX.

Um, the biggest, of course, being is sort of the good customer service.

Um, Mr.

Awali, I'm so glad you're still here with us.

Um, so much.

You know, I don't think I've talked to a professional opera singer in a very long time, so this is very exciting for me.

Um, but I'm um your story in terms of the importance of needing care.

Um, I think uh certainly resonated.

Um Mr.

Barros uh Marcelo, thank you again for being here as well.

Um I know that things are tough in terms of small businesses, but it's also good to hear your good customer service experience as well.

Um it kind of makes me feel like what is the rest of the government doing that every time you guys like you're like not the first person who's like they call me back, they want to close the ticket, and I'm like, is nobody else calling you back or or desiring to close their work ticket.

Um we'll make that rhetorical because it's okay.

I know the answer on that front.

Um, thank you so much for being here.

Um I'm curious, um, how many employees do you have at your child care center?

Um thank you again.

Um, right now we have 10.

10, okay.

And is are all 10 individuals participating in the program?

Um nine of them.

Nine.

Okay.

But again, for you as a small business owner to be able to offer health insurance um for your employees.

It's an amazing opportunity.

Yes.

How has it helped you in terms of um sustaining your staff?

Is that often when we're we have these larger conversations around the pay equity fund and a health care for child care, and I feel like of late it has gotten caught up in the well, it's not making anything more affordable for anybody else, so why should we have it?

And um had to remind people that, well, first, when we started healthcare for child care and the pay equity fund, it wasn't around grounded in quote unquote affordability for families, it was grounded in trying to stabilize and say save a child care sector that was on the brink of collapse in the district, but also you can't have more childcare slots if you don't have a workforce.

Yeah, and um the thing is that um I'm a new center, and right now I am on the wait list for pay equity program.

I have a very hard time finding staff because they all know that we are in DC and we are eligible for pay equity program, and they expect us to uh offer those rates, and I cannot possibly afford those rates.

Um but the only uh like option I have that is kind of a little bit attracting for the c the employees is to tell them that we offer health insurance.

Uh that's the only thing that helps me uh basically um hiring staff.

Okay.

Thank you.

Thank you for being here.

Um Ms.

Gomez, thank you for being here as well.

It's good to see you and always appreciate that you're continuing um to remain engaged and involved and serving in these on these advisory councils are super helpful in sort of getting direct feedback on how some of these programs are working.

Um I don't have any direct questions or any further questions at this particular stage.

Um, if you haven't provided your written testimony for the record, please do so.

Um, but thank you all for being here.

Okay.

We're gonna go to our next panel.

Uh Lee Bethel, Chris Gardner, Jay Yarborough, Blanca Huzo, Glenn Hall, Maria Ikanis.

Um, and Donna Stevenson.

Give it a minute for folks to come in.

Okay.

Alright, we'll keep going.

Uh Nicole Quaguero.

David Diaz.

Uh Che Rudell Timbo Sole.

Jonah Casti, Ruth Martinez.

And Irene Matakia.

Okay, and uh Martha Herdin.

Okay, I see Lee.

So uh Lee, when you're ready.

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

My name is Lee Bethel, and I'm here today on behalf of the health insurance and services community.

Thank you for the opportunity to share my perspective, which is informed by my experience as a fiduciary lecturer and consultant, advising employers on retirement plans and on group life, health, and disability insurance programs.

Through the shop marketplace, I assist district small businesses in finding health plans that help them attract and retain employees.

Many of these employers also qualify for the small business health care tax credit, which is a valuable incentive that makes offering coverage more affordable.

I've worked closely with DC Health Link leadership for the past 10 years and am honored to support the mission of the health benefit exchange authority in strengthening coverage options for small businesses.

I'm grateful for the strong engagement the staff maintains with the broker community, particularly through their ongoing webinars and direct outreach.

By making reliable, affordable ACA health plans available through DC Health Link, you enable smaller nonprofit organizations and small businesses that devote their time and talent to serving district residents to access the health care they deserve and to protect their workers from the financial devastation that so often follows unexpected injury or illness.

Before the ACA, many of these small employers faced insurance options that were unaffordable or entirely unavailable.

As policymakers continue exploring options such as the health savings accounts as additional tools for coverage, I respectfully ask that you continue to fully fund the health benefit exchange authority to operate the shop marketplace.

The limitations of the small business health care tax credit and the ongoing rise in premiums remain significant barriers for small employers.

I urge you to use every tool available in your engagement with stakeholders, local leaders, Congress, and the administration to help prevent businesses from being priced out or relocating.

I would also like to urge you to continue funding the Healthcare for Childcare program.

This well-received program has made it possible for employees, as you've already heard, who work for DC licensed daycare facilities to obtain adequate health care.

Many of these DC life licensed daycare facilities would not be able to provide a quality health and tourist program without this without this program.

Thank you for your leadership and for the opportunity to testify today, and I welcome any questions from the committee.

Thank you.

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

My name is Christopher Gardner.

I am a ward free resident and the founder and owner of a CPA firm that is proudly employed and served district residents for almost 40 years.

Today I'm testifying in my capacity as chair of the DC Health Benefit Exchange Authority's Standing Advisory Board.

The Standing Advisory Board provides recommendations to the DC Health Benefit Exchange Authority Executive Board on Insurance Standards, covered benefits, premiums, plan management, technology system development, and other policy and operational issues under the agency's jurisdiction, including the establishment of special enrollment periods.

Last December, on behalf of the Standing Advisory Board, I brought forward a recommendation to extend the loss of Medicaid special enrollment period.

The Executive Board approved the extension, which gives individuals losing Medicaid up to 90 days to select the private health plan with coverage beginning on the first day of the following month.

This was yet another effort by this agency to ensure that residents do not fall through the cracks during their transition.

Their work has been critical in helping thousands of residents maintain continuous care at a time when many are losing Medicaid eligibility.

As you know, maintaining affordable, reliable coverage is one of the most effective ways to reduce health disparities and strengthen the overall well-being of our community.

Throughout the planning process for designing and launching health DC plan, healthy DC plan, while simultaneously continuing our operations for the individual and shop markets, the healthy health care for child care.

