All right.

Good morning.

Still morning.

I'm calling this public round table to order.

Today is Wednesday, July 8th, 2026.

We're in room 123 of the John A.

Wilson building.

The time is 11:35 a.m.

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

Today we're holding a round table on the state of maternal and infant health in the district.

The mayor's FY27 budget proposal included over 3 million of cuts to maternal and early childhood public health initiatives and interventions with no new proposed investments or strategies to improve maternal and infant health outcomes.

This came even as the most recent perinatal and infant mortality report from the DC Health shows concerning trends for certain key maternal health metrics between 2018 and 2024, including an increase, including increases in severe maternal morbidity rates, marijuana use rates and pregnancy, and preterm birth rates.

The district has a substantial role to play in perinatal health, as 43.4% of district births in 2025 were funded through Department of Health Care Finances Medicaid programs or alliance.

The Committee on Health held a round table in December of 2023 on maternal and infant health, at which the executive highlighted efforts to improve health outcomes here in the district.

Since that round table, the council has also passed several bills and made investments aimed to improve maternal and infant health.

Today we will discuss how the executive and the council driven efforts have been rolled out through the district and what additional improvements must be made to meaningfully increase access to pre- and postnatal care.

Uh, address the maternal mortality uh rates and ensure healthy outcomes for district residents who are birthing uh children.

We will also hear from maternal health professionals, including doula's midwives, OBGYNs, and more about their experience on the ground ensuring safety and health of expecting parents and infants.

Uh we haven't been joined by colleagues.

Um, although I know some of them are in the building as there are other hearings that are going on, but we'll certainly welcome them if any of them join.

We are going to turn to our public witness testimony.

All of our public witnesses will have three minutes to testify.

You're welcome to submit longer written testimony for the record.

Uh, please be conscientious of your time.

Uh, I'm gonna call the first uh in-person witnesses, and then we'll go to our virtual folks.

So uh Crystal Jackson from a Queen Mommy uh Mama Doula Services, uh Leah Caslis from Children's Law Center, Rodrigo Stein, ah, there he is, uh, from La Clinica de Pueblo, and Dr.

Kate Sugarman from Doctors for Camp Closure.

Miss Jackson, when you're ready.

Oh, you can.

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

Since first testifying before this committee in 2023, I've gone from identifying barriers in the Medicaid DULA benefit to helping implement it as a Medicaid provider and the district's doula equity consultant.

There are four things I hope you remember today.

One, the Medicaid dual benefit exists, but implementation is incomplete.

There are challenges at every step that have not been corrected systemically since the benefit was released.

Dual is continue to struggle with enrollment, credentialing, billing, and reimbursement.

Two, uh, community-based organizations have been doing the implementation work through the Doula Learning and Action Collaborative and Interdisciplinary Group grown from the Ward 8 Health Council's Maternal Health Working Group.

Approximately 60 doulas have been supported with technical assistance, peer learning, and systems navigation.

This work has been funded through short-term grants rather than sustained public investment.

Three, um, the Medicaid Doula Implementation Infrastructure is a maternal health investment.

Creating a benefit was only the first step.

If the district wants the Medicaid dual benefit to improve maternal and infant health outcomes, it must invest in the organizations that help providers successfully participate in the program.

Three, nope, four.

Um, I urge the council to invest in community-based DULA-led implementation organizations that have demonstrated the ability to build and sustain this workforce.

We should not rely on temporary grants to support an essential part of the district's maternal health strategy.

Policies are designed in government, but they succeed or fail in community.

Don't forget your doulas in implementation.

I'm submitting more detailed written testimony describing my experiences and expertise.

Thank you for the opportunity to testify.

I am Crystal Jackson, a member of the Ward 8 Health Council and co-chair of the Maternal Health Working Group, a DC Medicaid Doula provider, and the district's doula equity consultant, meaning I work at the intersections of Maternal Health, Workforce Development, and Medicaid Systems Transformation.

Thank you.

Welcome any questions.

Thank you.

Leah?

Leah, before you start, you go ahead and move the mic closer to you.

There we go.

That's good.

Okay, perfect.

Good morning, Chairperson Henderson and staff.

Thank you for the opportunity to testify today.

As I reread Children's Law Center's 2023 Maternal Health Roundtable Testimony, I was able to reflect on some positive steps forward for maternal health in the district.

For example, a 2025 report from DC Health looking at 2019 to 2023 data found improvements in key perinatal health indicators, including decreases in rates of teen birth, preterm births, low birth weight, and infant mortality.

The district also has two very engaged agencies in this area, DC Health and DHCF, who've taken initiatives to seek federal funding like the Title V Maternal Health Block Grant and the Transforming Maternal Health Model from CMS.

DC Health and DHCF have been partners in this work.

They are responsive, and they invested time in working with community groups.

We share many of the same goals and are able to work together to achieve them.

Despite continued partnership and some improvements, we still have significant concerns that disparities in perinatal outcomes persist across racial and geographic lines.

These concerns arise from client experiences and anecdotal evidence shared from partners working in maternal health, but not in concrete up-to-date data.

For example, Cedar Hill's opening offered significant home hope for families in Ward 7 and 8.

However, we have no data or reports on birth outcomes from the hospital's first year of operations in this space.

Without consistent, clear, accessible, and well-analyzed data across the maternal health, we are left with more questions than understanding.

For example, despite having a doula Medicaid benefit, we continue to have limited access to doals for Medicaid beneficiaries.

Recently at Children's Law Center, we had a client in need of DUA services who was enrolled in HSCSN.

There was only one doula for us to reach out to.

Fortunately, they were available, but if not for that one doula, our client would have had to navigate their birth without this support.

Having the Dula Medicaid benefit is not enough.

There is a need for implementation support.

We are therefore proud to lead the Doula Learning Action Collaborative along with the Queen Mama Doula Services, where we are directly working on filling in these implementation gaps for doula benefit, including working with DHCF and MCOs in the district to provide trainings to do it on enrollment credentialing and billing.

The complicated process to even become a doula is why we are extremely supportive of streamlining Medicaid credentialing.

Additionally, sustaining the DLAC's implementation efforts is critical to ensure there remains an entity working on tangible implementation efforts of the Dula Benefit.

We therefore would advocate for the creation of a hub to support DULAs and other non-clinical workers like other jurisdictions have implemented.

The hub can also address other areas of focus like reimbursement rates, dual hospital friendliness, and beneficiary outreach.

Ultimately, this roundtable is an opportunity to take stock and strategize as the district prepares for both executive and council administrative changes.

We would love to see the committee prioritize supporting nonclinical staff being integrated into the Medicaid space with a focus on implementation.

My written testimony will go into greater detail, including programs like Healthy Steps, Perinatal Mental Health Task Force, and Home Visiting.

Thank you for the opportunity to testify.

Thank you.

Rodrigo?

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

My name is Rodrigo Stein, Director of health equity and Strategic Partnerships at La Clinica del Pueblo and FQHC, serving thousands of predominantly Latino families in Washington DC.

Thank you for the opportunity to testify today.

This year, La Clinica completed a perinatal community health needs assessment that brought together patients, frontline staff, and health system partners to better understand what is preventing healthy pregnancy and healthy births in our community.

And what we heard was clear.

The greatest barriers facing pregnant and postpartum mothers are not simply medical, they are social and structural.

Women describe navigating pregnancy alone, experiencing high levels of stress, financial insecurity, gender race violence, and difficulty accessing culturally responsive care.

Our own patient data reinforces these findings.

More than one third of women reported limited social connection, nearly four in ten reported moderate to high stress, and almost one in ten reported living in fear of a current or former partner.

These challenges underscore the importance of continuous access to health care.

When women lose health coverage, they are less likely to receive prenatal care, postpartum follow-up, behavioral health services, primary care, and care coordination needed to connect them with essential social supports.

That ultimately leads to worse outcomes for mothers, infants, and our health care system.

La Clinica is deeply grateful to the council for lifting the moratorium on new DC Alliance adult enrollment, restoring some behavioral health support, and investing in health care access for our communities.

These actions will make a meaningful differences for thousands of district residents and demonstrate the district's continued commitment to health equity.

These investments are particularly important because maternal health disparities continue to widen.

According to DC Health's perinatal health report, 2019 to 2023, pre-pregnancy diabetes among Latina mothers doubled over a four-year period.

Well, preterm birth increased by approximately 30%, the largest increase among any racial or ethnic group.

At the same time, providers like La Clinica are doing our part.

Using the findings for MR needs assessment, we're launching a redesigned culturally responsive perinatal care model that integrates behavioral health, social needs screening, case management, community health workers, peer support, and stronger care coordination between prenatal, postpartum, and pediatric care.

Our goal is not simply to provide prenatal visits, but to build a system that supports mothers before, during and after pregnancy.

Community health centers cannot address these challenges alone, though.

But with strong partnerships and sustained investments for FQHCs and community health centers, we can significantly improve maternal and infant health outcomes across the district.

Thank you again for your leadership and continued investment in community-based health care.

La Clinica looks for looks forward to partnering with the district to ensure these important investments translate into healthier pregnancies, healthier families, and healthier communities.

Thank you, and I welcome any questions.

Thank you.

Dr.

Sugarman.

Hi, good morning, Councilmember.

You gotta turn your mic on.

There you go.

Okay.

Good morning, Councilmember Henderson and the committee and the health committee.

Um I'm here as a primary care doctor.

All of my patients are low income, uh, mostly patients of color, and some of all the his health disparities that we've been discussing.

I'm here to advocate for maternal health by opposing the closure of the postpartum unit 5F at Washington Hospital Center.

A council member, as you mentioned in the introduction, in the District of Columbia, we have increased morbidity and mortality of our uh of our uh pregnant and postpartum patients.

Um but we have the answer to this problem.

It is the well-functioning um labor delivery and postpartum units at Washington Hospital Center that we should be strengthening uh rather than eliminating.

Uh African American women right now make up 90% of the pregnancy related deaths, despite being only 50% of the birthing parents in our district.

So we already know the problem.

We already know the answer to strengthening a well-functioning program.

Um I'm an organizer, I'm a family doctor, and organizer with the keeping DC Healthy Coalition.

Um, we know how acute a crisis is for hospitals, and um, and that we have to strengthen and increase their funding rather than closing down postpartum beds.

Now is the time to increase rather than cut support for maternal health care.

It means keeping our postpartum unit open and pressuring uh Medstar not to respond to budget pressures by cutting vital patients' care.

As a doctor, I know firsthand that um prepartum, postpartum in a woman's life is the most medically dangerous period of her life, and this is complicated by the increased rates uh that these patients have of gestational diabetes, of uh high blood pressure during pregnancy, which then puts them at risk and actually happens that they develop preecalampsia and eclampsia and then uh untreated or improperly monitored.

This uh has a high rate of leading to seizures, permanent disabilities, and death.

So we have the opportunity to monitor them, close, monitor these patients cl closely in the postpartum period so that they don't die from a preventable death, and these deaths also include blood clots, which happens in the postpartum period again, needs to be monitored for.

Um this will have a disproportionate these uh bed closures will have a disproportionate impact on my patients, their families if a child is left without a mother.

Um, and I asked the council members to please put pressure on Med Star, help us keep the postpartum unit open, make us make sure that MedStar is fulfilling its obligation to give three percent of its care to charity patients.

Right now it's only doing one percent.

Um please rally the community basis, and we're here to keep these beds open.

Thank you.

Thank you.

Uh thank you so much today's panel of witnesses.

Uh Heather, uh, can you put me on a seven minute clock?

Just keep myself honest.

Um, thank you so much to this panel of witnesses.

Um, and just for your overall dedication to the public health of um district residents, um, even and also our visitors.

Um, uh, I'll start with you.

Um, both you and Ms.

Castellus sort of brought up the need for some additional support in terms of dual implementation.

Miss Jackson, you talked about um there have been community based organizations that have been supporting um doulas with techna technical assistance via grants.

Can you say a little bit more about uh if you can um what type of grants like um you said they were time limited, so like are they outside, are they private grants?

Can you just say a little bit more about that?

Yes, um, so a nonprofit organization, the Institute for Medicaid Innovation, um, offered a three year grant for multiple states across the nation to do DULA implementation work, and so DC has that.

We're halfway through year two and working on year three next year.

Okay.

Um, and I know that uh both you and Leah have raised some issues in terms of uh the credentialing process, as you know or may know, we do have legislation that's currently pending before the committee to streamline um the Medicaid credentialing.

Um while we had strong desires to move forward, we just know that the Department of Health Care Finance was going to be going through a lot next year in terms of the transition with some of the federal requirements, but that does not mean that we're we don't plan to move forward, but we just have to sort of pace things in time, and hopefully the streamlining of credentialing can help.

But I do want to ask, just in terms of um overall numbers, do we have enough doulas certified in the district to even begin to meet the need?

Definitely they're certified, but we can't credential with health care finance.

That's that's the issue.

That's the bottleneck from step one.

So we can't even get to serving families if we can't credential it as C C Medicaid dual providers.

Okay.

Is it most people just not being able to sort of navigate CMS Medicaid speak um to even begin that process?

Like if you have your certification, if you have your business license, if you have those pieces, I'm curious.

Like, is it a paperwork challenge or just a time challenge?

Uh it's a mixture of both.

Um, so for example, we hosted about five trainings to support dualists through just that step one.

Folks had to come back to multiple trainings in order to complete the process because one one training that was about an hour and a half was not enough time to get it done.

Yeah, um we sort of often talk about this in some of the other contexts of like, should there be a checklist?

Is there a checklist of the like these are the documents that you need?

What's up?

We have created one.

You've created one, okay.

All right, that definitely provides a good resource.

Yes, it's definitely helpful, but even with having um a program director from Maximus at those trainings to walk doulas through enrolling, again, doulas had to come back to multiple sessions to complete the process.

Okay, all right.

Um, well, thank you.

Thank you for being here.

Um, Mr.

Stein, thank you for being here and for the testimony that you've provided as well.

Um, you know, some of the information that you talked about is a little bit similar to what Lee was sort of saying around like the importance of data in this context, because you you brought up some things in the data report.

I think you were talking about preterm diabetes amongst Latino women.

And that's not normally an often an indicator that people talk about, right?

Diabetes as part of it, but as you guys know, right, the having uh diabetes and also being pregnant can lead to other types of uh risk within um the pregnancy.

Do you all feel like um as a clinic you're getting enough information?

Um, or eight or that there are enough feedback loops such that if you guys are seeing trends when folks are coming in for their prenatal visits, that you can like share that information with others around what's happening.

Yes, absolutely.

And part of the the reason that we conducted the disease assessment is we're redesigning and relaunching our perenatal uh care model.

Uh, this is a response to transition and leadership, but also uh to improve the care that was being provided.

So uh we'd be happy to share that data with other providers, specifically what's going on with the low-income Latino community, uh specific trends that the community told us uh are being reflected in the patient data, and we know how those social drivers of health have downstream effects on health.

So I'll be happy to share uh with the committee.

That would be super helpful.

Cause one of the things that um has been a frustration for me since being chair of the committee is that like a lot of our maternal health data lags behind by so many years.

And so um, like the last time we did a round table on maternal health, sort of hearing from providers that like we're seeing an increase in trend in terms of substance use and marijuana usage and pregnancy.

Well, that wasn't showing up in the data that we were getting from DC Health yet, because that was a couple of years behind.

So it's like, okay, if we're always getting our information three to four years after the fact, how do we address the crisis in the moment?

And so this is super helpful that you're kind of going through this process in terms of the need assessment piece.

Um Dr.

Sherman, thank you so much for being here as well.

Um we have some folks from MedStar who are testifying later in the hearing.

Um I've had conversation with Med Star.

