The DC Council’s Committee on Health recently held a performance oversight hearing on March 4, 2026, to discuss the Health Benefit Exchange Authority (HBX) and its operation of DC Health Link. Chaired by Councilmember Christina Henderson (At Large), the hearing provided critical updates on the Healthy DC plan, the District’s version of the Basic Health Plan (BHP).

As many healthcare providers, legal advocates, and small business owners shared their concerns, one concern across these testimonies was that although the transition to the Healthy DC plan was administratively successful, the reduction in benefits, specifically dental, vision, and behavioral health, poses a significant risk to the District’s most vulnerable residents. Below are highlights from testimonies given at the oversight hearing. 

Highlights from Testimonies of Advocates for Justice and Education (AJE) Staff

Chioma Oruh, Health Justice Project Director at AJE, raised concerns about proposals to phase out Medicaid coverage for so-called “childless adults” by 2029. Her testimony emphasized that the label “childless adults” does not reflect the realities of many DC families and removing their coverage could destabilize family caregiving systems and harm children with complex needs. 

Dr. Oruh’s testimony ended with asking the Council to clarify what concrete plans exist for immigrant adults who have lost coverage, and what pathways remain for home- and community-based services for children and youth with complex medical needs who rely on Medicaid or Alliance. She also highlighted the uncertainty facing transition-aged youth who age out of Alliance but still require ongoing care due to pre-existing conditions. Her testimony further emphasized the financial strain many families already face, such as families of children with disabilities, who often carry higher out-of-pocket costs than those of typically developing children, and projected premium increases in ACA marketplaces threaten to make coverage even less affordable, even with subsidies from the Inflation Reduction Act. 

Dr. Oruh asked what strategy the District has to educate families about subsidy eligibility and enrollment options proactively, and whether the Council would consider additional local financial relief for families navigating the Exchange. However, Chairperson Christina Henderson responded that she did not have time to answer all those questions/ Unfortunately, Chairperson Henderson’s refusal to engage these questions on the record has left several critical concerns about coverage, affordability, and continuity of care unanswered.

Daniela Gonzales-Rious, Health Justice Coordinator at AJE, raised concerns that the decision to lower Medicaid eligibility from 200% to 138% of the federal poverty level is expected to push about 25,000 residents off Medicaid, with some moving to the Basic Health Plan. However, that plan provides more limited benefits, excluding services such as comprehensive dental and vision care and certain long-term supports. She emphasized that these eligibility thresholds fail to reflect the high cost of living in Washington, DC, where families are struggling to afford housing, food, childcare, and transportation. The testimony highlighted that low-income Black and Brown communities are most at risk, as healthcare access is deeply connected to broader economic stability. Reduced coverage could lead to delayed care, worsening health conditions, and increased strain on emergency services. 

Highlights from Testimonies of DC health workers and advocates

• Elizabeth Davis (DC Hospital Association): Reported that nearly 16,000 residents transitioned to Healthy DC on January 1, 2026. While hospitals have seen no decrease in access because all member hospitals are contracted with the new plans, she raised concerns about rate setting. If the cost of care for this new population exceeds Medicaid targets, provider rates may become insufficient.

 

• Anne Gundersen (DC Fiscal Policy Institute): Focused on the Healthcare for Child Care (HC4CC) program, which now reaches over 3,300 workers. She noted that despite its success—with no facilities currently on the waiting list—there are 53 facilities that are eligible but not currently enrolled in HC4CC.

 

• Dr. Kate Sugarman (Unity Healthcare): Emphasized that dental care is a medical necessity, not an elective service, noting that patients can die from dental infections. She warned that interruptions in care for chronic conditions like diabetes or kidney failure can be life-threatening and that clogged emergency rooms are an inevitable result of reduced outpatient coverage.

 

• Elizabeth Falcon (DC Jobs with Justice): Representing the Keep DC Healthy campaign, Elizabeth strongly opposed the elimination of the DC Healthcare Alliance and the reduction of benefits for Medicaid recipients. She recommended including $21 million on the contingency revenue list to restore Alliance coverage.

 

• Roberto Carlos Salas (Small Business Owner): Shared that his health insurance premium doubled this year following the loss of federal advanced premium tax credits, reaching over $1,000 a month. He described the current healthcare pricing as lacking transparency and unsustainable for minority small business owners.

 

• Jaye Yarbrough (Whitman-Walker Health): Reported that many patients only realize they have lost Medicaid or been shifted to new plans when they arrive at a pharmacy or medical appointment, leading to confusion and gaps in care.

