On Monday, June 23rd, the DC Council’s Committee on Health, chaired by Councilmember Christina Henderson, finalized its Fiscal Year 2026 budget recommendations. During this budget review, the Committee made budget recommendations to protect vulnerable residents and preserve essential access to healthcare and services. When the budget hearing period concludes, each Committee Chair prepares a budget report of recommendations that is then marked up and approved by all members of the Committee. The Committee budget report includes recommendations for: (a) funding and personnel levels for each agency, (b) policy proposals, (c) legislation necessary to implement the recommendations, and (d) any other budget-related analysis that the committee deems appropriate. 

The Committee on Health’s budget recommendations carry major implications for the District’s Medicaid and DC Healthcare Alliance programs. Informed by these proposals, along with public hearings and testimonies, the full Council will vote on the District’s FY26 budget on July 14 and July 28, before submitting it to Congress for final review. Below is a summary of the recommended budget changes related to Medicaid and the DC Healthcare Alliance.

Medicaid: Budget Pressures and Policy Shifts

Councilmember Christina Henderson mentioned that the District’s Medicaid program is under financial strain due to costs rising faster than revenue. The Mayor’s proposed budget included significant cuts to Medicaid and proposed moving roughly 25,500 residents—primarily childless adults, parents, and caregivers—to a Basic Health Program (BHP) administered by the DC Health Benefit Exchange.

These residents will no longer receive Medicaid, but instead will be covered under the BHP. The BHP will include primary care, hospital services, specialty care, skilled nursing, behavioral health, and durable medical equipment. However, some services currently covered under Medicaid—dental, vision, substance use disorder treatment, and non-emergency medical transportation—will not be covered under the BHP. The Committee was unable to secure funds to restore these benefits under the BHP, but urged community stakeholders to help identify $5.2 million in funding, particularly for dental coverage.

Alliance: Defending Immigrant Health Coverage

The DC Healthcare Alliance (DC Alliance) —a crucial program for low-income immigrant residents—also faced steep eligibility restrictions in the proposed budget. Originally, the Mayor’s proposal aimed to cut the DC Alliance eligibility for adults to 135% of the federal poverty level, end adult eligibility altogether by FY27, and impose strict rules like in-person recertifications every six months and proof-of-residency requirements.

In response to  collective advocacy and community voices, the DC Council’s Committee on Health made recommendations to counter many of these restrictions, including:

• Restoring $3.7 million in FY26 and $12.1 million across the financial plan to eliminate harsh provisions.
• Removing in-person recertification for adults and youth.
• Allowing public school enrollment as proof of residency.
• Extending eligibility for new youth beneficiaries up to age 26.
• Restoring durable medical equipment coverage for all Alliance beneficiaries through FY27.

While the Committee achieved major wins, it stressed the need for ongoing oversight, especially given uncertainties at the federal level and upcoming program transitions due to the federal budget. The Committee committed to continuing its push for adequate provider reimbursement rates and to preserving services that residents rely on daily.

Additionally, a few weeks ago, AJE posted a blog about the critical shortage of school-based nurses. The Committee announced a major shift in how the School Health Services Program will be managed. The program is transitioning from being operated as a grant (previously through Children’s School Services) to being managed directly by DC Health. School nurses and health staff will now become DC government employees rather than working for a private contractor or grantee. The shift aims to improve training, oversight, and staffing by bringing health professionals directly under government management.

Councilmember Henderson noted that neighboring jurisdictions like Prince George’s County increased competition for nurses, making it harder for DC to retain staff under the old contractor model. However, Councilmember Henderson shared that DC Health has extended offers to existing staff, and none have declined so far. The hope is that nurses can receive better salaries and benefits as DC government employees.

She also noted that a mistake was discovered during the budget process. Although funding was reprogrammed for FY25, the new staff positions were accidentally left out of the FY26 budget book. The DC Department of Health and the Office of the Chief Financial Officer (CFO) are working to correct this and ensure staffing is in place by the start of School Year 2025-2026.

These budget recommendations are an important step in protecting health, but while progress has been made in Medicaid, immigrant health coverage, and school health services, more work remains. The Council’s votes on July 14 and July 28 will be crucial in deciding the future of these important healthcare programs. Advocacy and community engagement remain essential to ensure that the needs of all residents are heard and addressed throughout the process.