I think this is um one of the interesting things that I don't know if we've all sort of come to terms with in terms of public health, but we're gonna have to think about, which is um the trends of there are just less babies being born, right?

Less women getting pregnant, less babies being born, and so what do we do about the infrastructure that we have built for a different time when there were lots of babies and all of those things, and how do we um allow for um institutions, whether it be clinics or otherwise, to adjust to the new volume without um threatening patient care?

Well, it's a great question, but there are times that Med Star solution because you know, births are cyclical and you might have a quiet week and then you'll have a quiet, you know, you'll have a very busy week.

And so Medstar has been like shipping postpartum mothers to St.

Mary's County in Southern Maryland, which is really really far away, or Georgetown, which also doesn't work for this, you know, disadvantaged population.

So they need to, you know, literally not throw the baby out with the bathwater, right?

Because they need to have enough um beds for when the census is high, but then not, you know, do what they've been doing, where shipping people out to St.

Mary's County or to Georgetown or to St.

Um into Baltimore.

So there are times that the census is still high.

So eliminating postpartum beds cannot be the answer unless we want our statistics to get even worse.

Correct.

And I I don't.

I'm just trying to figure out like to your point around the flexibility in terms of census.

How do we provide institutions with the flexibility such that you don't have a unit of 30 open and no, like without anybody there?

Does that make sense?

Yes, and I'm sure that they other hospitals have figured this out.

Yeah, what to do when census is low, how to make use of the beds or whatever, without closing the beds so that our uh statistics will get even worse and more women will die from eclampsy or things like that.

All right, okay.

Well, thank you guys so much.

Um, if you if you haven't uploaded your testimony, please make sure you do so.

Thank you.

Okay.

Our next panel of in person, uh, Dr.

Rochelle Logan from the DC Primary Care Association.

Uh Shanita Edwards from OA BB.

OABI.

Okay, I mean, I didn't, you know, everybody has different names for their acronyms, so I didn't know I didn't want to make assumptions.

OABI Natural Hearing.

Okay.

Uh, Tambra Stevenson from Wanda.

All right.

Uh Women Advancing Nutrition Dietetics and Agriculture.

And uh Corinne Golston.

Great.

All right.

Uh, Dr.

Logan, when you're ready.

No, it's not on.

Now it's on.

Okay.

Good morning.

Thank you for the opportunity to provide testimony as part of the round table on maternal health.

My name is Dr.

Rochelle Logan, and I am the Chief Program Officer at the DC Primary Care Association.

DCPCA represents community health centers that serve approximately 180,000 people, including one in five district residents in every ward in the city, and over 4,500 prenatal patients just last year in 2025.

DCPCA drives collective action to sustain health centers and their impact on transforming care.

Our version is that every resident in every DC community has access to high quality preventative primary health care.

The March of Dimes 2025 report card provides all the information policymakers require to understand the urgent need to act.

We must use every available tool to change the course of the maternal and infant health outcomes.

Despite attention and effort by providers, policymakers, advocates, and families, the district worsened on every measure tracked in the report.

Our written testimony contains recent data from DC Health focused on concerning trends in births to teens, as well as persistent and growing gaps in outcomes between mothers.

To highlight just one statistic here, the pre team preterm birth rate shrunk by more than 10% for white mothers between 2019 and 2023, but grew by 18% and 23% for black and Latina mothers respectively, showcasing why infant mortality rate for black mothers is nearly five times as high as that for for white mothers.

Our residents deserve better, and we can do better by leveraging tools that support close and consistent monitoring of conditions that put the health of birthing people at risk for adverse outcomes.

By resourcing capacity to track blood pressure and glucose, we can better manage hypertension and diabetes during pregnancy and postpartum.

We can intervene early to protect health and well-being of mothers and babies.

District policymakers still have opportunities to help support, and DCPCA urges district agencies to implement the following remedy specific to pregnancy and postpartum coverage.

Authorize community health centers to certify presumptive eligibility for pregnant patients.

Health centers already support patients in the application process for health coverage, and we are confident that they can meet the standards for presumptive eligibility authority.

Failure to implement these policies may lead to continued increases in low birth weight, preterm births, maternal mortality, and infant mortality and ramidity.

Thank you.

Thank you.

Greetings, Chairperson Henderson and members of the council.

My name is Shanita Edwards, and I'm the founder and CEO of OABI Natural Healing, a Ward 8-based nonprofit providing culturally responsive doula care, holistic wellness education, herbal support, community-based maternal health services, and end-of-life support.

I am honored to testify today on behalf of my ancestors and future birthing families of East of the East of the River, also in partnership with the Ward 8 Health Health Council.

OABI believes that improving health outcomes in the Great War 8 requires more than adding another program.

It requires building a coordinated system where residents no longer have to navigate disconnected services on their own.

As a second generation Washingtonian, I have lived in Ward 8 most of my life.

Every day, families in Ward 8 face barriers that begin long before expanding their families.

The same issues I've witnessed and faced growing up.

Housing instability, food insecurities, chronic stress, limited health, limited access to culturally responsive care, and fragmented health systems all contribute to poor maternal and infant outcomes.

These are not failures of individual families.

These are systems that have failed us.

At OABI, we see firsthand the birth that birth is often the first opportunity to break the curse and interrupt generations of health inequities.

When mothers receive continuous support before, during, and after birth, families are healthier, babies have stronger starts, and community communities become more resilient.

I just started to see small changes in Ward 8, and we owe it to the residents to keep the momentum and assist with implementing systems I didn't see growing up.

OABI stands for overcome adversity and become a better you.

Our work aligns closely with Ward 8 Health Council's vision and improving health across the entire life course, starting before conception for Black mothers, affecting their babies to children, tender teens, active adults, and seasoned residents.

We hold the shared goal of increasing the life expectancy in Ward 8.

As a community-based birth organization, OABI contributes by expanding maternal health education, connecting families to trusted resources, and ensuring residents with lived experience have a voice in shaping the systems that we serve.

Today I respectfully ask the council to continue investing even more resources, even more resources in a comprehensive health care ecosystem east of the river by providing sustained support for Ward 8 Health Council and organizations like OABI that are going that are doing the work alongside residents every day.

When we invest in doulas, we invest in mothers.

We invest in the children and families as a whole.

Together, we improve the future health of the Great War 8, along also highlighting the doula support needed for incarcerated mothers giving birth while shackled.

I give thanks for your time, your leadership, and commitment to our community.

I look forward to continuing work together.

Don't forget to OABI and all that you do, overcome adversity and become a better you.

Thank you.

Thank you.

Tambra.

Good afternoon, Chairwoman Henderson.

Uh, I'm Tamper Stevenson, founder and CEO of Wanda, women advancing nutrition dietetics and agriculture.

I serve as a health chair for NWCP DC branch, formerly on the DC Food Policy Council, a member of the Tufts Food and Nutrition Innovation Council and Milk and Institute Food is Medicine Advisory Board.

The last time I spoke in front of the council was urging the expansion of dual services east of the river, seeing the facing reduction of labor delivery services yet the more birth babies in the district.

So I want to build on that conversation by highlighting another essential part of maternal health that deserves greater investment, which is access to nutrition and community partnerships that make healthy pregnancies possible.

The issue is quite personal as someone who birthed uh two babies, uh needing community health hope birth center and Washington hospital center when I had emergency C sections.

Um, but my nutrition background greatly benefited me from having healthy babies.

And families need a full continuum of options from community-based prenatal support birth centers and hospital-based specialty care.

And a healthy pregnancy is not created uh during birth but before conception and continues well in postpartum period.

Yet nutrition remains one of the least integrated components of maternal health beyond WIC.

Uh despite its influence on gestational diabetes, hypertension, anemia, as my colleagues have mentioned.

Last fall, Wanda piloted nourish maternal food as medicine in East of the River to help with access to trauma-informed cultural meaningful culinary nutrition education support, grounded and lived experience in partnership with Dreaming Out Loud, training birth workers as those who testify today serving our families in DC.

And we found that the doulas and community health workers and other trusted professionals are eager to receive cultural relevant nutrition guidance to support clients, but they need sustainable support, evidence-based training, and strong connections to the health care system.

The Milk and Institute Feeding Change initiative has shown that community-based organizations are essential partners in food as medicine because they build trust, improve partnership, bridge the gap between health care systems and everyday life.

And we if we want healthier babies in pregnancies, we must not only invest in clinical care but in trusted organizations that help families put healthy practices in action.

So as the district evaluates maternal health investments, I encourage the council to view nutrition as a core infrastructure, not an add-on option.

We should invest in CBOs that provide cultural responsible nutrition education, strengthen the partnerships between providers and organizations.

Finally, I want to respectfully ask that DC Health and Healthcare Finance with the following questions.

How is the district incorporating food as medicine into maternal health strategy?

How are CBOs being supported as implementation partners?

And how will the district measure these investments or improving outcomes for moms and babies, especially east of the river?

Because the first food of medicine for a child is through the mom, and healthy moms require more health, more than health care, but nourishment, trust, and community.

When we invest in all three, we give each child a healthier beginning and every family a strong future.

Thank you for the opportunity to testify.

Thank you.

Corinne.

Oh, gotta turn your mic on.

There you go.

Hello, my name is Corinne Golston.

I am a nurse at Washington Hospital Center.

I have worked there for seven years, the last three, as a labor and delivery nurse.

I am also a shop steward for the National Nurses United and a student of midwifery and women's health practitionering in at Georgetown.

I am here to advocate for maternal health by opposing the closure of a postpartum unit 5F at Hospital Center.

One in three babies are born at hospital center that are born in the district.

We are the trusted delivery site for three of the seven district federally qualified health centers, and our physical connection to Children's National allows us to have their doctors, surgeons, nurses, medical transporters, and specialty equipment in the room with our babies as soon as they're born.

They're also able to be transported to the children's um ORs and as well as their specialty units within minutes without being at the whims of DC traffic or weather.

Something else that I am personally very proud of being able to deliver as a district nurse is the time and care for people who do not get to take their babies home.

The district is a hub for access to abortion care, and we have patients from all over the country come to hospital center so that they can grieve their children in a timely manner.

Without postpartum, I do not have a place to put the mother who has to grieve.

I don't have a place to put the mother who needs to have their baby.

I will not have access to ORs because they're being used for rational deliveries because we cannot put our recovered and um antipartum patients at our postpartum unit.

Everyone deserves dignity in their delivery as well as privacy.

Laboring inside assessment rooms, triage rooms, operating rooms, and hallways is not an option.

When we asked Medstar what was their plans for mitigating the effect on our community with disclosure, they had told us that we'll be relying more on other facilities in the health system, particularly Georgetown and Franklin Square.

This is not an option for most of Washingtonians.

They also had said that they were starting to help Cedar Hill bolster their women and infant health services.

Cedar Hill has recently celebrated their hundredth delivery in their first year of being open.

Hospital center averages 200 to 250 deliveries a month.

Aside from this, we were given platitudes of how it will be good times, there'll be bad times, there are roses, therapy thorns.

Today I asked the council to please put pressure on Med Star.

Please help us keep our postpartum unit open.

Please help make sure that they fulfill their obligation of 3% of charity care, which, as Dr.

As one of the doctors earlier has said, they're only fulfilling one percent.

And also to rally your community basis.

We also ask for those who are here today or listening later, please follow union nurses at MWHC for how the community can get involved in this issue, as well as we'd like to thank the healthcare workers that are here today for fighting the good fight and the council for inviting us.

Thank you.

Thank you.

Thank you so much to this uh panel of witnesses.

Um, I want to follow up on a couple of things.

Um, Miss Stevenson, you talked a little bit about a program that you guys did in partnership with Dreaming Out Loud.

Yeah.

How many participants did you all were able to have for that?

Yeah, we were successfully recruited 20 applicants for that program.

Okay.

How long?

How don't you just I know you were time constrained, so I want to ask if you could say a little bit more about what you all did and and what were some of the outcomes that were observed.

Most definitely.

So we did conduct an impact report and for internal use, and we'll be presenting at the Society of Nutrition Education Behavior and Mama Black Mama Matters Alliance uh health training conference in Atlanta, uh, in September.

Uh, from that uh intervention, it was over a course of four weeks.

Uh, we had every topic from gestational diabetes to hypertension, um, also case-based uh studies rooted in DC uh communities, so ward eight um and also providing resources uh to those attending.

Many of them are were birth workers who had day jobs, and so we conducted it in the evening at the Marion Barry um market before it launched.

Um we had a registered dietitian, also a mom, chefs who are also moms who could talk from their lived experience.

Um we incorporated African diasporine foodways, um, Caribbean, African American um recipes, we had them participate and actually conduct the recipes as well so they can gain their own uh kitchen confidence, being able to help replicate these menus with their patients, and for many who were birth workers and also uh food providers, it helped to enhance and build their own confidence.

Many of them in our baseline said they had no to low nutrition education, and with the cost of academic training and student loans, we know that nutrition is cost prohibitive for many folks, and so being able to democratize education, providing it in community and safe spaces.

Um we were told they would love to do it again, which we're looking to bring it back this year, but again, it takes funding and we relied on dreaming out loud to help cover those costs, give scholarships to make sure that no one had to take um any money out of their pockets, but we did know that they would have loved and would have paid for it if we did put a price tag on the program as well.

So we're taking their data, doing both pre-post testing and interviews to help expand and make a more robust longer program that's also hybrid, in-person and virtual, uh, in order to meet them where they are.

We did allow them to bring their children, which only added value to show this is why we're here to do this work.

Um, and so we say no mom should ever apologize for bringing their children along because it helps to make a more rooted grounded and robust experience of why we do this work every day.

Yeah, yeah.

Um, well, that sounds great.

It it also kind of reminds me of once upon a time before the Republicans took over, there was this program called SnapEd.

Um, the FNF educator, yeah.

So it sounds like you guys are sort of picking up and also kind of expanding to this uh very uh specific population, something that used to be federally funded and I think are super helpful.

Um, to the point that you said like nutrition is helping make healthy babies, it's core, not an add-on, um, and more work needing to be done in that arena.

Um just in terms of helping people make healthy choices.

I don't know.

Yesterday I was I went ran to PRET after what was too long of a meeting in this building, and um I didn't have my water bottle, but I was thirsty, I was gonna sit there and eat, and so I was like, okay, let me look at the options.

I could get the lemonade for five dollars and forty-nine cents, right?

Or I can get the 12 ounce can of coke for like three dollars, which is expensive.

Um, and I was like, this is just the lemonade is clearly the healthier option, but it is also the most expensive option, such that we're just pushing people into, you know, yes, the it is a system designed, and that is why we have to incorporate um nutrition professionals in a part of this maternal health conversation, which many of times we have not been a part of the process.

It's critical that we're part of the policy making process because from the maternal health policies I've seen, they have a very light watered versions of what nutrition truly means.

We're more than a cooking demo.

We're trained literally one class away from being a chemistry minor.

And so for us, it's equally as important to understand just as much as we need a doctor, we need someone who also knows how to grow the food but could cook and not cook out the nutrients in the food, and understand how do we make sure that families feel comfortable when they get the food, prepare it, and if they can't, how do we train those who are the culinary and birth worker professionals to make sure they can provide that support for those families because in the end we may not be the hard savings that is apparent, but we are the soft savings in the beginning when we think about what public health means and having been a foreman extension agent at University of District of Columbia, that is where I cut my teeth of understanding being like the Mary Poppins and nutrition being in child care centers and housing authorities in schools, it senior centers.

That is what the most fundamental experience it helped me to understand.

We are not simply telling folks what they already know.

We're helping to say you are worthy, you're deserving, you are valuable to eat the foods to make a healthy body to live your God given purpose, and people need to understand that basic decency of what it means to have culturally competent nutrition educational professionals and training those to be the next generation to follow in our footsteps.