The DC Health Benefit Exchange Authority sought the standing advisory board's feedback.

The standing advisory board supports the thoughtful and rigorous work carried out by the agency's leadership and staff.

From year to year, the agency agents' approach to staffing and resources remains prudent and conservative.

For these reasons, I urge the council to continue prioritizing the health of district residents and to fully support the DC Health Benefit Exchange Authority's budget.

Adequate funding is essential to operating the DC Health Link website, maintaining seamless enrollment systems, supporting plan management, and providing consumer outreach and customer service.

Thank you for your attention and for your ongoing leadership on issues that matter so deeply to district residents.

Thank you.

Thank you.

Okay, bear with me.

So everybody knows that I said their name multiple times.

Jay Yarbrough, I don't see Jay.

Blanca, don't see Blanca.

Glenn.

Don't see Glenn.

Maria.

Don't see Maria.

Donna.

Donna, I do see Donna.

Yes.

I'm here.

Great.

When you're ready.

All right, great.

Good morning, Councilmember Henderson.

My name is Donna Stevenson, and I'm the Senior Director of Health Operations at Community of Hope.

Community of Hope is a federally qualified health center and homeless services provider.

And in 2025, Community of Hope served over 15,000 patients across our three health center sites.

I am here today to discuss the proposed FY27 budget for the health benefit exchange and the potential impacts of the budget on health centers and our patients.

First, we strongly support the mayor's proposal of a $5 million addition to the budget to support dental and vision benefits for healthy DC enrollees.

The loss of dental coverage and the switch from Medicaid to Healthy DC has been devastating for our patients who have had to pause care or forego dental care altogether due to the inability to pay for coverage.

Financial impacts have also been substantial for our dental care providers.

Community of Hope has seen a $200,000 decrease and dental revenue since the tradition the transition of patients to Healthy DC began, reflecting an approximate decrease of about 100 patients.

We are pleased to see an increase as well in the FTEs assigned to Healthy DC plan and the health benefits exchange included in the proposed FY27 budget.

Currently, Community of Hope's team of three enrollee assistors is carrying the full weight of ensuring that patients are maintaining coverage and accessing the various healthy DC beneficiary platforms.

They have regularly worked overtime, attending community outreach events and answering enrollment questions from patients who are unsure about the status of their coverage.

The addition of the eight FTEs to the exchange of health coverage and innovation and the 12.6 FTEs for the Healthy DC plan will hopefully increase this bandwidth for patient enrollment and prevent patients from falling through the cracks in the transition from Medicaid.

Community of Hope supports the mayor's proposals to fund Vision and Dental for Healthy DC enrollees and increased FTEs allotted to the Healthy DC plan.

It is more important now than ever for patients to maintain access to high-end health care and for the health care centers of our patients to maintain trust in their financial stability.

Thank you for the opportunity to testify, and I am available for any questions.

Thank you.

Don't see Nicole.

David.

Che.

Do you see Che.

Uh good morning, Chair Henderson.

I am J.

Riddle Tavasola, Managing Director and Vice President of Government Affairs at the Russian Association of Metropolitan Washington.

The restaurant industry is a cornerstone of the district's economy and its largest private sector employer.

But the current economic climate for our members is incredibly challenging.

Rushroom closures in the district's climbed to 102 in 2025, more than double the closures in 2022 with mid-priced middle-class neighborhood restaurants bearing the brunt of that.

They accounted for the majority of closures and report the deepest declines in sales traffic and profitability of any full service full service industry segment.

And in that environment, the DC Health Benefit Exchange is a vital resource that allows our operators to still be able to offer competitive health care benefits necessary to recruit and retain the best workforce.

From October 25 to March 2026, RMW executed a high impact strategy to bridge the gap between this marketplace and our community.

First, we maintained a continuous industry HBX presence.

HBX was front and center at our Torbo October board meeting and fall member networking event after at our annual holiday party and as a featured exhibitor at our annual meetingslash state of the plate in March.

Across those events, we engaged with more than 600 owners, operators, and decision makers.

Second, we drove a high volume digital outreach with over 800 DC restaurants every month with HBX information through our weekly operator messages and monthly industry newsletter.

And we amplify that through our social media presence of nearly 50,000 followers, keeping enrollment deadlines front and center for district residents businesses.

Third, we meet residents where they live and work.

We staffed an HBX information table at our recent hospitality hiring fair, reaching more than 200 attendees, and we engage DCPS students and their parents with HBX information at our ProStart Hackathon.

These events let us educate the next generation of our workforce while closing the information gap for entire families.

Fourth, we led HBX awareness for strategic initiatives like African American Week of Action during the open enrollment period.

We use our member network for tabletop HBX QR co-promotions, reaching district diners in a unique neighborhood focused way.

And finally, through our broker plus business connect sessions, we act as a vital navigator for our members.

We translate complex insurance jargon into practical steps for busy chefs and owners.

In conclusion, RMW remains a committed partner to HBX as our industry navigates a complex recovery.

The stability provided by DC HealthLink is essential to keeping our small businesses competitive and our workforce healthy.

Thank you, and I'm happy to answer any questions.

Thank you.

Hi, Chairperson Henderson and members of the Committee on Health.

Thank you for the opportunity to testify and to share my thoughts on the critical importance of maintaining access to affordable health coverage for my family and me through DC HealthLink.

Before DC Health Link coverage, my young family had health insurance through my job with the federal government.

When the administration changed and I lost my position, it felt like the ground shifted under my feet.

My wife is a dedicated physical therapist working with patients across the DMV.

She pours our energy into helping people like many professionals these days.

She doesn't have access to employer-sponsored health coverage.

As a federal employee, I've long been aware of DC HealthLink and marketplace coverage as a resource for friends and neighbors who do not receive insurance through their employers.

But while we are grateful for the coverage, the reality is that it is barely within reach for us financially, even with the tax credit.

Tax credit is the only reason we can afford coverage without making what would be painful choices about what essentials we would have to give up just to say insured.

