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DHCF: mayoral authority, income caps and equipment costs complicate buy‑in and RPM implementation
Summary
Deputy Mayor Wayne Turnage and DHCF staff told the committee they support both bills’ aims but flagged legal sufficiency (mayor’s authority over state plan amendments), tradeoffs in income caps and federal match, and equipment/monthly service costs driving fiscal uncertainty.
Deputy Mayor Wayne Turnage and DHCF policy staff used the hearing to outline the technical and fiscal considerations that will determine whether the Executive can implement either bill quickly.
Turnage told the committee that the Attorney General has advised the District that the mayor, not the Council, has authority to amend the Medicaid state plan — a legal point DHCF said can be addressed in bill drafting but requires coordination with the mayor’s office. "The AG has informed us that the mayor, not the council, only the mayor, has the authority to amend the Medicaid state plan," Turnage said. DHCF staff explained that some buy‑in implementation options (e.g., Ticket to Work variants) preserve federal match for higher‑income enrollees, while a no‑income‑cap approach complicates matching funds and fiscal forecasting.
On RPM, DHCF said narrowing the scope to blood pressure and glucose and focusing on high‑risk individuals reduced the estimated universe and cost compared with earlier analyses, but equipment costs and monthly service fees materially affect the year‑one estimate. DHCF provided a preliminary FY‑24‑based estimate and told the committee it will prepare a new fiscal impact statement (FIS) aligned with the narrowed scope and updated caseload assumptions.
Committee members requested DHCF work with CFO and DDS to provide enrollment proxies, per‑member costs, and a local/federal cost breakout to inform legislative decisions and the city’s budget process.