I want to leave it there, but I do need to ask some additional questions.

But thank you.

Thank you for your passion and and and thank you for the work that um you're doing.

Um I love that uh the nutrition piece of the our work in government is in the health committee, and sometimes that's a little weird for people, but it it's it's there on purpose.

Um, and it's something that we definitely focus on for sure.

Um, Miss Golston, I wanted to ask, you know, in your testimony, I think you brought up something that we don't often think about, which is what happens if someone isn't able to bring their baby home.

Yeah.

And the recovery piece there, but I just want to get clarification.

So you said that um patients who are recovering from those procedures aren't able to be on the postpartum unit.

No, they are not.

Um at hospital center, we kind of figured that having someone hear someone else's crying baby next door, um, is kind of traumatizing.

So we usually keep them on our labor and delivery unit for as long as they need.

Um, they oftentimes are medically clear to go home, but emotionally they just need more time.

Yeah, as well as um navigating things like we the meeting earlier was talking about um burial procedures, navigating things like burial procedures because no one has ever thought about how to bury a twin-a-week fetus.

Um, so we take our time, we let them grieve as much as they can before they have to start saying those really final goodbyes.

Um, and that just is something that like we won't be able to provide as easily if I have to think about well, I need her to get out of the room because I have three laboring patients in my triage, but she has been medically covered and everything like that, and she's just there grieving, which is an important part of their healing process.

Got it.

Okay, um, like I said, we have met we have some folks who are testifying for Med Star later, so um, we'll have some opportunity to um follow up there.

And I I think the uh comparison in terms of the volume that you gave is pretty striking, right?

So Cedar Hill open for a year, yay, a hundred births.

Woo-hoo, it's just very impressive, and I'm proud that they are able to do that, but it's just and you're like no, we do 200 in a month.

Yes, um, we are the busiest um hospital for women's health in the district.

I think I looked up uh statistics where comparatively in 2025, we the estimated at least was almost like 40% of the babies, not just like the one-third that we had from beforehand.

Yeah.

Um it was about estimated 40% in 2025 we're born at Hospital Center.

Okay.

All right.

Um, I don't have any other questions.

Thank you, Ms.

Edwards, for being here, Dr.

Logan as well.

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

Thank you.

Okay, we're gonna go to our virtual witnesses.

Um for those who haven't done virtual hearings with us before, you're gonna you have to affirmatively accept our invitation to become a panelist.

There'll be a little box that pops up on your screen, and you do have to click the button in order to become a panelist.

We're gonna do a panel of six.

Um, because I have 11 people here, but I'm just gonna assume that perhaps somebody might not join us.

Um, so Justin Palmer from DC Hospital Association, Jaren Hill Lockridge from Dreaming Out Loud and the Ward 8 Health Council, Antonio Myers, Elizabeth O'Donnell, um Nandy Janja, and uh Lauren Messinger from uh Mary Center.

Okay, I'm gonna give it just a moment for folks to join.

Okay.

Okay.

Um, the other thing that I need to mention is that um we can't promote you if your name on your Zoom is like iPhone A or just two initials.

Um, you do have to like really tell us who you are.

Okay.

Uh Justin, when you're ready.

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

My name is Justin Palmer, and I'm the Vice President for Public Policy and External Affairs at the District Columbia Hospital Association and a resident of Ward 7.

Thank you for the opportunity to provide testimony at today's round table on maternal and infant health.

DCHA is proud to lead the DC Perinato Quality Collaborative, a multi-stakeholder partnership funded by DC Health and HERSA, dedicated to reducing maternal mortality, improving maternal and infant health outcomes, and narrowing racial and place-based disparities through quality improvement initiatives.

The collective the collaborative brings together over 250 stakeholders across the district's birthing hospitals, federally federally qualified health centers, community-based organizations, and other public health partners to improve the safety and quality of perinatal care.

One of DC DCPQC's current initiatives is improving a perinatal mental health.

Earlier this year, we launched a year-long alliance for innovation maternal mental health safety bundle aimed at improving maternal mental health screening education and referral practices from the prenatal through the postpartum periods.

This initiative aligns with the broader transforming maternal health team up model recently implemented by the Department of Healthcare Finance and is the first DC PQC effort to include hospital, outpatient, and community organization-based teams in adopting best practices.

As the first year of implementation continues, the PQC is actively supporting participating organizations through technical assistance, education, and training on the reporting platform.

To date, over 100 participants through across 10 organizations have engaged in perinatal mental health implementation activities.

The PQC also continues to make measurable progress in implementing nationally recognized maternal safety initiatives through the aim of obstetric hemorrhage patient safety bundle.

Um participating hospitals have increased the adoption of standardized quantified blood loss measurement practices and the documentation rates of record of recognition from 69.8% in Q4 of 2023 to 92.8% in Q3 of 2025.

Use of a quantified blood loss tech uh techniques has improved teams' ability to identify hemorrhage events earlier and initiate initiate appropriate management and care teams.

Beyond clinical quality improvement, the PQC is also expanding community education and prevention efforts.

In May 2025, we launched Count the Kicks, which is an evidence-based program that teaches expectant mothers about the importance of tracking fetal movement and improves patient provider communication to reduce preventable stillbirths.

Since launching this initiative, DC has shown the strongest growth across all states implementing Count the Kix with an 83% increase in engagement among registered users.

Building on the surgical early success, DCHA is uh expanding the program's community footprint through additional investments from the collective community investment funds at DCHA.

The additional funding uh we have allocated allows us to broaden our reach and strengthen partnerships with community organizations, prenatal care providers, and ensure that more expectant mothers have access to the educational resources through very various public uh engagement strategies.

The progress we have made reflects the power of collaboration and sustained investment and quality improvement.

Together with DC Health, the PQC is strengthening systems of care, uh advancing evidence-based practices, improving birth outcomes for moms and infants throughout the district.

Thank you for allowing me to testify, and I'm happy to answer any questions and apologize for going 26 seconds over.

Thanks, Justin.

Jaren, good afternoon, Chairperson Henderson and members of the committee.

Um I'm Jaren Hill Lockrid, and you know, I wear a lot of hats.

Um I'm here in my role as director of strategic partnerships at Dreaming Got Loud and the Ward A Health Council.

And really, as a black mother east of the river, you know, I have first-hand experience navigating the complexities of our maternal health care ecosystem.

And I want to also name something that's sometimes missing from these conversations that maternal mortality is not just affecting mothers who we've lost, but it also affects the mothers who are still here as we make choices about our future.

See, it's not always that we don't want to have more children or that we don't want to grow our families.

Sometimes we're afraid that we might not survive the pregnancy and childbirth.

Um, and that's just really crazy, right?

When we're forced to weigh the joy of having a baby, and if we'll come home, that's more than just something that can be solved by a hospital solution.

That is explicitly a maternal health crisis.

And we need a complete ecosystem that supports women before pregnancy, through their pregnancy, during birth, after birth, and throughout motherhood.

But I want to also acknowledge the progress that has been made.

I'm so proud of the maternal working group and the way that they have showed up today and all the work that they've done.

Shout out to some of those other stakeholders east of the river for the city for investing in the Cedar Hill Regional Medical Center, which again allows us in Ward 8 to have a labor and delivery resource that we haven't had after way too long.

So I commend the district for the work that they've done supporting doula's um and to strengthen the collaboration across CBOs, providers, agencies, and the booths on the ground.

But as Tambra said earlier, these investments are not enough.

Um it's a step in the right direction, but we need to be clear in how we're supporting our mothers through food specifically.

That's a mechanism for social cohesion.

And we know that maternal food is medicine is a no-brainer.

You know, I can go on and on and on about the work that we do at dreaming out loud.

Y'all know how we at the Ward A Health Council stand on maternal health care, particularly for our mamas east of the river.

So that's why I really want to encourage the city, the council, and everybody else to invest in maternal health care, no, maternal food is medicine initiatives east of the river specifically.

See, we're trying to do something really cool by embedding it with doodle support at Cedar Hill and Children's and all these other things.

Tamper spoke to the work we did last year with the pilot of NERSH, providing nutrition education directly to birth workers and community.

So really trying to build this partnership, this ecosystem to wrap our arms around what it means to make sure that our mamas, particularly those east of the river, have all the resources that they need.

So I look forward to partnering with the council, DC Health, Healthcare Finance, GW, CRU, anybody else, to say that our zip code should not determine how long we live, nor should it determine my future grandchildren's ability to get to know their mama.

So again, thank y'all um for the opportunity to testify, and I look forward to any questions you may have.

Thank you.

Um, I don't see Antonio, but I do see Liz.

Hi everyone, um, Councilwoman Henderson, members of the committee.

Thank you so much for this opportunity to testify today and for your continued commitment to improving maternal infant health here in DC.

My name is Liz O'Donnell.

I am a very proud Ward 8 resident and the founder and executive director of Aelea in Action, which is a DC-based nonprofit.

We provide bereavement support for families experiencing any form of pregnancy or infant loss.

And I also serve as the Count the Kicks DC ambassador, which helps implement evidence-based still birth prevention strategies so that more families can make it home together in a way that mine was not able to.

So this program empowers expectant families to really recognize changes in fetal movement and seek care when something doesn't feel right.

Um, I personally would have greatly benefited from this had we had this program in DC while I was pregnant.

And since launching in DC, thousands of education materials have been distributed, hundreds of families have used the app.

We know the resources are available in multiple languages, and the digital outreach outreach numbers.

When I looked yesterday, have reached tens of thousands of DC residents.

One of the most encouraging examples that I was actually able to be a part of has been with Community of Hope Birth Center.

Seeing their providers really embrace Count the Kicks has just showed what's possible when these healthcare organizations really invest their time in our evidence-based education, and I hope to see even more hospitals and prenatal practices throughout DC actively promoting this program, and I'm happy to help with that in any way that I can.

Fewer families experience stillbirth.

But of course, we know not every loss is preventable, and so when a loss does occur, the quality of care they receive really truly matters.

Um the US has no standardized perenatal bereavement framework, so care is very fragmented across systems, even here in DC.

And after the stillbirth of my daughter Aliyah, I founded ALEA in action to really help address that gap.

Um, we have bereavement packages that are available to all DC residents and are in almost every DC hospital and birth center.

And due to provider to request, I actually just developed an accredited training program to help provide compassionate and anti-racist um bereavement care.

And so I would love to see DC, the city that my daughter should be growing up in, become a leader in helping to build standardized perinatal bereavement care, as sadly so many of our DC families need it, and the providers that are giving them this care need the knowledge and confidence to deliver that care to these families.

Um, just real quick, after hearing the previous testimony, I really want to thank Washington Hospital Center for the amazing work that they do for families and for advocating for safe spaces post-loss because I know firsthand how valuable that is.

So, really, my ask is simple continue investing in stillbirth prevention through programs like Count the Kicks, and then also start considering how equitable bereavement care for families can also become a part of the maternal health conversations here.

Um, and then real quick, I mentioned that Alia in Action is currently partnered with almost every hospital.

Um, Cedar Hill is the one hospital that I've been trying very hard to connect with and have not been so successful.

So if anyone knows someone in the L and D unit there, please please please let me know because I want to make sure that we support them if families do need uh perenatal bereavement care.

Um, so thank you so much for your time, and I'm of course open to any questions.

Thank you.

Uh Nandy.

Nandy.

Did you did we freeze?

Did you freeze?

I don't know if she's not.

Okay, am I still frozen?

We can hear you now.

Okay, perfect.

Okay, um, um, good morning.

Christina Henry and the members of the committee.

Uh, my name is Dani Majinga.

I'm a mother of four years, working to improve maternal health in the district.

But today I'm speaking as um a mother.

Please be with me as it took me three times to write this and a way that my emotions are clear, and we written to form the council to hear me.

Um having postpartum depression feels like a curse.

You know what you have, you know why you are struggling, and you know what the reach is researching data says and evidence that's showing what postpartum depression anxiety can do to a mother.

Yet every day you are still expected to show up and practice if your struggles are not real, just to be accepted.

Although I have advocated for myself, has shown me how much work we still have to do.

It feels like no one believes you.

It feels like the data and history of black mothers needing to show up while suffering on the inside is getting it's overlooked.

Like, no way Naughty is suffering.

She is here, not knowing it took me tears and breaths and God to be here.

Even now I struggle with my confidence.

I have six weeks left before my unemployment ends, and I am terrified of finding a job that can't actually make that I can actually maintain while managing my mental health.

The way postpartum depression affects memory, executive, executive functioning and concentration, everyday administrative task is really recognized or accommodated by the way it should be.

Postpartum parade has been overwhelming.

I have a $7,000 bill from Sydney Hospital from giving my birth to my daughter on February 19th.

During pregnancy, even though I have access to SNEP 10 and you efforts to help parents drive, I still struggle to maintain bills.

I have lost my teeth.

We know postpartum pregnancy affects oil health, yet mothers still told that dental implants are cost matter rather than a medical necessary.

I also was not able to access paid maternal leave.

I have to lose my job.

Leaving me with very little time to recover before worrying about what how I can support my family.

I had the artist part of my postpartum journey.

Um Jerry during with the war and health council for giving me with my doula crystal and making sure I had groceries and encouraging me when I could not no longer encourage myself and even watch my and Crystal, who watched my four-week-old daughters so I can attend my unappointment workshop to restore my unappointed benefits.

Leah and work here at DCH reminding me who I am, as I felt like when days I felt like I had failed and could no longer show up for myself.

Thank you.

My midwives, Abney, Lauren and Daughter Pascal and my care team, a community of care for me before beyond the traditional six weeks postpartum period because they no longer knew I was ready to lose my relationships with them.

Um Navigator Jamila who continues to check on me even when I cannot um have the strength to answer the phone call.

Chairperson Christina Henderson for helping me restore my electricity with my family lost power, Robert Wright's office, especially Jasmine for connecting me with service when I could no longer get through my own, help my family avoid eviction.

As of June 25th, my love family is no longer in risk of policy.

The department of health for responding when I could no longer reach out to my network, and I sent one email blessed and they connect me to the right person in a mere health because I no longer could hear community resources say I had no more funding.

Martha's Table's baby and me program who continues to run my family with care and remind you the whole person here.

Every morning I listen to forever for every mountain to remind myself that God is still with me.

My faith together with the people God has placed in my life, remind me every day to keep choosing to be here.

Even when I feel weak, some days simply put on clothes and either good meal or taking a small step reminds me that I'm still capable.

Recovery is not always big victories, but sometimes it's choosing to keep going.

I have included several policy recommendations in my submitted rent testimony.

Include expanded post-partum support to one full year, recognizing pregnancy-related dental care as a medical necessary on the middle case, invested in workforce reentry opportunities for postpartum mothers, expanding postpartum dual care.

Protecting parents who lose employments during their postpartum period, striping workplace accommodations for postpartum mental health conditions, and investing in a fatherhood programs and building strong community-based family support citizens around parents for finished before family.

Thank you for listening.

Thank you.

Thank you for sharing.

Thank you.

Seriously, thank you.

Don't go away, but I know you got it.

Take a deep breath.

You got through it, and we appreciate you sharing.

Okay, Lauren.

Hi, good afternoon.

Um, thank you, Chairperson Henderson and members of the DC Health Committee for having us here today to speak upon such an important issue in our district.

Um, I'm Dr.

Lauren Messinger, the women's health clinical lead at Mary Center, a community health center dedicated to providing equitable and comprehensive care to underserved populations in our city.

Today I would like to highlight several critical clinical issues impacting maternal health in our district.

I'd like to start with the recent developments at Medstar Washington Hospital Center, which some people have already spoken about today.

The pending closure of their postpartum unit is of a significant concern.