It is an impossible situation for any family to put in, especially within when you're doing everything you can to build a stable life here.

I hesitate to even think about it, but we would be forced to seriously consider leading this wonderful community filled with dear friends and incomparable professional network.

This would be truly devastating for both my wife and me.

Right now I do have peace of mind in knowing that if something happened, something unexpected were to happen, like an accident or sudden diagnosis, my family wouldn't lose everything.

That security is priceless.

It allows us to focus on raising our daughter without the constant fear and anxiety that comes from wondering whether we would survive a medical emergency.

I'm here today because I know we are not the only family in this position.

So many young families in DC are doing everything they can to make it work here and to contribute to their communities.

Having health insurance can make the difference between holding it on and failing falling behind.

I want to thank you for everything you have already done to protect the health of the district residents and to make DC a wonderful place to raise a family.

My wife and I love raising our infant daughter here, and we are proud to call Ward 4 home.

I respectfully ask that you do everything in your power to keep health insurance affordable for families like mine.

Your work makes a real difference in our lives.

Thank you.

Thank you.

Ruth?

Don't see Ruth.

Don't see Irene.

But I do see Martha.

Martha, when you're ready.

Good morning, Chairperson Henderson, members of the committee and council staff.

My name is Martha Herndon and I have lived in the district for 32 years.

My family resides in Ward 6, and I have been part of the Capitol Hill community since my 20s.

Thank you for the opportunity to testify in strong support of healthcare for child care and the DC Health Benefit Exchange Authority.

Healthcare for Childcare is a clear example of government working well, and it has been a lifeline for my staff and myself.

When Healthcare for Child Care first launched, I was unsure whether I could take on another administrative responsibility while running a center.

And I did not initially explore it.

Once we did, the team at DC Health Benefit Exchange Authority guided us through a setup and has provided consistent responsive support ever since.

My employees know that they can rely on the assistance whenever questions arise.

I went to a specially recognize Jessica Speaks for handling tasks that small school leaders simply do not have the capacity to manage.

The stability and efficiency of this program make it possible for us to offer health insurance, which would otherwise be out of reach.

I enrolled myself and my family in February.

Until this year, my family received insurance through my husband's employer.

When he lost his job, we were caught off guard, but because of health care for child care, I did not have to leave the work and community that matters so much to me just to secure benefit for family.

Our teachers have had similar experiences.

One of our strongest educators, a young widow in her 30s, was considering whether she could stay because she needed coverage for herself and her young daughter.

Healthcare for childcare enabled her to stay, continue the work she enjoys and maintain stability and flexibility that she needs as a single parent.

This program kept a beloved teacher in our community.

Before healthcare for child care, we faced significant staff turnover.

We follow a school year calendar, and many teachers would leave in June.

I would regularly need to replace one fourth of my teaching team, and some years it was as high as 75%.

Since adopting healthcare for child care in 2023, turnover has nearly disappeared.

Only one staff member has resigned, and that was due to family circumstances.

The stability of our teaching team also allows us to support families who are experiencing financial hardship.

Recent job losses in agencies such as USAID, a severe strain on some long-standing families.

Three families currently cannot pay tuition because they have had months with little or no work.

I am grateful that our center can help them temporarily, and that stability is directly linked to retaining experienced teachers through programs like Healthcare for Childcare.

Healthcare for Childcare has strengthened my center, supported my teachers, and allowed me to remain in the work I am deeply committed to.

It makes a meaningful difference for early childhood educators and families across the district.

Thank you for your continued leadership and investment in Healthcare for Childcare and the mission of DC Health Benefit Exchange Authority.

I welcome any questions you may have.

Thank you.

Thank you so much to this panel of witnesses for your testimony.

So have a couple of follow-up questions.

You're still here.

Ms.

Councilmember.

Hey.

So I'm curious if your members have had any sort of feedback around the change in cost for premiums now that the federal subsidies were not renewed.

A hundred percent costs for concern.

It's also, it's one of many costs, right, that are rising all together.

And so I I'd be pressed to say that it oh, it's it's this particular cost, but it's just the general cost of living, cost of goods, cost of product, um, insurance utilities, etc.

that are going up that um everything is a pressure point right now.

Okay.

Um, Miss Stevenson.

Oh, I think she left us.

I think she did.

Okay.

Folks have to get back to work.

That's totally okay.

Um, Miss Herdenan, thank you for being here and for your testimony.

Um, again, as I said to an earlier witness, I think that healthcare for child care has been truly helpful in terms of retention of staff, and so it's good to hear that center directors are seeing that as a selling point.

Um, how many staff do you currently have at your center?

We have um 19 staff throughout our center.

Okay.

And it's a single site location.

Yes.

Okay.

Okay.

Um, well, thank you all so much for being here.

I don't have any further questions for you all.

Um, if you don't mind, um, if you haven't provided your written testimony for the record, if you could please do so.

That would be fantastic.

Um, we're gonna take like a three minute since when.

Sorry.

Okay, we're gonna take a three minute break.

Um, we'll be back with our government witnesses.

Okay, we're back.

Uh and we have uh the executive director of TC Health Benefit Exchange Authority with us, Mela Kaufman.

Um before you begin, I do need to swear you in.

So if you can raise your right hand, do you swear or affirm under Penosia Law that the testimony you're about to provide to the Council of the District of Columbia and this committee is the truth, the whole truth and nothing but the truth.

Great.

All right, Mila, when you're ready.

Good morning.

That was a little loud.

Good morning.

It's on.

So if you are not awake yet, you will be.

Um good morning, Chairperson Henderson, and members of the health committee.

It is a pleasure to be here uh with you uh to discuss the health benefit exchange authority budget, and I just want to recognize with me I have our executive board chairwoman uh um Diane Lewis, and she's also available to answer any questions you may have after I get through my um uh my budget slides.

Uh so first I want to give you a quick reminder of our background, then give you a detailed update on healthy DC plan.

I also wanna uh highlight for you a few federal proposals that will impact uh how we do our work uh and our budget.

And then I'll give you some highlights from our proposed uh budget for FY27.

Uh we uh the health benefit exchange authority.

