Agencies detail Healthy DC auto‑enrollment and outreach; data glitches and pharmacy gaps remain

Mila Kaufmann, executive director of the Health Benefit Exchange Authority, and Wayne Turnage, director of DHCF, walked the committee through the operational steps HBX and DHCF have taken to move eligible residents to the Healthy DC Plan.

Kaufmann said HBX has auto‑enrolled over 13,000 residents and will run additional enrollment batches before Jan. 1. She said Healthy DC was approved by the federal government and designed to provide no‑premium, no‑cost‑sharing coverage for essential health benefits; however, adult dental and vision are not included in the current benefit set unless Congress acts to extend premium tax credits that would finance those additions. Turnage noted a federal law change created a funding/eligibility mismatch for some lawfully present residents and that DHCF is seeking CMS flexibility to avoid unnecessary churn.

Officials flagged operational risks: HBX identified about 1,100 applications with data problems that require manual review; HBX asked community partners and assisters to help those residents respond promptly to avoid short gaps (HBX said a resident could be enrolled if they respond by mid‑January, but a brief coverage gap is possible). DHCF clinical staff also said several pharmacies — including some large chains and out‑of‑area stores — have not completed enrollment as fee‑for‑service vendors, producing prescription denials that staff are working to resolve. Committee members requested detailed enrollment and claims data and urged coordinated direct notifications to pharmacists and frontline providers.