Hearing spotlights funding shortfall and wait list for DC’s Health Care for Child Care program

Councilmember Christina Henderson, chair of the Committee on Health, convened a Jan. 29 hearing on the FY24 performance of the DC Health Benefit Exchange Authority (HBX), focusing in large part on Health Care for Child Care, a program funded through the Pay Equity Fund that helps early childhood educators obtain health insurance.

The program matters to thousands of early educators and to small child-care businesses, witnesses told the council. “The Health Exchange recently instituted a wait list for new child care facilities enrollment and Health Care for Child Care coverage due to insufficient funding,” said Anne Gunderson, senior policy analyst at the DC Fiscal Policy Institute, adding that HBX previously enrolled 79% of eligible child-care facilities but that almost 60 facilities remain without access unless additional funds become available.

HBX Executive Director Mila Kaufman told the committee the program had 1,967 people enrolled and covered 220 facilities as of her testimony, and that HBX set its policy to limit new enrollments beginning Jan. 1 after input from an advisory council. Kaufman said HBX has $12,000,000 in FY25 funding for Health Care for Child Care, a level intended to preserve coverage for workers, dependents and facilities already enrolled and to allow DC residents who are workers to enroll in individual plans. Kaufman said the exchange “developed the policy this past fall” and that, at the time of the hearing, no facility on the wait list was actively queued for enrollment.

Early-education advocates and providers urged the council to restore or increase funding during the FY26 budget process. “Without additional funding to reopen enrollment, the health and financial stability of many educators and staff, and the stability of the early learning system as a whole are at risk,” Audrey Castleman, senior policy analyst at DC Action, told the committee. Julie Luhan, who owns two child-care programs in Ward 1, described the program’s direct effect on families and employees, saying her daughter received needed medical treatment in February 2023 after the family’s household gained coverage through Health Care for Child Care.

Witnesses emphasized uneven participation by neighborhood. Gunderson and others said wards 7 and 8 have the lowest percentages of facilities enrolled and warned that gaps in outreach could leave more providers unaware of the program or excluded by the wait list. Destiny Bolton, a community organizer with Spaces in Action, urged “sustained and increased investment” and asked the council to allocate additional funds to maintain core programs that support early educators.

HBX staff described outreach and partnership efforts that helped the program reach multiple wards. Kaufman told the council Health Care for Child Care began in January 2023 and has helped 2,414 people and 231 facilities since inception; she said HBX previously achieved approximately 79% penetration among eligible facilities before the funding change. Kaufman also highlighted HBX’s advisory committee, assisters and community partners who provided enrollment and health literacy support to workers and employers.

Committee members pressed HBX on operational details, including how the wait list was developed and how HBX is working with outreach partners to reduce disparities. Kaufman said the exchange had solicited input from the advisory group and from the agency that administers the Pay Equity Fund when setting enrollment limits. Several witnesses and the director noted that the program design requires coordination among agencies because funding for the benefit comes from the Pay Equity Fund.

The hearing also included broader remarks about HBX operations — HBX staff and outside partners discussed the exchange’s role during the Medicaid redetermination outreach, special enrollment periods, and the risk to lower ACA marketplace premiums if federal enhanced premium tax credits expire. Brett Allen of the DC Chamber of Commerce warned that expiration of federal premium tax credit enhancements could raise premiums sharply for self-employed residents and small businesses that buy coverage on their own.

Where it stands now: HBX told the council it will continue the current enrollment cap until the agency receives additional direction or funding changes. Witnesses urged the council to prioritize funding for Health Care for Child Care in the FY26 budget cycle to eliminate the wait list and expand enrollment, particularly to reach underserved wards.