Uh we were established by DC policymakers as a private public partnership.

We're responsible for DC Health Link, which is the Affordable Care Act online health insurance marketplace.

We were one of four state marketplaces to open for business on time on October one, twenty thirteen, even though we were the last to start our IT build out.

We're also responsible for health care for child care, which we partnered on with Aussie uh to establish, and that program has now become a model for other states in how to support early child development workers and providers.

So that is our most recent um coverage initiative that I want to give you an extensive update on.

Um I do want to also uh remind um everyone that currently we cover approximately one hundred and fifteen thousand people, more than fifty three hundred district small businesses and nonprofits.

We work with more than 700 DC Health Link brokers who provide free help to our customers, and we're responsible for approximately eight hundred million dollars in annual health insurance premiums.

Uh and help them operate their exchange for their uh small business community.

Now, healthy DC Plan update, and this is an update since the performance oversight hearing a couple of months ago.

Our current enrollment in Healthy DC Plan is 14,800 twenty six district residents.

Since performance oversight, HBX staff and staff from DHCF worked closely to do a fourth auto enrollment transition for folks who no longer qualified for Medicaid.

We did three earlier three rounds, and this was the fourth, and I believe the final auto enrollment round, and through that, we were able to enroll a few hundred additional residents for coverage that started April 1.

Most recently, we worked with all three of our carriers in Healthy DC plan to find a solution to cover residents who do not qualify for federal funding due to changes with HR1.

So these are lawfully present, lawfully present residents with incomes below 100% of federal poverty level.

We identified 44 residents who fell into that category and worked very closely with CareFirst, Blue Cross Blue Shield Healthy DC plan to cover those residents starting May 1.

Another area we continue to work on and don't have a solution for, but are committed to finding a solution is uh it's helping residents access non-emergency transportation.

That is not a covered benefit under healthy DC plan.

We've had a number of cases uh where residents expressed a need for that benefit.

So we're working uh on a solution for that.

I'm happy to report that we and our carriers are on track to implement risk adjustment.

We're leveraging the existing federal government risk adjustment program, and I just want to say how much I appreciate CMS and their entire team to help us implement risk adjustment for our healthy DC plan.

We are also uh working with our carriers to plan to implement the dental envision benefit.

Both of those benefits are funding for those benefits are in Mayor Bowser's proposed budget.

And should, and I know that's been a very high priority for you, Council Member Henderson, and assuming that funding stays in the budget, we've started the early implementation uh planning uh with our carriers to make sure that those benefits begin if funded locally, they will begin January 1 of 2027.

And just as a reminder, there are additional HR1 changes that begin January 1 of 2027 that will impact about 850 or so 825 uh currently uh uh covered residents uh even though all of these residents are lawfully present, present and have a visa status.

Unfortunately, starting January 1, their visa status no longer qualifies them for federally funded coverage.

I also want to highlight, and this is really more of a plea to residents who are currently covered in healthy DC plan.

We've identified close to 3,000 residents that have what we call an outstanding verification.

That means unless those residents provide us with documentation that they qualify for healthy DC plan, federal law requires us to terminate their healthy DC plan coverage.

A resident may have multiple outstanding verifications.

Although we've been able to clear some, we still have about 2,0357 enrollees at risk of losing their coverage.

So if you've received any notice from us and you're watching this hearing, please provide us with the documentation we need to make sure that you stay covered.

Health care for child care.

Just a quick update.

We're thrilled to see in Mayor Bowser's budget 12 million dollars to fund health care for child care.

And we currently cover 2,447 people in the program and 213 facilities.

We do have one facility on the waiting list as of now.

Proposed payment parameters notice for 2027.

This is one federal proposal I want to make sure you're aware of because it will impose a significant new cost locally to us.

And under current law, due to several changes, states are not required in some cases to pay for those benefits, locally required benefits.

The proposed regulation, if finalized, will change that and once again require states to pay for state required benefit mandates.

And we estimate that if that requirement becomes final for 2027, DC will have at least an $8 million price tag attached, and that amount will increase substantially every year.

Our recommendation is to make cover that coverage mandate applicable only if the federal government does not require defrayal.

And I see I'm out of time.

May I have extra time?

Thank you.

Federal law has changing.

We know some changes because the rules have become final.

However, major changes under HR1, the rules to implement those changes are not even proposed yet.

And those changes, and I'll give you one example, no longer allowing automatic renewal for health insurance.

State exchanges and the federal exchanges under HR1 are required next year to pre-verify enrollment for renewing customers.

So no more auto enrollment.

States built our systems on a very basic assumption that we can auto-renew to have to re-architect our systems depending on what federal regulations do, may cost tens of millions of dollars.

Those regulations are not yet proposed and are not final, so we're not sure what the final price tag for us will be.

We're very committed to following federal law and making changes on time to comply with federal law, but we do not yet know what those requirements look like based on regulations, and we do not yet know the cost.85%, just a slight increase over this year.

And as we do every year, our staff proposed budget, we get a lot of feedback from stakeholders.

It goes through a robust review of our board's finance committee and then is reviewed by our executive board before it is submitted through Mayor Bowser's process and then submitted to you.

I will not go through any of these because I'm pretty much out of time, but I just want to close out by highlighting a few recognition.

And Deputy Mayor Turnage for DC Impact Award, and the Medical Society of the District of Columbia honored us with John Benjamin Nichols Award.

And none of that recognition would be possible without this strong support and leadership that we have from our board chair, Diane Lewis, and our entire executive board without the strong support of you, Chairwoman Henderson, and other council members, Mayor Bowser and her entire team, and of course, none of this would have been possible.

None of what we do is ever possible without our team, our entire HBX team.

So with that, I'm happy to take any questions you may have, and I appreciate the extra time.

Great.

Thank you so much, Director Kaufman, for that testimony.

Do you have some follow-up questions?

The length of which it's all Rebecca's fault.

Okay.

All right.

So let's uh start just in terms of general on insurance premiums and things like that.

Um so all of our DC health insurance carriers increase premiums across the board for plan year 2026.