While hospital officials have stated that this will not impact our ability to schedule C-sections and inductions and their ability to care for our federally qualified health center patients, the reduction in postpartum capacity will ultimately diminish overall labor and delivery resources.

We already see multiple announcements each week that the hospital is on hold and not accepting new patients and labor.

The closure can only seek to worsen those capacity limitations.

We worry this will lead to increased strain on remaining facilities as well as barrier to timely and quality care for our birthing families.

I'd also like to highlight a few clinical challenges that we are already seeing with the current changes in the last year that have negatively affected our ability to care for these women and their children and affected infant and maternal health outcomes.

We've already seen insurance coverage gaps where we encounter numerous patients whose Medicaid insurance is inexplicably marked as inactive.

This results in months of missed prenatal care.

The lapse in care is hampering our ability to manage pregnancy complications such as diabetes and hypertension, both of which have long-term health consequences for both mother and child.

Data from literature shows that the conditions in these conditions in pregnancy correlate with poorer long-term outcomes for children, including things such as diabetes, obesity, developmental issues, and cardiovascular disease.

How we care for these women today is going to impact the health of many generations to come.

We've seen alterations in medication access and formulary changes.

These changes in Medicaid and insurance formularies have made acquiring essential medications such as insulin and supplies for blood glucose monitoring more difficult.

We're seeing delays in treatment, which increases the risk of uncontrolled diabetes during pregnancy, adverse fetal outcomes, including fetal growth restriction and preterm birth.

We've seen an increase in uninsured patients and their seeking of emergency care.

Patients without insurance often end up in the emergency department for things that we can and should manage in the outpatient setting.

These are costly to the healthcare system, provide fragmented care and lack proper coordination.

I would like to highlight one thing that I think we do really well at Mary Center, and we have an incredible dedicated social work team that helps our patients navigate these complex issues, connect them to resources, address social determinants of health, and facilitate access to care.

We realize that not all clinics and facilities have this capacity, and they're not uniquely revenue generating resources, but I do want to highlight the importance of funding for social services because it does help us ensure integral continuity of care and improving health outcomes.

And I know I'm running over, so I'll just say that the stability and expansion of prenatal care and postpartum care services in the district is really essential for maintaining maternal health and child well-being.

So I thank you for your attention and your ongoing commitment to maternal health in DC.

Thank you.

Thank you so much to this panel of witnesses for your testimony and for your advocacy in your work.

Uh I'll start with uh Liz.

When you um when you popped up on the screen, I was like, I've seen you before.

Um, and then I was like, oh, okay, I remember because it was your advocacy that um led to the committee funding uh count the kicks the first time, and so it was great to hear from Justin at the DC Hospital Association about um the implementation but also the decision to go further and expansion.

So um I appreciate so much your advocacy and continue work um in this regard.

Um Justin, I wanted to follow up with you.

You talked a little bit about how um one of the priorities for the PQC was around uh perinatal mental health.

Um, and in light of some of the later testimony, I was wondering if you might be able to expand upon how the hospitals are choosing to approach this.

So, with the the mental health bundle, the the community involvement is essential, and that is uh through the PQC, working with um the outpatient and community providers is going to be essential to making sure that we have the resources and the network for um uh for uh prenatal postpartum um uh moms.

And so that has been a lot of the the the groundwork that has been laid.

Um that is one of the reasons why the mental health bundle is um is challenging, but that is one of the reasons why the the it has been a priority for the PQC, and they have spent, you know, we're implementing you know starting implementation this year, but the planning for implementation, you know, uh was a year before that to make sure that we were tracking everything that we needed to and making the connections, um, and we continue to do that as we roll out the program.

Um I can get more information and um offer a particular briefing on everything entailed on that to follow as a follow-up to the hearing.

Yeah, I mean, I would just be helpful to kind of know the issue is obviously complex and multi-layered.

It it it uh shows in a variety of different ways and sort of what our hospitals doing versus say what a um clinic's doing, etc.

That it would be just very helpful on that front.

Um I do recall though one of the foci, yeah, that's right, foci areas of PQCU before was around uh uh preclampsia.

Um, and hypertension, and I was wondering if you guys have any updated around the results from that previous work.

I don't have that with me right now, but I can follow up on that after the hearing.

Okay.

I know that there were just there's some things that um I think in the pre-prior conversations of like it's just very systematic in terms of what hospitals can do.

Um I think also there have probably been some additional, whether it's remote patient monitoring and some other tests and things like that that have been uh deployed that could help with a lot of this.

That and the hospitals um and uh we've been working with them to deploy blood pressure cuffs, yeah.

So we've we've deployed blood pressure cuffs to all and continue to supply those to hospitals in order to make sure that they are uh being distributed as well.

Okay, thank you.

Um, Miss trying to decide where I want to go here.

Um, well, Miss Messinger, first I'll say thank you so much for being here from Mary Center.

Um I'm curious in terms of implementation on the ground.

So um, you know, this year, this current fiscal year there were changes in terms of um the alliance uh health program, um, but we had made provisions available that if an individual if a patient was pregnant, they were able to still be able to continue.

Um has that been happening in in a somewhat um easy manner, or have there been challenges in terms of that?

Yeah, I think we've we have encountered certainly some challenges where patients who were pregnant um are still being told their insurance is inactive, and the paperwork and the process to notify Alliance that they are still pregnant is complex and has required our social workers, which again we're lucky to have here, and have been great at stepping in to help our patients, but it has been a challenge, and I have called many a patient who's missed their appointment to find out why they weren't here, and it's an insurance issue.

Nine times out of ten when I'm calling them.

So we are appreciative of the provisions that are there, but there were some challenges in our patients being able to communicate and get the district the alliance team to know they're still pregnant.

Okay, all right.

Um we'll ask some follow-up questions to health care finance on that front.

Um Nandy, again, I want to say thank you so much for being here and for sharing your story and being vulnerable to share your story.

Um there are lots of different things that you talked about, and some of them that um, you know, people don't necessarily think of uh the dental piece being part of it.

Um, sometimes when I hear people talk about like, oh, you know, pregnancy, it's fine, and you know, whatever, and I'm like, you know, there are all these other um uh complications uh that can arise that don't have anything to do with the actual delivery or giving birth, but the impacts that it has to the health of the person who is carrying um the child.

But can you I think you mentioned this, but you said that um lost teeth or um dental-related issues that is related to pregnancies considered cosmetic and therefore not covered by insurance.

Is that what I think you froze?

It's considered a cosmetic, so you can't get implants if um you can't get implants is covered through insurance because it's considered a cosmetic.

Okay, even though we know what the cause was.

Right.

All right.

Yeah, yeah.

Um, okay, we'll follow up on some of these pieces.

Um, thank you for being here.

Um, and um, Jaron, thank you uh for the work that the Ward 8 Health Council does because I feel like in in this situation and so many others, that network is truly helping um to provide that additional support to community, especially when they're in deep need, and um, all the various folks that came together.

Um, I know it's not a one-off.

I know it's something that you guys are doing often, so thank you so much.

All right.

Um, we're gonna go to our next panel of witnesses.

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

Um, so these are our last group of public witnesses.

Uh Laura Brown from the First Shift Justice Project.

Um, Amy Sawyer from Sibley Memorial Hospital Johns Hopkins Medicine.

Uh, Raina Smith Jordan from Sibley Memorial Johns Hopkins Medicine, Dr.

Angela Thomas from Med Star Health, and uh Dr.

Tamika Agusti from Med Star Health.

Give them just a minute.

Okay.

Uh, while folks are coming on, uh Laura, uh, when you're ready.

Good morning, council or afternoon, maybe.

Councilmember Henderson.

My name is Laura Brown, and I'm the executive director of First Shift Justice Project.

First shift's lens for improving maternal and infant health is employment.

We help clients request pregnancy accommodations and paid job protected leave so they don't lose their jobs.

Pregnant workers' ability to feed, house, clothe, and care for themselves and their babies is dependent on their economic stability.

Workers' rights directly impact maternal health.

Here are some examples of our clients.

A pregnant worker with diabetes needed breaks to eat to manage her blood sugar.

Her boss said she should just get a juice and keep working.

Her request for breaks should have been granted as a reasonable accommodation.

A pregnant nurse had a low-lying placenta and needed a temporary lifting restriction.

The hospital's human resources department told her she had to take unpaid leave.

She was the sole breadwinner for her multi-generational family of four, soon to be five, and could not afford to miss a paycheck.

She found another doctor who cleared her for work against medical best practice and made her sign a waiver of liability.

The hospital should have granted the lifting restriction.

A teacher was told by her boss that she was not eligible for FMLA leave and could not take time off to recover from childbirth.

Her boss didn't know that she had that right under DC's pregnancy accommodations law.

DC has had this law on the book since 2015.

How is it even possible that her boss did not know that?

First SIFT helped her avoid losing her job.

Efforts to improve maternal and infant health must include consideration of employment and other social determinants of health.

The centering pregnancy model of providing prenatal care is one such program.

My medical colleagues will tell you that this is an evidence-based prenatal care program proven to reduce preterm births.

First Shift works with centering groups at Community of Hope, Unity, and Mary Center to teach pregnant workers about their workplace rights and offer our legal services.

Last year we gave 17 presentations at Community of Hope Alone.

We can reach more moms in a meaningful way because of pregnancy centering programs.

Another way to improve maternal health is to develop and support OBGYNs, DOLAs, midwives, and community health workers who have a deep understanding of the lived experience of their patients and a holistic approach to care.

Finally, making DC paid leave benefits portable supports maternal and infant health by allowing pregnant workers to access the benefits they have earned even if they are not currently employed at the time they need them.

First SHIFT sees a lot of pregnant workers who have lost their jobs for one reason or another, sometimes an illegal reason, who are otherwise eligible for paid leave benefits but are prevented from accessing this safety net program that was intended for them.

They do not generally qualify for unemployment benefits.

Thank you for the opportunity to testify today.

Thank you.

Amy.

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

My name is Amy Sauler, and I'm the Director of Women's and Infant Services at Sibley Memorial Hospital, a member of Johns Hopkins Medicine.

I'm joined by my colleague Raina Jordan, Sibley's Director of Government Affairs.

I am testifying today to share our insights regarding maternal and infant health outcomes in the district and to highlight Sibley's maternal health access program.

Sibley's Maternal Health Access Program, or MHAP, was developed to directly address disparities in maternal and neonatal morbidity in the District of Columbia.

The program works with community-based providers to improve hospital services for the most fragile newborns, address adverse social drivers of health, and enhance outreach in underserved communities.

Since its inception, MHAP has enrolled more than 1,0100 patients, with 38% residing in wards 7 and 8, 57% identifying as black, and 40% identifying as Hispanic.

To further expand this reach, Sibley will soon announce the establishment of a collaborative relationship with a local FQHC to ensure that vulnerable patients seamlessly transition between community clinics and hospital-based services.

The true value of MHAP lies in our ability to manage highly complex cases by bridging hospital clinical care with district community resources.

For example, the program recently supported a single mother with three children facing an unexpected pregnancy and a complicated health history.

Sibley's MFM team and high-risk nurse navigator integrated with her community support team, including Smart from the Start and Mama Toto Village.

Together, they determined discharge barriers, coordinated physical therapy, arranged child care, and picked-up medications, and through MHAP, Sibley provided a crib, car seat, and formula while coordinating transportation and follow-up care.

This coordinated ecosystem allowed for her to safely deliver a healthy baby girl and successfully transition into postpartum medical and mental health counseling appointments.

While providers coordinate effectively within their own organizations, clinical teams frequently encounter patients who receive care across several different entities in the city.

Sibley strongly advocates for policies that incentivize closed loop communications to ensure vulnerable patients are not just directed to the appropriate specialist, but that their receipt of care is seamlessly communicated back to critical members of their primary care team.

Our ultimate vision is a unified communication network where hospitals, FQHCs, and organizations supporting health-related social needs speak to one another in real time on behalf of the patient.

In closing, Sibley shares the city's goal of improving maternal and infant health.

By catching high risk patients early and addressing critical social needs, we can help ensure that district moms and babies receive the care that they deserve.

Thank you for the opportunity to testify today.

We're happy to answer any questions you may have.

Thank you.

Reina?

No separate testimony for me.

I'm just here to have help with that.

Oh, patients.

If we have got it.

All right.

Dr.

Thomas.

Dr.

Thomas, we can't hear you.

No.

No.

Oh, we can.

Yes.

Okay, okay.

We got it.

Yes.

Okay.

All right, sorry about that.

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

My name is Dr.

Angela D.

Thomas, and I serve as the vice president for health care delivery research at Medstar Health and MedSTARS Research Institute, where I provide oversight for the Medstar Health Care Delivery Research Network, the Medstar Women and Children's Research Network, the Center for Biostatistics, Informatics, and Data Science, and our Safe Baby Safe Moms Initiative.

I'm pleased to offer updates on Safe Baby Safe Moms, Medstar's Hallmark program at today's Maternal and Infant Health Roundtable.

MESTAR Health offers a comprehensive spectrum of clinical services through over 400 care locations, including 10 hospitals, 33 urgent care clinics, ambulatory care centers, and an extensive array of primary and specialty care providers.

As a not-for-profit health care system, Mr.

Health is committed to its patient-first philosophy, emphasizing care, compassion, and clinical excellence.

As part of our work, we also aim to address health disparities informed by the evidence and patient-centered care.

In partnership with Mama Toto Village and Community of Hope, Medstar developed and implemented the Safe Baby Safe Moms care delivery model, which has significantly reduced both the overall rates and the disparity rates of very low birth weight, low birth weight, preterm births, and severe maternal morbidity.

In March 2020, the A.

James and Alice B.

Clark Foundation funded $27 million of the $30 million Safe Baby Safe Moms Initiative.

Save Baby Safe Moms is a novel multi-generational integrated care delivery model aimed at reducing maternal and infant health disparities.

The initiative combined more than 70 interventions, including universal social determinants of health screening and referrals at every point of care, integrated behavioral health screening and referrals for depression and anxiety, remote patient monitoring for hypertension, diabetes education and care bundling, interprofessional care coordination, medical legal partnership services, perenatal navigation, healthy steps, didactic pediatric support, postpartum outreach and follow-up, extending the chat through the child's first year of life.

Initial results offer promise for care delivery.

Important metrics such as preterm birth improved for birthing people receiving care as part of safe baby safe moms compared to their counterparts who received care elsewhere.

Additionally, results for black birthing parents are notable.

This is particularly important considering black mothers and living living in Ward 7 and 8 are three times more likely to die from childbirth related complications.

Women in two wards account for 70% of all pregnancy related deaths in DC.

Between April 2020 and March of 2025, Safe Baby Safe MOM served over 53,000 patients and delivered over 16,000 babies.

More than half of those patients were black.

These results are clear as SBSM works, and it especially works for well for the patients who face the greatest risk.

Mothers who receive safe baby safe moms prenatal care were significantly less likely to have low birth weight babies or preterm birth compared to Safe Baby Safe Mom patients.

Those who receive prenatal care elsewhere were 1.4 times more likely to deliver a very low birth weight baby, and 1.15 times more likely to deliver pretern.

I'm happy to provide more data about Safe Baby Safe Moms in the submitted testimony.

Thank you for continuing to bring attention to this important issue.

Thank you.

Dr.

Augustie, Hello, can you hear me okay?

Yes.

Wonderful.

So good morning, Chairperson Henderson, members of the Committee on Health.

I'm Dr.

Tamika Agusti.

I'm chairwoman of the Women and Infant Services at Medstar Washington Hospital Center, and I'm the physician executive director for the Women's Health Service Line for Medstar Health.

