Department of Health Care Finance Performance Oversight Hearing

Testifying before the Committee on Health, CLC Executive Director Judith Sandalow outlined four priorities to improve medical services for children who rely on D.C. Medicaid.

Sandalow applauded the Department of Health Care Finance (DHCF) for making significant progress over the past several years under former Director Julie Hudman and stated she hopes such work continues under new Director Wayne Turnage.

Despite noted progress, much work remains to solve the crisis facing District children who rely on Medicaid. Sandalow made four primary recommendations:

• Fix the fragmented mental health system which makes it difficult for quality community-based mental health providers to serve children and thus has resulted in more children being removed from their families, hospitalized or incarcerated.
• Develop a system for providing oversight and accountability to the Managed Care Organizations (MCOs), whose failure to provide adequate preventative mental health services has been clearly documented.
• Move forward with the Administrative Service Organization – a single billing system - that is essential to improving the provider pool and maximizing federal reimbursements.
• Work with sister agencies, in particular the Child and Family Services Agency (CFSA) to ensure federal Medicaid dollars are maximized.

Sandalow also urged the D.C. Council to allow DHCF to reduce its 20% vacancy rate, which has left many leadership positions unfilled and hampered teh department's ability to respond to inquiries. 

Problems in the current system include:

• It is difficult to navigate, for families and providers.
• There is a shortage of providers.
• Children fail to receive important medical and mental health treatment, or face long delays that impair their health. Too often, children go without services or treatment until a crisis arises. 
• The Department of Mental Health estimates 14 - 20% of District children have an emotional or behavioral disorder, yet the District's public mental health system serves just slightly over 5% of District's children.
• Many MCOs authorize only a limited number of mental health visits, which often doesn't adequetely meet a child's needs. 
• Evidence suggests many children enrolled in the MCO Health Services for Children with Special Needs (HSCSN) do not receive adequete - or sometimes not any - non-hospital behavioral health care. 

A properly functioning Medicaid system is vital, Sandalow explained. Not only does it help ensure the health of D.C.’s children, it is also the backbone of the child welfare, mental health and early intervention systems - providing the services that reduce children’s stay in foster care and aid their academic achievement.

Read the full testimony here.