Um we asked Disby this question, but I guess they didn't necessarily know as we sort of head into what will be plan year 27 and carriers were just submitting their rates at the beginning of May.

But what would you say is the main driver of the premiums going up?

Is it the loss of the subsidy?

I guess for this year it would be, but I'm curious, your thoughts.

So multiple factors.

So even if premiums stayed exactly the same, the loss of the federal health insurance tax credit means that our residents, and in our case, seven of ten people who qualified for the federal health insurance tax credit, they're actually self-employed people or small business owners with employees, but they don't get group coverage, they get individual coverage through us.

So even if uh if premiums stayed exactly the same, the loss of the federal health insurance tax credit means higher out of pocket that you pay for your premiums, period, because under the expanded federal uh health insurance tax credit, the federal government uh paid more of the premium through the tax credit, um, and now it it's back to the original ACA levels.

So that's one big uh issue.

The other, of course, um issue that we see every year uh is health insurance premiums going up for individual, for small group, and large group coverage.

And though the drivers of health insurance premiums are twofold.

One is uh how expensive or how much higher is the cost of medical care.

Uh every year that the cost of medical care goes up because clinicians and hospitals have higher costs every year, so cost of medical care goes up.

And the other driver is who are you covering?

So if if you're covering a population of people who use medical services, and as we age we use more and more of medical services, then that also drives the premium for the following year.

Okay.

You mentioned in your testimony details on an increase to the plant plan management center, which included anonymous shopping.

How many anonymous shopper outreaches did your staff conduct?

And what were some of the findings?

You're referring to our consumer decision support tools where our customers can go online and shop anonymously.

I guess it is the plan match program.

Yes.

So that so that is the online consum consumer decision support tool.

And so that's available to anyone who wants to go to DC HealthLink.com.

It's all we also expanded that to Healthy DC plan.

And it's also available on our small group side as well.

And for small group on our small group side, essentially the way our IT system is set up is it really is catered to what your employer offers.

So if your employer picks a metal level, you have a gazillion options within the metal level, the tool automatically provides to you how much your share of the premium is, how much your employer is contributing, and it helps you shop.

On the individual side, there is no employer contribution, so the tool tells you exactly what your premiums may be.

And the tool estimates how much in the federal health insurance tax credit you might be eligible for.

The anonymous shopping tool is also available for health care for child care as well, both on the group side and for individual residents who qualify.

Okay.

How often are folks using the doctor directory or sorry?

Not how often are they looking for it, but how often, sorry, do we update the doctor directory and the prescription drug formulary lookup tool that you guys have on your websites?

I can follow follow up with you on the exact timing of the updates.

I believe uh we get uh our vendor gets monthly feeds on the provider directory from um all the participating carriers uh and um the formulary um I will follow up with you on the exact timing uh uh because updating the formular is also requires uh some oversight that my team performs.

Okay.

Um the proposed budget um has it increased for Octo for approximately $63,000 in FY27.

Um I know that you guys use a lot of outside contractors for a lot of your IT work.

What's this um relationship that you all have with Okto?

Oh, sure.

So we rely on Okto for our employees, computer software, um, email, it it uh unlike other quasi government agencies that may be off the districts, you know.gov email system, we're in uh we leverage what um other district agencies do uh as much as possible to be as efficient uh with our expenses as possible.

So um uh, you know, windows, the um uh all of the software that employees use, um, we get all of that through Okto.

Okay.

You said in your testimony um that you currently have one facility on the wait list for health care for child care.

I know this is kind of hard because I guess maybe you don't necessarily know how many employees of that center would choose to um elect to get coverage, but I guess for my benefit, but also the benefit of my colleagues who might decide that they want to try to fund um to clear the wait list.

Do we know how much that would cost additionally?

So it's a little bit complicated.

We uh review our expenses and who is covered on a very frequent basis, monthly, sometimes even more frequently, and the population we cover uh does change sometimes.

And so it may be that older workers um uh um leave their job and and maybe that facility has younger workers, so there's funding that frees up automatically, and that's how we're able to get folks in uh off the wait list.

Uh and so um we do that review and and we may have um some ability to get this facility off the wait list just based on a change um in who we cover.

Uh premiums are age-based, that's why I mentioned that if older workers leave um and we're covering a younger population, uh, there's less of a premium cost.

Okay.

Um, you know, I great testimony from folks.

I feel like for whatever reason, you might be the only agency where people like come and say positive things in the cluster, uh, which is good.

I mean, you know, there's occasional sprinkle here or there, but like nobody's banging down the door of the Department of Healthcare Finance to talk about how like excellent their customer services, or I would say the same for TPW or any of the sort of agencies.

I think you guys have like a good track record going here.

Um, but even still sort of the game changer that this has been for a lot of yes, child care centers are small businesses, but the economics hadn't really worked for them before to be able to even enter, you know, the shop market or the for the um for the smaller businesses, et cetera.

Um have you guys had outreach from other jurisdictions who have said like, hey, what's going on here, and how you guys making it work?

Um yes, we continue to provide technical support uh both to uh legisl elected officials, legislators in other states, um, as well as um stakeholders, advocates, and um state government agencies looking to looking to us as a model.

Um the interest has been in both the pay side as well as the uh health care for childcare side, and the way uh we partner with Aussie is we handle the the health care for child care side, and they're the ones um who provide the follow-up on the pay side.

Okay.

Um let's talk a little bit about the IVF benefit.

Um I have to tell you earlier this week I had like it was the highlight of my week.

I love being with you, but this the highlight of my week.

Um I was in an elevator here in the Wilson building, just coming back from lunch, and there was a woman who was on the elevator with me with only two, and um, you know, she said, Councilmember Henderson, I have to thank you.

And I was like, I don't know, for what?

You know, but thank you, but for what?

And she said um last year she attempted to use her IVF benefit, her insurance company denied the claim.

She contacted our office, we helped with the help of HBX, we got it reversed.

Um, and she's pregnant.

And I looked down, I was like, oh yeah, you're pregnant.

She's due in August.

Um and I was just like, it is to see the manifestation of a policy sort of like in front of you physically, um, is a very great thing.

