DC Health Annoyance
Darrow Montgomery/File
NEWS LOOSE LIPS
Another budget cycle goes by without removing barriers to health care for undocumented immigrants in D.C. By Mitch Ryals @MitchRyals By some accounts, Ward 7 Councilmember Vince Gray is in a slump. Over the past five months, Gray has lost a handful of hotly debated legislative efforts. He’s twice tried and failed to stop a halfway house from opening in his ward. He carried water for Mayor Muriel Bowser’s unsuccessful efforts to meddle in a lucrative Medicaid contract. Along the way, he accused his fellow councilmembers of contract steering, and they returned the favor. In May, Gray asked his Council colleagues to pour more money into United Medical Center to avoid triggering a financial control board—a board that he himself created (with agreement from the rest of the Council) by reducing the cap on the subsidy D.C. provides to keep the hospital running. A narrow majority of councilmembers were unwilling to bail him and the hospital out. As the D.C. Council finalized the 2022 budget, Gray whiffed again—this time in his yearslong quest to fully fix a problem with the D.C. Healthcare Alliance. The locally funded program provides health insurance for more than 15,000 low-income immigrants who don’t qualify for Medicaid, many of whom are undocumented. For the past decade, D.C. has required Alliance enrollees to reapply for their health insurance in person every six months. Applicants would line up outside Department of Human Services locations as early as 3 or 4 a.m. to get appointments. About 600 to 700 people, roughly half of those up for recertification each month, fail to do so and lose their coverage, an effect of the requirement to reapply in person twice a year, advocates say. The onerous chore does not apply to traditional DC Medicaid applicants, who renew their coverage once a year. The recently passed 2022 Budget Support Act does include some reforms to the Alliance program. But major changes don’t fully kick in until 2025. Alliance enrollees are currently still required to reapply every six months from now through September 2022, but won’t have to do so in person. From October 2022 until 2025,
Ward 7 Councilmember Vince Gray
enrollees may complete only one of their two required reapplications in person. After March of 2025, they will only have to reapply once a year, but may have to go in person. First-time applicants are still required to register in person, according to Deputy Mayor for Health and Human Services Wayne Turnage. During the public health emergency, Bowser allowed Alliance enrollees to keep their health insurance without reapplying. The public health emergency ended in July, but a general public emergency remains in place through Oct. 8. Damon King, director of policy advocacy at the Legal Aid Society of the District of Columbia, believes the Council’s failure to build on Bowser’s pandemic-induced policy marks another lost opportunity. And Bowser shares some of the blame, King says. “The administration has now had six years to fix this,” he says. “They did inherit the policy, but having inherited it and having heard testimony … year after year, they’ve had ample opportunity to address this on their own, and they’ve declined to do so.” Gray sees the incremental changes to the Alliance as progress, according to a staffer familiar with his thinking. He pushes back against the notion of a legislative losing streak. “In the Fiscal Year 2022 budget, we secured significant investments for Ward 7, Birth-toThree, and citywide health equity,” Gray says in an emailed statement. Among the highlights he included: $1.9 million for school-based
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mental health services expansion, $365.9 million toward building a new health care system east of the Anacostia River, nearly $127 million toward fair pay for child care workers, and $24 million for the Deanwood Library. What is a simple solution to a major problem with Alliance has been complicated over the years, as lawmakers tripped over each other to fix it. A clusterfuck of legislation passed since 2017, a lack of funding, and what Gray believes is an overestimation by the CFO of the total cost of reforms have stood in the way. Meanwhile, Alliance enrollees such as Selene Lara, who have had to line up outside DHS locations at ungodly hours just to keep their health insurance, are once again left waiting for reforms sought for the past decade. Twice a year for the past eight years, Lara has stood in line before sunrise to apply to keep her health insurance. She recalls one particularly hellish rendezvous about three years ago. It was January, the dead of winter, and she and her partner arrived at the DHS building on New York Avenue NE around 5 a.m. Others were already waiting, she recalls. They brought their own chairs. Lara, 30, had her then-3-month-old daughter in tow. It was so cold that she and her partner took turns waiting with the infant in a nearby Starbucks while the other held their place in line. They weren’t let into the building until 8 a.m., she recalls. When it was her turn to see a caseworker, her daughter started
to cry. The caseworker became angry and refused to help them until the infant quieted down, Lara says. She tried everything—talking, singing, rocking. At one point, her partner stood up to walk around, but the caseworker said he couldn’t leave the cubicle. “It was really upsetting and sad,” says Lara, who is now a community health worker for La Clínica del Pueblo. “It’s a service that you need. Like, oh my god, I understand why people don’t come here. They really don’t care. At that point, I was crying.” When the caseworker finally processed their application, Lara says she was told she was missing documentation and needed to come back. She says she had to return five more times before she was able to complete the process. On one visit, the system was down, so caseworkers couldn’t enter her information, Lara says. During another appointment, a caseworker entered her income incorrectly. Rodrigo Stein, La Clínica’s director of health equity and community partnerships, says Lara’s experience is not unique. Lara speaks f luent English, but many Alliance enrollees don’t, Stein says. Clients report that caseworkers rarely speak Spanish, and though DHS has translation services, they’re not always available, Stein says, and they’re sometimes ineffective. “We still have technology barriers, waiting a long time over the phone, and poorly translated documents,” Stein says. Enrollees “have to ask landlords for proof of residence.