In my role, I provide oversight of the OBJON department with the highest acuity and volumes in the District of Columbia, Medstar Washington Hospital Center, and all of the OBI joined services provided at Medstar Health.

Thank you for the opportunity to present to the Council Council's Committee on Health an overview of our experiences in supporting expecting parents and their infants.

I continue to dedicate my career to ensuring patients have healthy pregnancies and births in my clinical practice and through my advocacy work to improve the quality of maternity care of the District of Columbia.

I cannot do this alone, and my partner in this work is MedStar Health.

We are confronting our nations and districts' rising maternal and maternal mortality rate, which disproportionately impacts Black and Indigenous women.

As members of the committee are aware, the United States still has a maternal mortality problem, with the latest being 17.9 per 100 births, and the district's pregnancy related mortality ratio is 43.8 per 100,000 births.

It's estimated that more than half of these deaths are preventable, especially concerning other stark racial inequities in maternal mortality in the district, where black residents are approximately 81 to 90% of all maternal or pregnancy-related deaths, despite only representing half of the births in the district.

Of the pregnancy-related deaths that are occurring in the US, an estimated one-third occurs one week to one year after pregnancy ends.

This highlights the critical need for proper recovery and support during postpartum, a key tenant in the women's health services at Medstar Health.

Key findings from the district's maternal mortality review committee found that leading contributors include cardiovascular conditions, mental and behavioral health conditions, infection, and hemorrhage.

We also know social determinants of such as housing, access to care, structural racism, and care coordination played important roles in many of these maternal deaths.

Social and structural determinants of health describe environmental conditions, both physical and social that influence health outcomes.

Addressing social determinants of health is critical to reducing inequities in health status, including maternal morbidity and mortality.

Evidence shows that improving access to social services reduces the risk of developing chronic diseases and other health conditions and may also lower health costs.

Recognizing this, like Dr.

Thomas just mentioned, in 2020, Medstar Health in partnership with Mama Toto Village and Community of Hope launched DC Safe Baby Safe Moms with generous support from the A.

James and Alice B.

Clark Foundation to address this adverse maternal and infant health outcomes in the D in DC.

Since launching, over 53,600 individuals have received comprehensive patient-centered care through the Safe Baby Safe Mom Initiative.

And our data shows that racial disparities in maternal infant health outcomes have been reduced in our patient population.

At the conclusion of our five-year project, we have been able to show the patients who received prenatal care under Safe Baby Safe Moms at 66% lower odds of very low birth rates, 47% lower low birth rate babies, and preterm babies, 10% lower odds of severe maternal morbidity.

Specifically, black patients received preenal care under safe baby safe moms showed similar and even slightly better outcomes with lower odds of preterm babies and severe maternal morbidity.

However, an additional factor has to be taken into consideration that we've also seen the birth rates in the city change over the past few years.

Births and birth rates in DC have decreased consistently over the past six to ten years, with the same trends being seen at Washington Hospital Center.

Medster Washington Hospital Center remains committed to providing safe access to patients requiring obstetrical care.

We expect these downwards trends to continue.

Birth rates have declined consistently due to a myriad of factors.

We as we are adjusting our operations to change to the changes in the environment, our commitment to our community and services that we provide at best.

In our commitment to the community of maternity patients we serve, our services are not changing.

We recognize that the great work we've been able to accomplish with Safe Baby Safe Mom was dependent on our partnership with our community partners, and it is important that that continues and it will.

I believe as leaders in maternal care in the District of Columbia, we continue to make significant changes to improve the care that we deliver to our women in DC.

As a health practitioner in the DC, I applaud the committee on health for holding this important round table to address the coverage care and challenges of maternal infant health and district.

Thank you, Chairperson Henderson, and the committee members for this opportunity to testify.

I'm happy to address any questions that you may have.

Thank you.

Thank you so much to this uh panel of witnesses.

Um it's always good when we get uh the practitioners and institutions to sort of weigh in, especially the ones who are, I think between Sibley and Medstar.

You're doing more than half of the births um in the city for uh individuals who are choosing to um give birth in a hospital.

So I want to ask um a couple of uh follow-up questions before before I get there.

Um Ms.

Brown, I don't want you to feel left out.

So I want to say thank you so much for the work that you guys are doing around uh workforce accommodations uh as it pertains to pregnancy.

Some of the examples that you gave, um, just for clarification, were those in DC or really all of them.

All of them, including the hospital that made the patient sign a waiver or the the worker sign a waiver.

Interesting.

We could follow up on that offline.

Um I wanted to ask a question.

Uh one of the issues that we have had in the past in DC has been with regard to diversions in terms of labor and delivery.

Um I think, well, I think Raina knows this, and and um Dr.

Augusty, I think I've said this before.

Um, I had that experience with my first um when I was giving birth to my first child of multiple hospitals happened to be on diversions in DC at the same time one beautiful day in March.

Um, and I'm curious, um, whether or not you all are seeing that trend going down.

We got a little bit of data from um DC Health about uh some of the diversions at the hospitals with regard to labor and delivery.

But uh I just wanted to hear from you all.

Sure.

Um I can speak to that uh to Medstar Washington Hospital Center.

So over the past years, uh, the number of times the ground diversion has gone down.

We see spikes every so often in certain months.

Um, but uh when you compare the past year to the year previous, the number of times diversions is has happened has gone down.

I think this is multifactorial because the birth rates and the number of births happening are going down, but also we have implemented uh very clear plans on what to do when we're getting close to a diversion to try and offload to try and help um expedite um the availability availability of beds.

We have a very clear process and we have very um our leadership is intimately involved when we're going on diversion, so it is not made by one single person, but by a uh the group of our leaders, both in the department and at Met Star Washington Hospital Center.

Putting all that together, I think is why we've seen a less number of times that we've been on diversion.

Okay.

What about Sibley?

Yes, I'm happy to speak to that.

Um, I think Sibley has seen some recent spikes in that.

Um, but overall, I think we're we're going down in our times of diversion.

Um again, similarly, we have a very clear process and policy in place and really try to um make sure we're not just one person is making that decision, we have a whole team with our medical director and our nursing director that are making that decision, um, and really um looking throughout our entire women's and infant services to see what other levers we can pull before labor and delivery needs to go on diversion.

Um overall, our volumes have been down as well.

We're experiencing that, you know, lower birth rate as well.

Um, but still seeing some of those big fluctuations from day to day where volume may be really low one day and high another.

And so our team is really looking at everything related to our schedule and making sure anything that we have, anything that we can do to impact that um that we're putting into place.

Great.

Um, one of the things though I wanted to ask in terms of the data, and I could also follow up with um DC Health and FIMS about this, but when the hospitals report that you're on diversions, do you also report the length of time?

Because I know that sometimes it could be you're on diversions for like three hours, it's not for the whole day.

Um is that information also conveyed as well?

When we go on diversion, it's for a specific amount of time, the minimal amount of time that we are we we go for.

We don't we often say we have a conversation with DC Health saying, you know, is it three hours?

Is it four hours?

And at the end of that time, we have to communicate again with DC House, explain where we are, and then again determine if we need to be on diversion any longer and for what period of time.

We never say, oh, let's we're gonna go on diversion for the day.

Um, unless there's some catastrophic uh physical plant problem, um, that doesn't happen.

So that's how we usually um work in terms of how long we're on diversion and um internally we you know it is we could try the four hours, but we need to we are working towards alleviating the bottleneck at the end of those four hours so that we can come off of diversion.

Okay.

Um that's helpful to know.

I um, you know, obviously we have had a couple situations where I don't think it is necessary labor and delivery, but the issues have been in terms of like the emergency room where there was like a pipe that bursts.

Well, yeah, okay.

You you do need to be on diversions and and probably for the remainder of the day until the repair can be made.

Um so I definitely understand that.

Um it is just often though, I know that this data point is kind of used to speak to uh demand and um capacity within our public health network to deal with the number of um deliveries that we've had.

Um and so Dr.

Gussi, I wanted to just give you an opportunity.

Um there were a number of witnesses who testified today about some of the changes that you guys have made at Washington Hospital Center, and I wanted to give you an opportunity to respond.

Sure.

Thank you very much.

Um so um uh Medster Washington Hospital Center have made the decision um to uh shutter one of our two postpartum units because um the unit the it was not reaching capacity, we were having decreased volumes.

Um, and so um we looked at the data, we looked at how many times the unit was full, how many times it was empty, um, how many available beds we had on the other unit, and the decision was made um to uh close the unit.

This is again, we have looked at the data, looked at what our services are, looked at the numbers that are coming through labor delivery, and we really do think that this would be um is going to be able to uh occur without significant change to any services.

There is no change to any services.

I've had conversations with our community partners, particularly FQHCs, where our their interaction with high-risk obstetrics or uh perinatal ultrasounds, none of that is changing.

Um our, you know, uh ability to take patients, nothing is changing.

Our our community partners being able to schedule C-sections, schedule induction of labors, none of that is changing.

Um, I understand that there is concern that will change.

Um, but what I think many people don't have is the data that we have internally, and we've looked at that, and we know that we are going to be able to handle this.

Um we may have um, you know, the the when we have a bottleneck, it's always because of what's on labor delivery, it's not necessarily because of what's on postpartum.

So that's why we think we're poised uh pretty well to be able to handle this change.

Okay, and it's not as though the rooms are going away.

Should you see a reversal in volume, the hospital is able to adjust.

Correct.

The rooms aren't being destroyed or going away.

Um, it's not um, you know, similarly, just as we are pivoting right now.

If things change in the city, let's just say a hospital closes or something, and at bursts will have to be diverted, um, then we always have the opportunity to reverse course.

Um that similarly happened um a few years ago when Providence Hospital was closing.

That's right.

Um I wanted to also ask um uh for both of the hospitals.

Um, Dr.

Augusta, you testified at our last maternal health round table, um, and it was you and I think you had another colleague who is with you maybe from Med Star Georgetown, but sort of talking about some of the trends that you all were seeing of patients who were coming in.

Um, and it was from that conversation that we that conversation, but I think also uh a convening that the DC Hospital Association did around uh substance use and pregnancy and trying and whether or not there were interventions that interventions or more public education that needed to be there.

Um I was curious what type of trends you all are seeing now, being that the hospital probably has the most up-to-date data around what's happening in the maternal and infant health space in the district.

Um you could go first and then of course, Amy, um, thereafter.

Oh, sure.

So I do when I last spoke, we had seen an unusual spike in the number of substance use disorder opioid um uh involved pregnancies.

It was highly unusual.

Um, thankfully, we don't we're not seeing those sustained numbers any longer.

Um I think from that, I think it's multifactorial again.

I think there was a lot of education, a lot of knowledge that was shared in terms of what to do from these for these patients, not when they hit labor delivery, but beforehand, and I really do think that has worked.

And we're also integrated a lot more substance use disorder services for patients um antenatally and when they're on labor delivery.

I think some of the trends that we are seeing now, I'd love to hear uh from Amy if she's if she's seen it is that we are seeing hypertensive disorders like we've never seen before.

Um things like gestational hypertension, pre-eclampsia, preeclampsia with severe features.

Um, in years past, where we on any given time on labor delivery, where we would see have one or two patients that were had a diagnosis of preeclampsia with severe features, we now have six, seven, eight patients.

Um the hypertensive disorders in pregnancy and before pregnancy, chronic hypertension is skyrocketing.

Um, and that is something that we are definitely noting and having to pivot and try and and mitigate antenatally as well.

Yes, thank you.

I would agree with that.

You know, what I cannot say we're seeing a lot of um patients that have substance use.

Um I don't have the numbers off the top of my head, but it's not a significant concern.

But um to Dr.

Auguste's point, we are also seeing lots of patients that just have complex pre- that are complex in their pregnancy.

Um they may have um preeclampsia, a lot of patients with um severe features with hypertension with severe features.

We have a lot of readmits for postpartum mag sulfate, um, and patients that are are really very sick, um, as well as diabetes, gestational diabetes, and just a lot of very complex patients, very highly acute patients, um, as well as patients that have significant mental health needs or even behavioral health needs.

Um, and that's where I think we're we're seeing a lot of this focus.

So I know, you know, we're a part of the DC PQC as well, and working on some of the same bundle, and I think it's very timely looking at the the mental health bundle this year.

Um, I think that's something that um is really very helpful in this time.

Yeah.

I think it's so interesting in terms of the hypertension, the preclampsia piece.

You we just passed and and funded um legislation around remote patient monitoring, which could be incredibly helpful in some of these things, particularly um Miss Ori when you're talking about the readmits.

But also just sort of the monitoring in that postpartum period once someone actually leaves the hospital.

Just for clarity, both of you mentioned this.

You said, quote, severe features.

What does that I'm not I'm not a doctor, so what does that mean?

Sure.

So preeclampsia is a diagnosis um associated with pregnancy where you have elevated blood pressures and um some end organ damage like kidneys and protein.

Um we have the diagnosis comes with or without severe features, and the severe features has to do with uh significantly sustained elevated blood pressures um or some neurological symptoms that might have like an unrelenting headache that doesn't go away, um, or some um um visual changes.

Preeclampsia with severe features, um uh like the title kind of says, um, is much more concerning than pre-eclamps preeclampsia without severe features.

Um, the those that have severe features need certain uh treatment to prevent seizures from happening.

That's the magnesium um sulfate that was mentioned before.

Got it.

And so that is a progression of the disorder to the to the almost to the highest level.

So that is what we are seeing.

More more severe preeclampsia, worsening hypertension and disorder in preeclampsia.

Okay, interesting in terms of this whole panel kind of being together because I had imagined that um sometimes working conditions can exacerbate or lead to preclampsia, is that accurate?

Like if somebody is doing heavy lifting and those types of things or I mean we've seen enough of the data to show that it it it may cause someone's blood pressure to elevate, but the progression of preeclampsia is honestly still unknown.

Someone's gonna win a Nobel Prize for it because we don't know it has something to do with the placenta um and the vasculature.

Um, so um while like you said the stress and working conditions can add to elevated blood pressures, which then brings people in and gets them even, you know, we have to do that evaluation to make sure that isn't pre-eclampsia.

So it is contributing to the work to patients being seen, the workflow and what has to be done.

Um, but I wish we knew exactly how to prevent preoclampsia.

We're getting close, but we don't have the answer yet.

That's so frustrating.

It's like it is 2026, and we have this thing that is literally causing, you know, mothers' um risk and harm, and yet we have no um right, pre-eclampsia has been existing for decades, forever, and we still don't have an answer as to why, but also how to prevent it, right?

We need to do put more funding into research on women's health, particularly around pre-eclampsia.

That's the way we're gonna get the closest to it.

We're we're getting close.

There's some some bright spots that we need to do, we need to push more.

Yeah.

Um, it is sort of makes me think of Jaren's testimony from earlier, but just also in general, right?

Um, I remember when I um had a meeting with my doula and said, like, you know, what are your goals for your pregnancy and in your birth?

And I was like, um, healthy and uneventful.

That's it.

Yep, just want to survive and be uneventful.

Um, and that shouldn't it is weird um that for America that is uh something that people have to say as opposed to it being sort of just a joyous occasion, but you just want to survive it as opposed to experience and and live it.

Um thank you so much.

Um I know that Dr.

Gusty and Um Dr.

Thomas and Miss Sawyer, thank you for being here.

I know that you guys have uh crazy schedules and seeing patients and and whatnot.

So I really appreciate you taking the time to be a part of um this conversation.

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

Um we're gonna take a five minute break and then um we're gonna uh get to our government witnesses.

Thank you.

Okay, we're back with our government witnesses.

We have Sarah Beckwith, who is the senior deputy director for community health administration at DC Health, and Melissa Bird, who is the Medicaid Director at the Department of Health Care Finance.

I need to swear you guys in.