Um, and I know that there are other people who have been using this benefit, so it is a bit frustrating to sort of hear that um this rule uh we could be caught up in a changing rule from CMS.

That has nothing to do, I think, on its space around like reducing access to IVF.

I feel like this administration exactly wants to do sort of the opposite, but um, you know, we're gonna keep fighting on that front.

Um to your best knowledge, what is the timeline for CMS finalizing this proposal?

Uh OMB has had the final rule for a couple of weeks at least.

Uh I I could not venture, I guess, as to when it might be released in its final form.

Okay.

Um, I do want to uh say that in our comments to the federal government on this proposed rule, uh, we highlighted some of the very personal and compelling testimony from the hearing you held uh uh before you enacted this new law.

Um from our perspective, um uh especially because uh the president issued an executive order uh uh stating clearly that he believes that IVF and fertility treatment should be made more affordable.

Um uh we we made very strong arguments in our comments that uh as CMS finalizes its proposal, it should um reconsider perhaps exempting fertility uh from its proposed uh approach in recognition that doing so would be consistent with the executive order, uh but at this point in time we we can't predict um what the final will look like and I think it's very important to just make sure that you and other policymakers know that uh DC may have a significant uh local requirement if the proposal is finalized as proposed.

Yeah, um just question how many unique individuals are we talking about here who have used the benefit um since it went effective in January 1 of 2025.

I think a few thousand um I can follow up with you on the exact number.

Okay.

Okay.

All right.

Um I know that might not sound a lot to people, but 971 people uh using a benefit in a year and a half, a year and a half, has it been a year and a half?

Yeah, like a year, almost a year and a half.

Um that's not like going to the dentist.

Like it's not like uh uh one where you're like, oh, I got this coverage and now I'm just gonna like go do the thing and like get a claim, but it actually requires um doctors' visits, testing, and a variety of other things.

So 971 unique individuals using this benefit is pretty remarkable.

It might be higher on that that is for 2025 usage, so we we're now past the first quarter, so it actually may be higher.

Uh, but I also want to note um if federal law requires local changes, uh, with this particular benefit, because the tr the treatment and the medical intervention is ongoing.

Ongoing.

It is um it could be very disruptive uh and uh very damaging to uh the health of the person trying to get pregnant, and that is one of the uh areas that we also raised in our comment to the federal administration, the implications of being potentially forced to um to stop providing this benefit.

Um and just for the public who may be listening, um, you know, the uniqueness of the DC marketplace and exchange is that it does include um congressional staff in some cases as well.

So it's not just taking one to the local residents of the district, but also um to some federal employees as well.

Yes, we cover congressional designated congressional staff and members, so as well as elected officials who enroll and of course small group and individual.

Okay.

Um I want to ask about uh the council approved this law in March.

Um can you provide an update on how HBX is working with Disby to incorporate this new requirement around cost sharing services into the 2027 plans?

And sorry, cost sharing for um it is uh prophylactic and post exposure medication for HIV prevention for those who are not familiar.

So it's PrEP, PEP, and other HIV prevention services.

Yes, Disby is the principal regulator, and so um form filings uh were due for the individual and small group market to Disby on May 1.

Um my team works very closely with the Disby team to make sure that uh everything that is um uh reviewed and approved for the following year complies with federal and local requirements and uh in terms of HBX staff uh we we uh also look at uh what's filed to make sure that anything that needs to change um in the coverage document is appropriately changed.

Uh we do heavily rely on the Disby team as the principal regulator.

Yep, and um Disby's part of this committee now, so I I was able to ask Commissioner Woods some questions about this um at their hearing uh last month on the budget.

Um we did receive written testimony from one of our managed care organizations who was expressed some concern around how the healthy DC plan federal funding methodology is calculated with a particular concern around HIV um pharmacy costs that are exceeding original projections.

Um now, again, this is only one carrier um who raised this.

Um heard any of these concerns from this particular carrier or any of the others, and do you share their concerns?

So we uh we have a very close relationship with each of the carriers, and uh we here um we've asked them to share all concerns with us, and if we have a concern raised by one carrier, we proactively probe the other carriers also to figure out if there is an issue that we need to be thinking about and if there's enough evidence that HBX needs to be in the position as a problem solver for.

Um, you know, sometimes the private sector is great at solving problems, other times um they uh the private sector relies on traditional government or in our case quasi um government to uh to to help problem solve for.

Um with this particular issue, I don't have enough facts yet to tell you that there is or is not a problem.

We really need time with all claims, uh medical, hospital, prescription medication, pretty much everything to figure out um if there is an issue that we need to problem solve for.

Uh we're always committed to recognizing issues based on evidence and coming up with solutions.

I also want to say that unlike other states with basic health plans, um, for us uh we took the pass-through approach, meaning every single dollar that the federal government provides goes to pay for the coverage.

Yeah, other the other three states that have a basic health plan uh have a different approach.

Those states uh are um had a bidding process, uh a competition process, and essentially um uh uh their their uh approach is um uh to pay for what the carrier their carriers bid for.

And um and so it's it's just a different approach.

So there are not all federal dollars go out to the carriers in those states.

Um in our case, there was no bidding, it was all qualified uh plans can come in, and they will get every single dollar uh that comes in.

So we're just a pass through.

Okay.

Um you mentioned in your testimony um this issue around outstanding verifications.

So first let me just say, I mean, you've gotten tremendous praise about this already, but the work that you all did in conjunction with um health care finance to transfer this many people over, um, and for our office or other offices in this building to not get some like crazy amount of folks who were calling saying, you know, what happened here or something went wrong, I think it's tremendous.

Um, but I think it's also a sort of a transition for people too, in that um, you know, the federal rules for these types of programs might be just slightly different than what they're used to from a Medicaid standpoint, where um, you know, under Medicaid, you could be passively renewed, um, there's specific subpopulations, etc.

But here, no, you actually do need to provide some documentation to verify your status of enrollment.

And you mentioned in your testimony that um we've got about 4,432 outstanding verifications, um, but there are uh about 2300 folks who are at risk of losing their coverage if they don't provide the necessary documents.