 

• Anna Jimenez (Home Aide): Shared the “overwhelming” fear and depression she felt when she received notification of insurance loss. Due to the letter’s formatting, she initially believed that she had completely lost her health coverage. It was only after reviewing the back of the document that she discovered information about an alternative insurance option. Her experience highlights the critical importance of clear, accessible communication in insurance notifications to prevent unnecessary distress and confusion.

 

Highlights from Government Witness 

Executive Director, Mila Kofman, JD, reported that the Healthy DC plan, which launched to provide affordable care for residents transitioning off Medicaid, now covers approximately 16,000 residents. While the transition was largely seamless, Director Kofman noted that some residents were initially unaware that their coverage source had changed because they could keep the same providers and Managed Care Organizations (MCOs).

 

Continuity for Birthing People and Pregnancy

Director Kofman discussed pregnancy eligibility, noting that HBX has developed a robust transition process with the DC Medicaid agency to ensure that when a covered person becomes pregnant, they maintain access to their healthcare. Kofman referenced having 35 cases of pregnancy, which were all redetermined for Medicaid to avoid being transitioned around insurances and keep their current coverage. 

 

HIV Care and PrEP Access

The Council recently passed the Prep DC Amendment Act, which ensures that PrEP and PEP are available at no cost. Director Kofman confirmed that as of January 2026, HBX’s “essential plans” have already removed cost barriers for HIV patients, offering $0 co-pays for specialist visits, lab work, and generic prescription drugs.

Regulatory Oversight and DISB Involvement

One of the concerns that arose was additional fees providers are charging on top of covered visits, such as “facility fees”.  To ensure the Healthy DC plan is properly regulated and providers are held accountable, HBX is funding a new Full-Time Equivalent (FTE) position at the Department of Insurance, Securities, and Banking (DISB). 

Medical ID Cards

In an exchange regarding patient access, it was revealed that Medical ID cards can take up to two weeks to arrive via mail for new enrollees. However, Director Kofman clarified that this is an “outer limit” and most plans provide electronic identification sooner. Patients can also call their health plan to receive their ID number immediately, allowing them to access care during that two-week window.

Towards the end of the hearing, Councilmember Zachary Parker (Ward 5) joined the conversation and questioned Kofman specifically on the implementation of the Prep DC Amendment Act and how it would hold up against federal challenges. Kofman explained that while PrEP is currently a federally required preventive benefit, a DISC bulletin clarifies that local plans must continue to cover it even if federal requirements change. They also discussed behavioral health, with Kofman acknowledging that some Medicaid-covered services are not currently available in the commercial-style Healthy DC plan, requiring close coordination with the Department of Behavioral Health to bridge those gaps.

 

Immigrant Communities at Risk

Perhaps the most striking part of the hearing was Director Kofman’s exchange with Chairwoman Henderson regarding future eligibility restrictions. Due to changes in federal law, the Healthy DC plan faces a significant narrowing of its scope starting in January 2027. Kofman warned that access will likely be limited to green card holders only, excluding a wide range of “lawfully present” residents. This means residents with asylum status or on student or professional visas, including F-1, J-1, and H-1 B, will no longer qualify for the Healthy DC plan. Kofman expressed deep concern for this population, noting there are currently no alternative coverage options for these residents once the federal changes take full effect.

 

Call to Action

Advocates for Justice and Education are partners of the Keep DC Healthy coalition, urging the DC Council to implement the following recommendations:

 

• Restoration of the DC Healthcare Alliance: We strongly oppose the elimination of the Alliance program and are calling for a full restoration of services that existed before October 1, 2025.
• Expanded Immigrant Access: We ask the District to provide a concrete plan for immigrant adults and “childless adults” who face being phased out of coverage by 2029.
• Clearer Communication: The District needs to move away from using dense postcards and technical acronyms. We recommend personalized notices that clearly explain what documentation is missing or why a resident is out of compliance, while also providing them with alternative and affordable solutions to coverage.
• Standardized Equity Data: We ask the Council to require disaggregated reporting by ward, race, and language to ensure that health equity gains are actually reaching the communities that need them most.

AJE urges the DC Council to restore coverage using contingency funds, expand comprehensive benefits, and improve communication with families so they can better understand their healthcare options and maintain access to affordable care. As budget season approaches this April, we urge community members to testify, share their stories, and advocate for policies that deliver meaningful, lasting improvements in care.