So if you could raise your right hand, well, you and anybody who might speak from your team.

There we go, the friends in the back.

Okay, do you swear our firm under penalty?

A lot of testimony you're about to provide to counsel of this, the council of the district of Columbia and this committee is the truth, the whole truth, and nothing but the truth.

Great.

All right, I think we're starting with DC Health, and there are some slides.

So Sarah, if you could just turn your mic on and you're good.

Nope, do it again.

Now you're good.

Oh, okay, okay.

Good afternoon.

My name is Sarah Beckwith, and I serve as the senior deputy director for the community health administration at the DC Department of Health.

I am testifying on behalf of Dr.

Ayana Bennett, director of DC Health.

Thank you for the opportunity to bring attention to the critical public health issue of maternal health in Washington, DC.

In public health, we define maternal health as the health and well-being of women before during and after pregnancy and childbirth.

We know that there are several factors that influence maternal health, including sociodemographic factors like race, ethnicity, education and income, factors before pregnancy, including chronic conditions like hypertension and diabetes, pregnancy factors during pregnancy, such as prenatal care, gestational hypertension and diabetes, and factors after delivery, including postpartum care, behavioral health support, and breastfeeding support.

At DC Health, we have created a perinatal and infant health framework, which aims to improve perinatal health outcomes.

We focus on improving pre-conception health, ensuring high quality health care services and care, strengthening families, and promoting healthy environments.

At DC Health, our current maternal health priorities are focused on reducing maternal mortality and severe maternal morbidity, improving maternal health before, during and after pregnancy, and improving coordination across the entire health care ecosystem.

We are showing past years of data from about 2019 to 2024.

It takes about a year for DC Health to validate our maternal health data.

So we should have our 2025 maternal health outcomes, which I will talk about more, ready for publication by December of 2026.

So on this slide, as we heard from our partners, we see trends in where district women are delivering.

So we can see that the percent of births annually, we've seen increases at Med Star Washington Hospital and slight increases at Sibley.

We've seen a decline in births at George Washington University Hospital.

Home births represent a small percentage of births every year.

And we also note that Cedar Hill was not included in this graph.

They came online in 2025, but they will be included in future visualizations.

We know that access to early prenatal care is critical to support healthy pregnancy outcomes.

Because of DC's small population size and the relative small number of annual births that we see, what we do at the health department is we combine multiple years of data so that we can identify meaningful trends in birth outcomes.

We also compare ourselves to other comparable cities that have a similar demographic makeup and population size instead of comparing us to other states and to the entire nation.

So if we look at early prenatal care, we can see that DC our rates of first trimester prenatal care initiation are lower than New York City, higher than Philadelphia, and in alignment with Baltimore.

This slide shows rates of prenatal care among DC residents by race and ethnicity in the year 2024.

We can see that across each racial and ethnic group, at least two-thirds of individuals are seeking prenatal care in their first trimester, which is what we're aiming to achieve.

However, we see that significantly higher numbers of white and Asian women are initiating prenatal care in that first trimester.

So on this slide, we can see trends in preterm births across DC residents, and here we see that rates of preterm births among black residents far outpace other racial groups and ethnicities.

And if you think back to the previous slide, the trends in prenatal care initiation mirror our trends in preterm birth.

On this slide, we can see rates of infant mortality, and in DC as well as across the country, we're seeing declines in infant mortality rates.

The decrease in DC is being driven by decreases we are seeing among black mothers.

However, infant mortality rates are still four times higher for our black mothers compared to white.

On these final slides, I will highlight programs and initiatives that DC Health is leading to help improve maternal health outcomes and address long-standing disparities.

At DC Health, our strategy framework to improving maternal health focuses on improving prenatal care, reducing rates of preterm birth, and reducing rates of severe maternal morbidity.

This slide highlights our initiatives focused on increasing access to high quality patient-centered prenatal care.

With our state maternal health innovation grant, I want to highlight the work that we have done that we heard about earlier to expand access to perinatal, postpartum, and specialty care referrals within our FQHCs, in particular in wards seven and eight.

We successfully worked with Medstar to scale up access to their safe baby safe moms initiative, and we were able to co-locate services and referral pathways in Bread for the City and Whitman Walker Health to MedSTAR's Safe Baby Safe Moms initiatives.

Over the past year, we've had about 78 referrals to MedSTAR, and 36 of those patients have been seen.

Within our Title Vaternal Child Health Block Grant, I want to highlight our work with Community of Hope supporting transportation assistance.

We consistently hear from mothers that transportation is one of the biggest barriers they face to attending prenatal and postpartum appointments.

Over the past year, Community of Hope has provided more than 1,700 rides to individuals to attend their prenatal and postpartum appointments.

And then finally, in our prenatal care strategy portfolio, we know how important it is to get the word out about the breadth of resources that our DC Maternal Health Ecosystem has to offer.

So we are working with the Department of Health Care Finance to launch a maternal health awareness campaign.

Our goal is to increase utilization of all of these health care and social care resources.

The MOU is almost executed.

We're working on the content for digital ads, Metro ads, bus ads, and we should see the campaign being launched by October-ish 2026.

For our next slide, I want to highlight our work in preterm births.

So we know that it's critical that we identify women at risk of preterm birth early and get them connected to evidence-based interventions that we know work to reduce rates of preterm birth.

At DC Health, we lead a preterm birth reduction initiative, and we currently work with three hospitals and FQHCs to deliver high high risk screening, group prenatal care, patient navigation and care coordination and referrals to specialty care.

So in partnership with Medstar, we've expanded access to their kids' mobile medical unit and supported them to launch a healthy futures pilot, which is supporting adolescents and young adults with complex medical social reproductive and mental health needs.

And then with our Title 5 Maternal Child Health Block Grant, we heard earlier today from our colleagues at La Clinica, and we are proud to support their work to relaunch their perinatal health services.

They have successfully completed their perinatal health needs assessment, and they are on track to launch services by September 2026.

In terms of our work in severe maternal morbidity, we know that timely access to severe maternal morbidity data and hospital quality improvement efforts are critical to understand root causes of SMM and implement effective interventions.

We've been working closely with the Department of Healthcare Finance and CRISP Shared Services, and we're on track to start receiving SMM data from the Health Information Exchange in August.

So hopefully, when I come back for performance oversight hearing, I should have some analyses that I can report back.

And then we heard from our partners at DC Hospital Association about the work we do through our perinatal quality collaborative.

We know that this is an evidence-based strategy that works.

And the progress that I have highlighted here, we honestly heard heard earlier.

Next slide.

So I want to end with some of our upcoming new maternal health initiatives and activities that we're working on.

We're working closely with the Department of Healthcare Finance to support increased access to dualist support.

We're working on to uh publish an all facilities letter, which is the best practice that we see across other states.

It's it's a it's a document that hospitals can post so that visitors and health care providers can see it, and it it provides guidance and sets expectations on creating a doula friendly environment in a hospital and ensuring that doulas are part of their team-based care models.

Our preterm birth reduction request for application is on the streets.

We encourage all of you to apply this cycle.

We um we have learned from our past successes across our partners.

So we're requiring, in addition to the um high high-risk screening, group prenatal care and referrals to specialty care.

We are requiring all of our funded partners to support transportation assistance and perinatal navigation and care coordination.

In the data and surveillance work that we are doing as a health health health department, we we are working hard, we we hear everyone, we need more timely access to maternal health data.

We launched a dashboard this year, visualizing our preterm birth data, and we are about to launch uh by December of this year an additional dashboard so that we can visualize more maternal health indicators.

We're also working to publish more frequent and smaller publications on maternal health outcomes.

So my team is working on two data briefs to highlight trends and policy recommendations in severe maternal morbidity and preterm birth.

And finally, we are working to improve the um data that health care facilities are reporting to us, and that we're able to share back to the public as part of the better access for babies to integrated equitable services amendment act.

We are very close to finalizing the regulations that aim to standardize hospital discharge services and education before during and after delivery.

These regulations will require hospitals and birthing facilities to report to DC Health information about newborn screening, lactation support, education, discharge standards, and clinical quality measures.

As part of this legislation, we are working on a hospital report card that will summarize these measures across our hospital facilities.

And so again, hopefully when I come back for performance oversight, I'll have a more solid timeline that I can share.

Thank you for the opportunity to testify.

Thank you.

And Melissa has slides too.

One minute.

Okay.

Okay, thank you.

Good afternoon, Chairman Henderson and members and staff of the committee.

I'm Melissa Byrd, and I serve as the Medicaid Director and Senior Deputy Director of the Department of Healthcare Finance.

I'm going to go to the next slide.

As was alluded to earlier, DC Medicaid is a key source of coverage for maternal health services in the district in calendar year 2025.

We paid for a Medicaid program paid for more than 40% of all births in the District of Columbia.

The services we provide are comprehensive, including but not limited to doctor's visits, hospitalization, lab services, dental behavioral health, reproductive health, and all the pregnancy labor and delivery dualist services as you've heard earlier today in midwifery.

And we also make available breast pumps to mothers as well.

We've heard throughout the morning about the decline in the birth rate.

When you look back at what we presented at the round table in December of 2023, we showed about 3,800 births that we covered in calendar year 2022.

So you see a slight decline of a few hundred there.

Next slide, please.

And so what you see before you still is the targeted reductions in Medicaid eligibility or focused on those first two lines of Medicaid childless adults and parent caretaker relatives.

And then if you drop down to the third line, you see where our coverage for pregnant women remained steady at 324%.

I also wanted to highlight the FCEP program, if you will, it's from conception to end of pregnancy.

And this is the opportunity where we can cover individuals who may not otherwise be eligible for Medicaid.

Members in our alliance program, when they become pregnant, they move into this FCEP coverage as soon as we know that they are pregnant.

And then also we the individuals who lost Medicaid eligibility.

Most folks had the opportunity to move into the Healthy DC plan, which is a basic health plan option, which does not cover maternity.

It is specified in basic health plan regulation that women have to go back to the Medicaid program if you will for maternity coverage.

So we have that.

We had some discussion earlier from I think Mary Center about some of the issues kind of coming into play because of those now like transitions and coverage.

We can say as of June 29th, we had 99 residents successfully transferred from the health benefits exchange or the healthy DC program and moved into their active Medicaid, and we have five individuals who are still in the process of making that transition.

The issues to date related to those changes is that sometimes, you know, from a systems perspective, we have to fix something in our system.

It's a specific case issue.

Some of our cases are not automatically transferring from DC Health Link over to the DCAS system, which means then we do it manually, which again just make takes more time.

And then I think we talked about last time I was here.

We are sometimes hearing of requests made to residents to show proof of their pregnancy, which is not required for Medicaid.

It is required, I believe, for cash assistance in their third trimester, so I think there were some confusion lies.

So we continue to monitor those issues as we go forward with the changes in Medicaid eligibility.

We can go to the next slide, please.

Also, when I was here for the last round table, we highlighted our outcomes mostly through our managed care program where most folks who, if they're pregnant, are receiving their care.

We still do not meet most national standards for prenatal and postpartum care.

If you compare and contrast again from the 2023 data, which focused on measurement years 19 through 2022, I believe, there's not a whole lot of difference.

It's kind of remained relatively steady in terms of what you see before you.

What we have done since then is, as you all know, we have an annual technical report that we have to issue on our managed care program.

Our quality improvement organization or QIO does that study for us, and in our most recent report, we included a maternal health and birth outcomes focused study to answer the three questions that are before you, to what extent are Medicaid managed care enrollees who have given birth receiving early and adequate prenatal care.

Do birth outcomes appear to correlate with the level of prenatal care received, and do disparities exist in the adequacy of prenatal care and birth outcomes based on wraith, ethnicity, and/or residents by ward.

If we go to the next slide, you'll see some of the findings, and less than half of enrollees received early and adequate prenatal care, which I think is consistent with the overall district data we just saw from my colleague Miss Beckwith.

We I thought this was interesting.

We only saw a correlation between early and adequate prenatal care and preterm births for ward one enrollees only, so something for us to investigate more.

And then we saw regarding birth outcomes in Ward 7 and 8, preterm birth and low birth rates, were actually slightly higher than our DC aggregate rates, but still those aggregate rates aren't really anything to, we still have overall improvement to do.

And then also the QI QIO determined that the varencies in prenatal care, preterm birth, and low birth rate by ward are not statistically significant.

So since then we've continued to work with our managed care plans.

We've started requesting enhanced monthly data reporting, trying our best to improve early detection, and then really figure out how we change our outreach methods in order to reach the folks that would ideally be in care sooner than later.

Next slide, I wanted to touch on the recommendations that we presented from the perinatal mental health care task force back in 2023.

There are several recommendations that we have implemented since then.

And I would say this also just speaks to a number of the rolling initiatives on focus on maternal health, starting with the maternal health advisory group and designing and implementing both extended postpartum care up to 12 months and dual services.

That work really moved into the perinatal mental health task force, and you can see before you we've added new Medicaid provider types.

We've been working on the collaborative care model, doing better integration of behavioral health case management in our managed care plans, and then that rolls into our TEMA provider or TEMA efforts, which I'll go into on the next slide.

I would say those efforts have really evolved into more integrated approach because of the transforming maternal health initiative.

Last year we were one of 15 states awarded 17 million dollars over the next 10 years to really look at how we can implement a payment and care delivery initiative to support whole person maternity care.

You can see the TEMA aims before you and the you know it's a fairly long period of time of 10 years divided into both pre-implement, excuse me, into two phases, one of which is pre-implementation, which is where we are.

So the TEMA work overlaps and builds on past work.

We can go to the next slide, and I also wanted to highlight while we have not implemented all recommendations from the perinatal mental health task force.

What we line up here is where some of those recommendations fit into the work under the TEMA initiative that's ongoing.

If you go to the next slide, since we were awarded the TEMA initiative funds last year, we've reconvened the maternal health advisory group.

It meets was meeting on a monthly basis until this summer.

We're moving to a bi-monthly cadence.

We've aligned with key partners.

I thought that was a really great thing.

We've heard throughout the morning is I don't recall ever hearing collaboration as much as I have in past roundtables or hearings about maternal health, probably going back five years.

We've been excited to support providers through the provider incentive program.

We were able to pay out a little over 200,000 to 17 organizations, key maternal health providers like FQHCs, DULAs, and other physicians, and then this next year entities will be eligible for up to a little over $60,000.

We've engaged focus groups in collaboration with the community of hope to collect lived experience insights.

We've completed journey mapping to inform screening referral and follow-up processes specific to behavioral health and social needs.

This was done in collaboration with the DC lab.

We've used our integrated care DCTA program technical assistance to prepare providers for value-based payment specific on maternal health.

And then this is exciting for me, and I think it speaks to some of the work we've been able to accomplish is that we've been able to add three staff with the fourth to come on board focused specifically on maternal health thanks to the TIMA grant funds.

Next couple slides, I'll focus on DULA services.

You know, access is improving, but the progress is really slow and incremental.

We had 24 beneficiaries utilize dualist services and 25, so that's great because it's up from six, but none of those numbers are amazing.

We have 43 DULAs enrolled in the program as of April, so excited to get out of the teens, which we had last year.

I think we were around 16, but we only have about four of those doulas billings.

So 20, you know, 46, excuse me, 43 is great, but I think you heard earlier.

No, I think you heard earlier about some of the challenges, and I think we see that reflected in just the four DULAS billing at this point.

We've partnered with the Doula Learning Action Collaborative to establish the State Doula Council, and we've continued to engage the managed care plans on trainings for credentialing and billing.

Next slide, please.

So they're receiving technical assistance on a number of areas also with how to connect and provide information into the health information exchange.

We have and will likely issue in August detailed billing credentialing information targeted to do as so.