Um, okay.

So let's talk about the 2,357 group.

So just to clarify, these are individuals who they're reaching the end of their 90-day grace period to provide the information.

Is that accurate?

Yes.

Okay, how are we reaching out to these folks?

Is it us?

Is it is it not us?

Is it you?

Is it healthcare finance?

Is it DHS?

Who who is reaching out?

HBX, we are responsible for sending many notices to the affected inju individuals about what exactly we need to verify.

Okay, and so we send a gazillion notices as required by federal law, uh, US mail as well as email when we have email for the affected person.

Um so there's been significant rounds of uh sending notifications.

Have we reached out to um the DC Primary Care Association that perhaps they could send not a specific of like this particular uh enrollee, but to just sort of do some general posting around their centers to say, hey, if you've received a notice from healthy DC, please open it, or you might be losing your health insurance because I know like in this day and age where I could open up my email today and it's probably looking a little bloodbathy and it's only 11 30, you know, um that some people might dismiss the sender, might dismiss the subject line, but maybe from another perspective that might help.

So, or even frankly, members of my you know, my colleagues, they send out newsletters where if we had a little blurb that said like, hey, this is what it looked like.

If you receive this, please open it.

Um, I don't know, put in the subject line, response required, or lose your health care.

Like, something to grab people.

Yeah, thank you.

We will be sending you a little blurb, yeah, motto blurb to use, and we will send it to every single one of your colleagues.

Yes, please do.

Appreciate you volunteering them for this.

Well, it's not even just sort of that, but like, um, even when we have a situation with Medicaid redetermination, I hate the idea of somebody losing their health insurance for paperwork and you didn't respond.

Yes, and we do too.

Um, and and it's like especially on healthy DC and Medicaid, it's free.

Just respond to the email.

Uh completely agree with you.

And um, so we've been um uh uh two things.

One, um, this is an area where we will be asking members of our um advisory council uh on healthy DC plan for their help to reach their networks.

Uh uh and uh DC Primary Care Association is on our advisory uh panel, and so they will be getting this request from us.

The the second um uh point I want to make is during Medicaid redeterminations, both what DC did and other states, there were lots of lessons.

Um what worked and what didn't work.

And one of the uh areas that we are exploring with our three healthy DC uh planned participants, the carriers, is could they notify the enrollees?

Oh, specifically, exactly.

Like if it came from Med Star that was like, hi, uh exactly to respond or we will not be covering your or something similar.

Um it's a a strategy that was used in some states um where the Medicaid MCOs sent the information that worked well.

I'm I'm not um uh uh that familiar with how uh we did this in DC, uh, but the this is an area that we're exploring, so the information comes both from us and the actual health plan.

Yeah.

Um hoping to get some positive outcome from that.

So the subject I mean, I guess the sender is it health benefit exchange authority?

The notices from us, um we we try to brand them either healthy DC DC when we can.

Sometimes it has it it's uh um it has um um other branding because some of our notices we haven't been able to fix.

Yeah, um uh uh so as much of it as we can make it from healthy DC plan we do.

Um and then the information that we hope that will come from the three carriers will be under their own uh uh um brand, but talking about healthy DC plan coverage being at risk.

And um, just and from a consequence, not consequence, but let's talk about that.

Um so you have 90 days.

Let's say somebody comes and they're like they wake up out of their stupor on like day 101.

Can they re-enroll?

Yes.

But only for this year.

Yes.

Okay.

So I think that I mean, there was testimony earlier from I think legal aid who had asked for annual continuous uh for continuous enrollment to go beyond this year.

Are we allowed to do that?

Uh no, and at this point in time, I think I I said this at performance oversight as well.

It it was an issue we heard from several advocates.

Um so our blueprint was approved uh to allow us this first year um to um to take care of all of the issues that any time you set up a new program in the first year, it's very uh it's very new and they're just issues.

And um we do not have approval to do what Medicaid does in our future years.

Right.

So essentially all of our commercial uh standards will apply in future years, and someone who has a special enrollment period if they are outside of open enrollment, they'll be able to enroll.

Um the uh so at this point in time we don't have any plan to revisit what the federal government has approved.

Okay.

Next year, if the if we have evidence that it's just not working and we need another year, um uh we will reconsider our approach, um, but that will be evidence-based.

Okay, um you mentioned in your testimony or noted in your testimony rather that 288 residents covered by healthy DC has already purchased dental coverage.

Um now um my question is how will this transition work?

So the mayor has provided funding for us to cover um dental envision for healthy DC.

I imagine that's uh would when would that start?

Is that starting plan year 2027, or can that start October 1?

It cannot start mid-year.

Okay.

It will start January 1 of 2027, and we've already started our discussions on how to implement that new the those two new benefits.

Okay.

For the individuals who have already paid for this particular year, um, well, I guess you said under healthy DC there's not an automatic renewal, or does that count for a dental as well?

For their or for the separate coverage that they've purchased.

So the uh the residents you're referring to have standalone dental that they purchased.

Okay.

And usually it's billed on a monthly basis.

So next year they can choose to keep keep their standalone dental if they want to, or they can choose to drop it and avail themselves of the new benefit under Healthy DC plan, assuming it's it's in the budget.

So I I just want to make sure that folks have prior knowledge going into open enrollment so that they don't sign up for an extra year when in fact they can actually get the dental coverage that they might be paying for under healthy DC.

Yeah, they're not obligated to sign up for the year.

So even if they decide to keep private dental standalone for one month, they can cancel the next month.

I just want to make sure that's clear to DC residents.

Um, usually going into open enrollment, we do a lot of outreach.

Uh and in our emails and in our formal notices, we highlight some of the major changes for the upcoming year.

Yeah.

Uh especially like if there's uh if the benefits are changing, and in this case, um certainly vision and dental as new benefits, uh, those will be highlighted in our uh official and unofficial uh written information.

Okay.

So according to the Medicaid data that we have, approximately 19,800 individuals lost coverage between December 2025 and January of 2026, which would mean that HBX successfully enrolled about 75% of the folks according to the Medicaid data who lost coverage in that month.

