DC Health Link highlights coverage gains, warns funding limits put Health Care for Child Care on wait list

The Committee on Health heard Jan. 29 from DC Health Link (HBX) and dozens of community witnesses about FY24 performance, outreach work during the Medicaid redetermination period, and the future of a program that provides subsidized health insurance to early childhood educators.

HBX Executive Director Mila Kauffman told the council HBX ‘‘ranks number 2 in the nation for the lowest uninsured rate’’ and that ‘‘more than 97% of residents have coverage.’’ Kauffman said the exchange helped nearly 100,000 people obtain private coverage and administers premium tax‑credit calculations that lower monthly costs for thousands of residents, adding: ‘‘If Congress takes [the IRA changes] away, expect huge premium hikes and millions of people to lose their health insurance coverage.’’

The hearing focused heavily on Health Care for Child Care, a program created under the District’s Pay Equity Fund that gives early educators access to either group plans purchased by employers or individual plans with subsidies. Witnesses representing child care providers, advocacy groups and business associations said the program has improved retention, reduced financial stress for educators and allowed small programs to continue offering services.

Anne Gunderson of the DC Fiscal Policy Institute told the committee that before HBX instituted a wait list, ‘‘the Health Exchange enrolled 79% of eligible child care facilities in Health Care for Child Care’’ but that a shortfall in funding has left ‘‘almost 60 facilities across the district without access to group coverage.’’ Audrey Castleman of DC Action echoed those concerns and urged the council to prioritize funding in FY26 budget deliberations so facilities on the wait list can enroll.

HBX provided program totals and policy context. Kauffman said Health Care for Child Care currently covers 1,967 people across 220 facilities and that ‘‘since we started Health Care for Child Care back in January of 2023, Health Care for Child Care has helped 2,414 people and 231 facilities.’’ She told the committee HBX budgeted $12 million for FY25 to protect currently enrolled workers and residents, and that the authority ‘‘developed the policy [for a wait list] this past fall’’ after consulting the program’s advisory council and community partners. She said that as of the Jan. 1 effective date there were ‘‘no facilities on the wait list.’’

Witnesses gave examples of how the program has been used. Julie Luhan, a Ward 1 child care owner, described paying about ‘‘$2,700 a month’’ for family insurance before the program and said Health Care for Child Care allowed a family member to receive lifesaving treatment when coverage became available. Destiny Bolton of Spaces in Action and others urged the council to restore funding so more educators—particularly in Wards 7 and 8—can enroll.

The hearing also reviewed HBX’s broader outreach and assister work during the Medicaid redetermination process. Dennis Angel of Mary’s Center said the center’s in‑person assisters supported more than 2,743 DC residents in FY24; Mila Kauffman described partnerships with community assisters, chambers of commerce and faith groups that made thousands of outreach contacts and helped enroll people through in‑person events, clinics and special enrollment periods.

Kauffman outlined other HBX work in FY24: open enrollment through Jan. 31 (27 plan choices this year), implementation of a fertility‑coverage expansion (now approved in the district benchmark plan for federal compliance starting plan year 2026), and a special enrollment policy to allow residents with DACA status to access marketplace coverage with lower premiums where federal guidance permits. She also described HBX’s equity‑based benefit design changes—removing cost barriers for outpatient care and medications for conditions such as type 2 diabetes and, beginning plan year 2026, HIV care—and said those designs are aimed at ‘‘remov[ing] cost barriers that prevent people from getting the care they need.’’

Committee members pressed HBX on implementation details and consumer protection. Councilmember Christina Henderson asked whether providers were adding ‘‘facility fees’’ that undercut new low co‑pay designs for pediatric mental health; Kauffman said HBX and the Department of Insurance, Securities and Banking (DISB) are investigating and ‘‘continue to work with our health plans’’ on point‑of‑service billing and coding issues. Members also asked how HBX escalates recurring plan‑level problems to DISB when necessary; Kauffman said HBX shares trends with the regulator and reserves escalation for systemic marketwide problems. Several council members also asked HBX to track PrEP (HIV prevention) coverage issues and improper coding that can cause surprise charges for consumers.

Committee members and witnesses raised budgetary concerns. Multiple witnesses urged the council to protect or expand the Pay Equity Fund so Health Care for Child Care can reopen full enrollment. HBX called attention to the role of federal premium tax credits enacted under the Inflation Reduction Act and American Rescue Plan: Kauffman warned that expiration of enhanced federal credits would ‘‘result in huge premium hikes’’ and that HBX is coordinating with business partners to advocate in Congress.

The hearing closed with requests for follow‑up data: how many new employers and facilities enrolled in plan year 2024, detailed counts of assisters’ activities, and further documentation of call center metrics and contract spending.

Without additional local funding for the Pay Equity Fund and full program enrollment, child care providers and early educators said the gains from Health Care for Child Care risk being limited to those already enrolled, with continued gaps in Wards 7 and 8. HBX officials said they will continue outreach and benefit redesign work while notifying the council of needed follow‑ups and data.

Ending: The committee requested written follow‑ups and said it will press HBX and the Office of the Mayor for budget and implementation details ahead of FY26 deliberations.