I know Crystal referenced a checklist.

I know, like in one of the documents, it is a literal, you know, claim form, and it goes line by line.

You don't need to report anything here, or this is what you say here, that level of detail that I am hopeful will be helpful, particularly for a group of providers that's traditionally outside of the health insurance kind of payment model.

So you'll see that on our website next month, and then we've heard or in some of the written testimony concerns about rates.

We continue to collect information.

We are looking at the rate, or started discussing, but related to TEMA, we'll certainly be considering the dual rates going forward.

I do want to note there was an inflationary increase for this fiscal year of 2.6%, so we're keeping up a little bit, but I know for those in the in the air in the profession may not be sufficient.

And then as we look forward, so on the next slide over the this year and 2027, uh Ms.

Beckwith already mentioned the public awareness campaign, so working with DC Health on that.

We're continuing with our technical assistance, so launching two types of support related to digital health and whole person care.

The provider incentive program as we go into 2027, we'll have up to 4.3 million dollars to support quality improvement and again the transition getting us to value-based care and payment.

And then finally, how I started out just looking at access and monitoring any changes causing issues with eligibility because of just general changes to the Medicaid program.

So that's all I have to present and look forward to taking any questions you may have.

Thank you.

Thank you.

Thank you to both of you.

Melissa, I was hoping you would put on your list implementation of remote patient monitoring.

I was surprised it took you so long.

But I'm glad we're just starting out with it.

It is part of the TEMA model.

Yeah, as we've discussed before.

So I know as we move forward on the payment methodology, remote patient monitoring will be a discussion point in that in that development.

Great.

Well, thank you guys so much for the testimony.

I think you covered a variety of different things and also all the various pieces, right?

From prenatal to what's happening in sort of in the postpartum space.

I have uh some questions just to get some clarity on some things and also follow up on some other stuff that we you know talk about on a variety of different issues for the public who may be watching.

Um, you know, we go through budget and performance oversight hearings with all of our agencies, and in all of those settings, we often talk about maternal health, so this is not the first time that we're having these conversations, but it is an opportunity for us to just focus in particularly on um one issue.

Um I wanted to ask a clarifying question first to Melissa, um, with regard to the from conception to end of pregnancy program, um, how long does that run for in terms of length of time?

So, for instance, right, we cover um 12 months of postpartum or three months here or that, but like for this particular set of folks, how long does it sure it's the um the old school coverage in terms of it takes you through pregnancy plus 60 days?

Unfortunately, we were not able and it's we're not allowed to extend to the 12-month postpartum period for this particular for that particular group, yep.

Okay, um, so what happens though if someone has a complication post-partum?

If they're within their 60 days, it's full Medicaid coverage.

If it's um be uh beyond the 60 days, if they are um uh an alliance member, they would transition back to their alliance coverage.

Okay, um but with all of this, and this kind of comes up even in the um the data that uh Sarah you shared around um prenatal visits, none of this kicks in unless somebody raises their hand and tells us they're pregnant.

It's not the only way.

Okay, it is um possibly maybe the fastest way.

Um, if we see a claim for prenatal care, um that's one way we can identify we are working through ways through our health information exchange where we could potentially um have the ability for provider to flag it and HIE that would come to us that would um offering.

But that's a retro though, right?

I mean, applicability.

If if some if you're seeing a claim that comes through, yes, it could be in that sense.

Um, it just depends on how timely they claim.

So the the self-reporting is again gonna be the most expedient, um, but it's not the only way, but the most likely way.

Okay, it seems to me a little bit um that the numbers of individuals who are seeking prenatal care beginning in the first trimester, we're gonna the first two trimesters hasn't really changed much.

Um what needs to change in terms of our outreach piece around some of these important things, right?

And we heard from um, you know, two of our hospitals talking about the increases that they're seeing around hypertension, gestational diabetes, preclaims data, all of these things like if we could catch it early, it could be managed as opposed to catching it in the third trimester, which at that point now you're having to take some more extreme measures to ensure the safety of the patient and the and the child.

Well I think I mean in one of and I'll add an additional concern before responding a little bit I do think too as we move forward with more eligibility changes in the Medicaid program while our pregnancy coverage remains stable and static in terms of what's available.

We heard Miss Beck with speak earlier that you know you're talking about preconception care too and so I I do think it's an area we're gonna have to look at going forward if someone is like a childless adult and having to maintain a work requirement and what's happening to their coverage and their access right um to actually try to respond to your question not add more concern um you know I think that the outreach is always a question I am cautiously optimistic with the public awareness campaign you know part of the the scope of that is really to make sure folks understand you know what's Medicaid eligibility is and then what we've always heard is um you know making sure folks understand what services are actually available to them if they're within the Medicaid program and then also just teaching folks or making more awareness about what you know that prenatal or maternity care is and so that's one way of a more kind of uh holistic approach and trying to to kind of really have it out there for folks to understand and so that when they do get their call or a call for their managed care plan they know oh wait I understand why they're doing this now let me connect with them or even better you know I am pregnant now so like I'm gonna reach out to my physician or my care provider and initiate that myself.

I don't know if you have anything to add.

Miss Beckwith I wanted to ask questions about the preterm birth uh reduction initiative so DC Health continues to administer this grant program even though grantees have shown um rather uneven outcomes I would say in previous years why does the agency still believe that this grant is a productive use of public funding we do think that it is it is a good effective use of funds we have looked at what are the interventions that work and that's why with this current RFA we're requiring all all of our partners to include transportation assistance perinatal navigation um and so I think that we've had a couple cycles to understand where our partners um struggle and need additional support and so with this upcoming um RFA um I I am hopeful that we've we've been able to learn from our successes and our challenges okay um DC Health's preterm birth dashboard indicates that the preterm births are rising in the district which I think you guys said a little bit in your testimony um so we're at uh 12% of preterm births in 24 compared to 10% in 23 um the rates are much higher for um uh black birthing folks in the district that 15.2 percent um which is well above the national average which is like 10 point four beyond just the initiative grants what are some other initiatives that we're investing in or ways we're trying to bring that number down we're also working through um our maternal health advisory committees to help um although we we don't need to fund a partner in order to convene them and help to coordinate and organize our our work.

So through our state maternal health innovation grant, Dr.

Gray, who is be behind me, is working to lead our maternal health task force.

And so that's where we've brought in some members from all of all of our task forces so we can start to streamline.

And we're focused on we have working groups focused on community engagement, data, and innovative models of care.

And so through through this task force, we have developed a maternal health strategic plan that is about to be published on our website.

And we had held a maternal health symposium back in 2024, I believe, and we're going to reconvene.

So by the fall, we're going to bring back all of our partners.

They made action commitments in those categories.

And so that is a way that we know we need to do something different.

And we're really trying to coordinate work.

That, as we've heard, there's there is a lot of collaboration happening, and we want to have us aligned in terms of our strategies and outcomes.

Yeah.

Okay.

So the Office of the Chief Medical Examiner's last maternal mortality report was published in 2024, but it was based on 2022 data.

Does DC Health or does healthcare finance have access to more recent unreported data?

I don't think I don't think we do.

Okay.

I mean, I think the only we would have typical claims data that kind of reporting that would be more recent than 2024.

Okay.

Um I would just be nice to know what the rate is.

Even, I mean it's 2026 and we're still operating off of 2022 data.

I know that the maternal mortality review committee, it is a more in-depth process, right?

They're looking at case notes and all of these different things, but even just pure numbers of like what's happening.

All of that comes from OCME.

We can get back to you on that.

Um I don't want to misspeak.

Okay.

All right.

Um, one of the recommendations from the last maternal mortality report was expanding the number of social workers and hospitals to help new um parents.

And I think one of the FQHCs, I think it was Mary Center who talked about they have actually taken that up and they haven't increased the number of social workers that they have working in terms of their women and infant health program.

How is this recommendation being implemented or is it something that's been raised with the P PQC members?

I can speak for the work that we've done at the agency to improve social working worker licensure that we we have talked about.

I would also add that through Healthy Steps, we actually work to support hiring of Healthy Steps specialists, which are typically social workers.

So DC Health has worked to increase access and capacity of our social workers across hospitals and FQHCs in terms of working with the PQC in order to increase capacity of social workers.

I'll call Dr.

Gray up.

Okay, Dr.

Gray, if you could just introduce yourself for the record.

Yes, good afternoon, Dr.

Tiffany Gray, a maternal health program manager at DC Health.

So that is an initiative that isn't currently being implemented through the PQC, but as uh Sarah has mentioned through many of our initiatives, including through our state maternal health initiative and grant, and even with our preterm birth grant, the emphasis has been on ensuring increase in staff, such as perenatal care coordinators who can help to also facilitate some of the care navigation and referral to additional services that impact patients as well.

So there is work across the board for many of our grants of building social work teams, legal teams, including with our partnership with Med Star that are able to help support residents and patients.

Okay.

While you're there, Dr.

Gray, do you have a couple other questions about PQC?

If that's okay.

So one of the focus areas for the PKC has been around severe hypertension in pregnancy through what do they call it?

The Alliance for Innovation, Severe Hypertension, Patient Safety Bundle.

A lot.

Okay, uh, but um, so in the FY25 performance oversight responses, DC Health reported that they have transitioned to the sustaining phase for this project.

Um, do you all feel confident that the hypertension rates are decreasing sufficiently to move to this stage?

Yes, the DC Hospital Association with uh implements and leads our DC PQC efforts, and so as you mentioned, the lines for innovation on maternal health and patient safety bundles, they're implementing the severe hypertension bundle, which they've transitioned into the sustainability phase as you mentioned.

The PQC still provides ongoing technical assistance for the clinical hospital teams that includes for data submission as well, um, and it coincides with the obstetric hemorrhage patient safety bundle that's also being implemented.

So there's patient and provider education that's still being implemented and provided through the efforts through the PTC.

Okay.

Um, just for the public to know, so the data that shows um hypertension pregnancy in the district decreased from 9,000 individuals in 2019, which we were all going through a lot in 2019, but 9,000 individuals in 2019 to 7,884 individuals in 2023.

So there has definitely been a decline, but when we shift to the sustaining phase, it's not in the same high priority levels as some of the others, so that's why I wanted to ask that.

Um the PQC has also focused on obstetric hemorrhage, including starting a community of learning in 2025 to improve um to improve patient uh debrief and recovery practices.

What improvements have we seen in terms of this particular area?

Um, so similar to some of the outcomes we've seen with the hypertension bundle, one of the key examples I'd point to is the time to treatment.

So that's a core indicator or source of data across the board for the patient safety bundle.

So it looks at um, you know, time to treatment in the event that you know a patient is presenting symptoms or signs of an obstetric hemorrhage or in a the event of a hemorrhage that the hospitals and provider teams are responding effectively.

It also includes developing clear policies and workflows and procedures for what to do in the event of a hemorrhage event.

Um, another core component of that work is um provider um debriefs, so the clinical teams meeting after events to talk about essentially what went well, what went wrong, and how they can make changes or shifts in the future.

Okay, thank you.

Um I want to switch to talking a little bit about diversions.

So Ms.

Beckwith, you we heard testimony from public witnesses who were um concerned about some of the changes that were being or are being made at Washington Hospital Center, and some of the concerns is around what will this contribute in terms of decreasing the amount of capacity that we have available.

Um obviously, or I'm not gonna say obviously, but I would think in terms of protocol, Washington Hospital Center would have had to report to Shifta, which is the state health development planning and development agency.

Yeah, I just asked Mateo.

Because I knew you were gonna ask.

Yeah, so they would have had to report this to Shifta and provided some type of information and data, not just saying like, hey, we're we're gonna close down this unit.

Good luck to you.

We're currently in conversation with MedStar, okay, about this.

On this issue, yes.

Um, all right.

Um, in terms of diversions across the board, so you all provided some information about um diversions from the birthing hospitals.

Um, you know, if a hospital has a high number of diversions in a short period of time, um what is the corrective action look like from DC Health on that?

I will need to have my colleagues in the health systems preparedness administration reach out to you.

Sam Hurley, he can really give a much more comprehensive response.

Okay.

One of the things that we obviously heard some testimony from our FQHCs around their particular role in all of this because they see so many of the patients.

Um transition challenge that we're having.

So let's say for instance, um, you know, because we know that there are quite a number of individuals who are not seeking prenatal care at all.

For some folks, they're just arriving to the hospital when they're in labor, but there is no standard practice in terms of connecting um the uh patient back to a primary care home for follow-up.

I feel like we do a stronger job of this in terms of trying to connect the baby to a primary care home as opposed to um, you know, the birthing person to make sure that they have someone who's checking up on them in the postpartum space.

Um, is there something we could do better to address this particular challenge?

And I don't know if this is a question in terms of um care coordination with the MCOs or something else.

Well, um, I think I don't know the specifics of the data sharing between FQHCs and hospitals, but we do have CRISP D uh CRISP DC, where um all the FQHCs and all the hospitals are participating, and so if there is available health information, it should be accessible.

So I'm happy to follow up in terms of maybe talking with the hospital and primary care associations to seeing what is lacking there.

Um I'm not a clinician, so I don't understand all the things that need to be shared back and forth.

Um I would also say to your point, in terms of like trying to connect an individual back to a primary care home or a maternal provider home afterwards.

I do see that's where the managed care plans would certainly play a role.

I expect they would see also utilizing CRISP DC, the admin discharge transfer notices and be able to follow up uh timely, um, as we would expect them to do.

Okay.

Um can either of you provide an update on the implementation of the comprehensive new board screening and testing, new hospital discharge rules.

Yes, um, that's the baby's bill.

Um, so those regs are with our senior leadership for review right now, okay.

Um, and then they will be um sent to the usual rulemaking process to EOM and so we'll see them in 2027.

Um, I'm sorry, Sarah, that's unfair for you.

That is unfair.

Um, but uh can DC Health alert us once it leaves your building because then we can know who else to sort of bug about it.

Yes, okay, great.

Um all right.

So one of the testimonies that we heard earlier um today was around the this um critical piece around nutrition.

And WIC is great, and also I feel like WIC is limiting in terms of truly being able to meet the need, um, especially since not every grocery store or market in the district even accept WIC and participate in that program.

Um, are there other things that we could be doing to enhance the nutritional outcomes for um pregnant individuals?

I can speak to a few strategies.

So all of those individuals are receiving a free membership to Instacart.

So let me go back.

We um uh across DC Health um continually look for opportunities within our MCH initiatives, chronic disease management.

Um this could be because I've got a background as a dietitian.

How can we integrate nutrition support?

So with all of our home visiting work, help me grow, as well as across health care providers and health centers.

My team has developed a we have a federal nutrition program toolkit training where we can train individuals, and it's not some heavy certifications that you need to go to, but to understand what are the federal and local nutrition programs we offer in DC and how can you refer individuals to them.

So we we are working to help increase nutrition access during that prenatal period.

I also know that food and friends, they do work with um pregnant women, and um director Byrd might be able to speak more to this.

We we were hopeful about the 1115 waiver application.

It did have a nutrition support component.

Um, I think it's on hold right now.

So I'm happy to speak to that.

Um, the waiver approval process is moving forward.

We don't expect it to be approved as we submitted it.

Um we are doing it and we've discussed I think last within the last month with um this MCEC, the MAC subcommittee that focuses on this, um, that we're working on a concept paper specific to food and nutrition with a maternal health component to it to try to re-engage our federal partners and potential steps going forward and how we could bring in more food as medicine.

I will say from the uh Department of Healthcare Finance, we have the Produce RX grant, too, um that support folks with um I believe it's diabetes and hypertension and getting access to food.

And then I referenced earlier some of the um uh like journey mapping that was done with uh the DC lab, and part of that was also those screening and referral processes, not just health specific, but those social determinants of health, including access to um to groceries, to food, et cetera.