Um I guess we're trying to understand who's missing, and if anyone has sort of done any engagement with the missing folks to determine why, you know, it could have been enrollment or sorry, it could have been income change, it could have been they now have employer employer sponsored health care, it could have been that they moved, but um I'm not sure necessarily if this is a question for you or if this is a question for health care finance next week, but did we did we try to find these people?

It's a question for us, uh, and definitely um if uh healthcare for uh if healthcare finance um wants to also uh contribute, um we work very closely with them on a lot of outreach.

Um for us uh the information that we have uh on the uh uh residents who did have Medicaid and no and no longer have Medicaid, we ran L was automatic enrollments.

Um and when a resident more than 200% of federal enroll in Germany they qualified for local as formal and then a few residents who we try to figure out what the best coverage option is for them.

In some cases it was Medicaid.

It turned out that they had a you know change of income and they qualified for Medicaid again.

Other times we qualified them for health care for child care, um, or DC Health Link with lower premiums or full pay.

But very a very small percentage of residents we were able to actually reach and engage with.

Some residents told us they had other coverage, and that's great, but uh the uh a vast majority we we do not know if they're uninsured, if they've moved, if they have other coverage, and I'm very concerned about that population as year also hard part of on the of everyone, every opportunity some of the information asked for a clarification on something.

So um last year during the budget, um my colleagues and I had essentially a quote-unquote contingency list.

So it was if additional dollars were um realized uh at the start of FY26, this was like the list of things that we thought that the money should go towards.

Um, and dental envision was on the list.

Turns out there was money.

Um, but the mayor chose not to necessarily go by the full list.

But just from a timing perspective, after hearing when I asked the question around um dental envision for BHP and you saying nope, it can't stop it it wouldn't be able to start in October, it would have to wait until January 1.

Was there any way that dental envision one of was released?

Okay, they had said okay, January and you HBX, you have this money.

Could you guys have even have done it?

So, um we can get very quickly.

Let's be clear about that.

No, but the year would have already started.

Right.

The issue is um how much time do the three carriers need to have their dental envision networks in place?

So if you recall um when we still um had hope that the federal expanded health insurance tax credit would be extended, we thought there might be federal dollars coming in, and so we built an automatic trigger in the coverage documents with the three carriers saying if they're federal dollars, then they have to implement that benefit mid-year, yeah.

Um once it became clear that there was no federal funding, we stopped working on implementing this because there was there's still a lot of implementation going on, and we cannot be, you know, working on it something that's academic, we actually have to make sure stuff that's real gets implemented.

So we stopped working on implementing this with the carriers, and so um anything could be implemented given that there's time and as long as it's not academic exercise, we can we can start on the implementation efforts.

But for this budget, and seeing that this um that the mayor has proposed to fund this, uh our timeline is uh we're not gonna know probably until this summer.

Um that but we've already started the discussions with the carriers.

Okay.

Um this is small but mighty.

Uh health HBX spends more on return mail uh than notice printing.

Um so return mail services is 125,000, um, and then notice printing and mailing is about 75,000 as well.

Um now I know this is a federal requirement, but I also feel some kind of way about the federal government essentially requiring our agencies to keep the U.S.

Postal Service in business with these requirements.

Um is there anything that could be done to reduce the need for return mail services?

So unfortunately, I have other bad news to deliver.

Our mail, um, our US mail bill, that notice and printing bill, um, uh in implementing the basic health plan, we estimate that to be over a million dollars.

So our original estimate is before we actually had experience uh with um how much um uh how many notices um are generated by this newly covered population.

Um but to answer your question on return mail, um return mail is actually uh a big deal when it comes to program integrity.

It is one way that we learn that someone has moved, yeah, and forgot to tell us.

But I do wish that the federal government would reconsider um the amount of printing of notices that is required.

Could be one of their cost-cutting measures.

I don't know.

Okay.

One of your slides, I think it was slide 18 showed that the sent the center service contract was reduced by about 277,000.

Do you guys anticipate that this reduction will have any impact on support that you receive?

I'm sorry, we're the contact center.

The contact center.

Oh, thank you.

Yeah.

So I believe that's option year for the way we um negotiate uh contracts.

Um usually they have a base year with option years, and um option years are just priced differently.

So that's what you see, is what our team negotiated for option year for.

Okay.

No service is being reduced in any way.

Okay.

What's the status on hiring an FTE to assist Disby on matters related to healthy DC?

Um they are in the process of sorry, it's oh it's a Disney employee.

Yes, we're fun.

We're providing funding.

Okay.

Um and they are in the process of of um implementing that.

Okay.

Okay.

Um lastly, so one change that happened on the federal side was around lawfully present individuals losing coverage as of January 1, 2027.

Uh, you shared in your pre-hearing responses that there are approximately 825 individuals who would be caught up by this in DC.

Um now for the record, do these individuals have any other option for health insurance besides employer-sponsored health care?

Not that we're aware of.

Um, right now we have a certain number of residents who are covered, either under healthy DC plan or DC Health Link with uh the federal health insurance tax credit.

And so that is changing uh starting January 1 of 2027, and there will no longer be federal funding for those individuals.

We also expect some new enrollees, so um that is the 825 estimated population impacted.

So the 825 includes those who are currently enrolled and those who you estimate will a slight growth, okay.

Correct.

And as far as we know, um there is no affordable employer sponsored option available.

One of the criteria for receiving uh the federal health insurance tax credit is that you don't have affordable employer coverage available to you.

Yeah.

When you do, you do not qualify for the federal health insurance tax credit.

So we assume there is no option, no other option for these lawfully present, but don't have the the right visa status to continue to qualify for federal uh lower premiums.

Okay.

How much would it cost to cover the individuals who are currently there locally?

Um so that that will depend on what the final you won't know until Commissioner Woods makes final decision after um hearing uh with an opportunity for the DeFi and I testify.

All right, Director Cough, are there any that you want to share for the record?

No, I think we've covered everything.

Thank you so much, team, for um their approach to their work every day.

Okay.

Okay.