So there's some components that are coming into play, and just in terms of our ability to identify the issue and then refer connect someone to supports as needed.

Um let me follow up on that.

So the the lab at DC shared an update at the May Maternal Health Advisory Group on their research to determine how we can improve perinatal screening and referral process for Medicaid patients, noting that the majority of screening and referrals stop after three months of postpartum.

Um so uh DC Medicaid covers women up to 12 months postpartum.

What guidance has healthcare finance given MCOs and providers to ensure that mental and behavioral health needs and other needs are still being met in that three to 12 month period?

I don't know that we have provided direct guidance.

Certainly something we'd be willing to do, particularly with the the results of the lab work that were shared last month.

Um I'm just trying to think through, I don't recall if we've done something more pointed than that.

So I will follow up, and if we haven't, I'm happy for us to start work on that.

Okay.

In that, I also want to follow up on the perinatal mental health task force.

Um that is um housed out of healthcare finance.

Um, you know, during the round table that we did on this in 23, um, the co one of the co-chairs uh for that task force stated that she believed a priority coming out of the task force report was really a need to expand the continuum of care services for perinatal mood disorders, including perinatal intensive outpatient programs, mother and baby inpatient units, so they don't separate the babies.

What efforts have we been making around this perinatal mood disorder piece and the services that we can provide in the most compassionate way possible?

Um I'll touch on a couple things.

First, I mentioned earlier about how case management for behavioral health services is now provided through a managed care plan along with other services.

So that's one component, and just in terms of trying to manage the whole person and being aware of what's happening in both mental and physical health.

I think Sarah may have spoken to it a little bit earlier, but that's where we have a primary care physician, a behavioral health care manager, and psychiatric consultant delivering care management in a primary care setting too, so that can help someone if they're in a postpartum phase.

Okay.

Well, let me follow up on some of the more specific recommendations from the task force, and we can kind of see where some of these things are.

So one of the recommendations was for um quote unquote fast tracking to get pregnant patients insured within 28 days of application.

How are we doing on that?

We have not done that, I'm pretty certain.

Okay.

I'm gonna say we have not.

But I will say, I mean, one thing, and we'll follow up on this is to see.

So I know when we were talking about, let me think of this real quick.

I think it's the postpartum care.

I'm confusing things, but um most of before our more recent Medicaid eligibility changes, most women were already enrolled in Medicaid at pregnancy.

I think it was like five percent that maybe were not prior to the pregnancy.

So I think the first question for us to follow up on is when are we seeing someone come into coverage, um, related to when they may be pregnant?

Um, and I think this is probably a more recent issue because of the eligibility changes, right?

Right.

Um, and see where we can support on that.

I think that ties into the the comments earlier on the presumptive eligibility as well.

You know, I don't know if it was, you know, we always want folks to get into coverage if if they're eligible for it as soon as possible, certainly if you're having a health condition or you're pregnant and in a situation where specific or specialty care is needed, um, is because of how the level of coverage we had before, most people were likely covered.

And so as those things are changed, we need to probably think about how we adapt to that to ensure that we still have the fastest pathway to coverage available to individuals.

So we'll we'll look into the data on that and see what we can if we can make conclusions and then where we see.

I mean, I think one of the things too that's sort of similar on this issue, so in the performance oversight responses that healthcare finance submitted for FY25, you all noted that there were 117 Medicaid enrollees who would be potentially shifted to a healthy DC plan when their 12 month of postpartum coverage expired.

Um, so yeah, I guess the question in that is how many of them actually moved.

And when someone who has shifted from Medicaid now is um can has a confirmed pregnancy, how long is it taking for health care finance to switch them?

Over.

I don't have the timeline, but I can walk through the process.

Yeah.

Eugene Sims, I'm the policy director at Department of Healthcare Finance, DC Medicaid.

So for the timeline, it varies per case because you know, there are different things that happens with each reported pregnancy.

But the system we've set up with our colleagues at DC HBX is that either an MCO or uh the resident is going to report a pregnancy to DC Health Link.

DC HealthLink has a team of case managers who are then going to reach out to the resident to confirm the pregnancy and complete the paperwork that's necessary to redetermine eligibility.

So what that looks like is them entering a change of circumstance in their system, and there's two pathways for that to come back over to Medicaid.

Either it's going to automatically go over to Medicaid through something called our kind of automatic case transfer process, or if that uh case transfer fails because of a failed uh match with our system DCAS to DC Health Link, the caseworker's going to manually enter that uh information into DCAS so that our caseworkers at ESA can determine Medicaid eligibility.

Um that we work uh ESA, DH, DHCF, and HBX work very closely to make sure that eligibility determination happens fairly quickly.

It can be if we have that automatic transfer, it can be as simple as like an overnight case transfer, case worker touches the next day, Medicaid eligibility is established.

Um and then there's a process of selecting your MCO.

If you are let's say a mayor health on the uh basic health plan side, healthy DC plan, you you most likely want to be back in the mayor health on the Medicaid side.

You reach out to us, let us know that.

You reach out to the enrollment broker, let them know that, and you're placing your plan in just like that, you're receiving the same, you had the same MCO uh receiving mostly the same scope of services that you were uh in healthy DC plan, but now you have these more services because now you're enrolled in Medicaid.

Um that whole process can be fairly quick because it's simply you know, reaching out, reporting a change and then having that change to get central to district direct DCAS, it can be as under a week.

Uh, it could be also if there's something like we need a verification of income or um a few instances we've seen is that uh that birthing parent that that pregnant individual will come back to Medicaid while the rest of uh that person's household was doing something like a renewal.

So those are cases where we might need to do um a few more actions to make sure that Medicaid eligibility is established.

But we have a work group with HBX where we were monitoring all these cases.

That's why we know the exact number of people that have come back over.

Um, and whenever something's going wrong that's escalated to myself and my team, and we work to resolve it.

Okay.

Okay.

Um I think Melissa, as you sort of said, this is going to become an issue more probably in the next year, year and a half as things are shifting and changing on that side, and that's definitely something we want to keep an eye on.

Um another recommendation was around um developing a district perinatal psychiatric access program.

Um I think this is uh, it might be more of a department of behavioral health question, but I don't know if you all have had a conversation with DBH around is there a way for us to collate who are the providers in the district who do perinatal um behavioral health?

Psychiatric work, yeah.

Um the whole the whole point I think was so that there's not guesswork, right?

If somebody, you know, we had a public witnesses who testified today, she was like, I know what the issue is.

And it feels, you know, you need the help and support to do it.

My fear is that DBH would just say, Oh, we'll just call Access Health Line.

And Access Health Line is just gonna give you a PDF of all providers that isn't specific to this type of work.

Through the PKC, have we done any of that work?

So some of that work is being implemented or worked around and through the work as was mentioned earlier about the perinatal mental health working group.

Okay.

Um, and so it's bringing together many of the key providers who provide the uh those specific services around perinatal psychiatry care.

Um, and so the hospital teams, the care teams are beginning to have discussions about when we screen and identify a patient who is in need of additional services, making sure that we have a clear process or clear guidance of where to direct them to, so that there are services available.

So there is ongoing conversation and collaboration with our partners at the PQC and some of our birthday hospitals and um FQHC's partners at the Department of Healthcare Finance to make sure that we're building out the necessary services for patients.

Okay.

I think one of the requests I would have is as you guys are having this conversation with the PQC, it really is like what is a resource guide for the public of who do you call?

And even just share that with Access Helpline because I think that there probably would even be family members who are like, okay, let me call DBH.

And that is not going to be helpful for this, I think, unique type of situation.

To just refer someone to a traditional behavioral health provider is not probably going to accomplish what is necessary here.

But it's good to know that these conversations are ongoing.

So we could follow up with the hospital association to try to get more details around the timeline for developing something like that.

I can also add that we we know that this is a need.

So we are at DC Health applying through HERSA to a funding opportunity that is sort of like DC MAP, which is a pediatric psychiatric teleconsultation.

This is for the perinatal space.

Okay.

And it would allow us to screen and then give providers a tool to have psychiatric teleconsultation for prenatal and postpartum women with mental health and substance use concerns.

So hopefully we'll have good news that we've been selected.

And if I could add as well, through our work, through our state maternal health innovation grant, in our collaboration and partnership with Med Star, we have clinical providers who are providing training for providers in the district, including with our two co-located sites at Women Walker and Bred for the City.

So we are also working to ensure that providers are trained on how to appropriately treat and refer um and screen patients as well.

Great, great.

Melissa, you talked a little bit about the uh healthcare finance moving into the um what is it called?

It's not incentive model, but uh value-based care.

There we go.

Yeah, yeah, value-based care.

Um, and I'm curious how that will play out in the maternal health space, um, and whether or not there will be any metrics around what we're hoping for MCOs to sort of meet in this.

I'm gonna go ahead and ask my colleague Joe Weissfeld to come up because he can speak this off the top of his head and I cannot.

Um, but a couple different things.

Um earlier this year, February, March-ish, maybe.

I think had our um our quality uh our staff folks who are in our quality division present to the maternal health advisory group on the value-based um care uh roadmap for our managed care program, of which maternity is a component of it.

Um I'm gonna say this and then Joe's gonna clean it up.

But the the group has gone together to look at all the different kinds of metrics and measures that we would look at for maternal health, and then how can we pull it together and make them as um unified as possible.

So I know some of the uh prenatal care is included in the measures and so forth, but with that, I'll move it over to Joe.

Uh Joe Weissfeld, director of the health care reform and innovation administration at DHC.

You don't have to speak up, Joe.

All right.

Excuse me.

Uh, better.

Yes.

All right.

So uh yes, last year we uh released a five-year framework on value-based payment.

Uh the point here is to drive even more adoption of value-based payment in the district.

Uh we had seen pretty slow and not most aggressive use of VBP uh within our plans.

And so this was a framework to say over the next five years, this is what we want to see.

And part of that work we said uh we can only go so far in terms of what we direct the plans to do.

So we went as far as we could without making it a state directed payment, which requires a whole other set of things.

So this is as aggressive as we could be without it.

And so we set targets that the plans have to meet related to how much money they spend on arrangements and value-based payment.

And those uh arrange those uh percentages uh grow over the years and get more aggressive in how uh the types of arrangements have what they have to be.

Within those targets, we said uh one of those mark uh markers has to be your value-based payment arrangements have to be tied to primary care, pediatric, and/or maternal health.

Okay, and within those to count in the for compliance with the contract, you have to use at least one of our preferred measures in maternal health.

We said uh uh there are three like we'll call them subdomains, uh in maternal health.

And this is applies to primary care, pediatric and maternal health.

But in maternal health, those three domains are prenatal, labor and delivery, and postpartum, and there are five to seven measures in each of those buckets for a plan to meet the maternal health marker.

For instance, they have to have one at least one of those preferred measures in each of those subdomains.

They can use more, but we're trying to standardize uh and get more aligned across the board on those measures and driving more and more adoption within uh those three areas, including maternal health.

So when would be the appropriate time to ask for how it's going?

So this is the first year of that.

So this is that's what I'm asking.

When is the appropriate time?

Uh so we've set up a timeline that allows us on an annual basis to look exactly at that.

Okay.

And so uh these arrangements are in the calendar year.

We're gonna give ourselves three months for claims to run out, and then we have a process to look at those in uh the spring every year and make a decision if we need to change anything, measures, targets, ask for CMS approval for anything, funding and budget development, et cetera.

And so we're gonna do that on an annual basis.

But the first cycle really takes two years uh before we can change anything.

Um and so we're saying uh for many years now, we've said let us have some time.

And so, but those have been kind of one-year adopt uh approaches.

This is a five-year approach where we said these are our timelines, this is when we're gonna look at it, this is when we'll get more aggressive if we need to.

Um, this is how we can align it up with all of the other policy decision-making processes.

So I think that five-year process hopefully holds us a little bit more accountable to keeping um the momentum here.

Okay, I it I it's a great word for it in terms of the momentum piece because what I don't want is like it to kind of lose its luster um in terms of our our focus on um things.

Um a couple other remaining questions, and then we can go.

Um has health care finance or um even DC Health had any conversations in the last six months or so with Planned Parenthood about how things um have been going um after the federal, they've been sort of cut off from federal support, but they had a lot of patients who are receiving um maternal care with them.

I can start.

Um we actually support planned parenthood through our breast and cervical cancer screening program.

Okay.

Um so we are reimbursing them for mammograms and um cap tests.

We we haven't had those conversations per se, but we've got a relationship established so we could get that information.

Okay.

And from our side, it's um been more about uh working with them to be clear on what Medicaid payment can or cannot happen, because there were a lot of uh lawsuits at the time and it went back and forth.

So our discussions have been more along the lines of the reimbursement component and um and what they can or cannot bill for.

Okay.

It it would ask if um either of the agencies can do a touch base.

Um, you know, Maryland was able to do some things um using their state dollars to help support to ensure that um any of their patients that were seeking care um can continue to do so um with in terms of all the range of other things that Planned Parenthood does other than abortion care.

Um and it would just be helpful for us to make sure that they're still good, as they're still here in in the district um okay was there anything that you guys desperately wanted to say on the record that I we haven't talked about?

Yeah, one thing, um, just to your WIC comments um, because we finally have an MOU in place.

We did kick off the data sharing of Medicaid data for WIC eligibility last year it seemingly has gone off uh without a hitch I don't think we have um I can't recall if you had data yet or not but just tracking to see any impact so hopefully we'll have just a more efficient way to act uh help folks access resources okay anything else um if we had unlimited time and resources you had talked about that that preconception perinatal um period um helping w women enter pregnancy healthier so how do we um spend more time and effort um encouraging well women visits um it's just we have a limited amount of resources um but if if if if if we could spend more time on that pre-conception period and help women enter pregnancy healthier yeah um if we had a limited time and money for variety of different things um that would definitely um there's so much that we could be doing should be doing there's so much that I wish on um you know the federal side that they were doing like that conversation with Dr.

Augusti around like we need more research on pre-eclampsia well it's not as though the District of Columbia can fund that type of research on its own um we really need NIH and our federal partners to step up there in terms of something that is so dangerous to the risk of the health of you know a mommy and baby but also um it's been going on for so long and is so frustrating to be able to tell folks who are experiencing that like I don't know why I can only help you manage through it.

So anyway I this does conclude today's um round table on maternal and infant health in the district.

I want to thank all of you who participated today and for sharing your experiences and expertise I very much look forward to DC Health getting their new dashboard up and running because I think that that will help a lot in terms of telling a um a more up to date story about what the state of things are in the district as opposed to waiting for these reports that are um using old data and sometimes late and I could have that also that conversation with the Office of the chief medical examiner as well as like the whole point of the maternal mortality review committee is to like dig deeper and find where the trends and connections but like it is super unhelpful um if we go four or five years without getting any data or information and then when we do it's four or five years old um in terms of the work that we're trying to do.

But overall your perspectives are super critical to how we shape how the district responds as are the public witnesses and I want to thank them all again for being very vulnerable in sharing um and being a part of this conversation.

Written testimony will be accepted through Wednesday July 22nd at um 5 p.m on the council's hearing management system site at DC Council.gov backslash hearings um the committee will reconvene again next Monday July 12th at 1 30 it's a joint hearing with the committee on public works and operations to talk about everyone's favorite neighborhood critters rats um we will be discussing bill 26-492 the rodent abatement and transparency amendment act the rat act that was introduced by councilman's George and Bill 26-707 the rodent um education and management yields results the Remy Amendment Act um that was introduced by myself along with some of my colleagues so if folks are interested in talking rodents with us um I believe we will see DC Health there.

And with that the time is 252 and this round table is adjourned.

Thank you.