Development and Implementation Grant
Requirements
                            Phase Two National Press Release

District of Columbia Primary Care Association
Washington, DC

  

 

      Objectives

Goal 1:  Increase the number of insured by expanding Medicaid.  In order to get an accurate financial projection of the impact of covering current and proposed expansions, Communities in Charge (CIC) began a collaborative effort with the Department of Health's Medical Assistance Administration (MAA) to develop a plan for analyzing demographic enrollment data on the uninsured.

  • Obj. - Facilitate the implementation of health coverage expansions.  To facilitate implementation of health coverage expansion, CIC has developed tracking tools of current, pending and proposed waivers for the District of Columbia.  The tool is updated monthly, and includes information such as current status of each waiver's cost to the District and District Financing sources.

Goal 2:  Increase the number of insured by achieving excellence in Medicaid outreach and enrollment and retention.

  • Obj. - Conduct a Medicaid Enrollment Survey.  CIC conducted a survey among un-enrolled Medicaid eligible in the District to gain an understanding of enrollment and retention issues.  Results identified two major cause of "churn;" children aging out and barriers to re-certification.  Results from the survey will be used to improve Medicaid enrollment and re-certification policy in the District.

  • Obj. - Facilitate Development of a Medicaid Training Institute.  CIC is working with the District's administration responsible for Medicaid enrollment, and the Department of Health to develop a Medicaid Training Institute.  This institute will provide training to outreach workers, providers, physicians, social workers, and others who assist people in applying for Medicaid.

Goal 3:  Strengthen the primary care safety net

  • Obj. - Establish a Safety Net Clinic Certification Program.  CIC is facilitating the establishment of the DC Qualified Health Centers Program (DCQHC).  The DCQHC Program is designed to ensure the high quality primary care is available to all DC residents through its safety net providers.  In collaboration with partners, CIC has developed a methodology to assure primary care providers for "certification" and has pilot-tested the assessment with two providers.

  • Obj. - Place and  Secure Start Up Fund for a Primary Care Development Corporation (PCDC).  To provide additional needed support to safety net clinics, CIC is setting the infrastructure for a Primary Care Development Center Corporation (PCDC) to assist safety net providers in obtaining capitol funding and financial stability.

  • Obj. - Develop and Implement a Pharmaceutical Resource Center.  With the advice of the Alliance Program, pharmaceuticals were made available for all non Medicaid DC residents up to 300% of poverty.  To help ensure pharmaceuticals and enough available to meet demand, CIC is developing a Pharmaceutical Resource Center.  The center will allow the District to take advantage of pharmacy assistance drug programs available through pharmaceutical manufacturers.

  • Obj. - Support the Successful Implementation of the DC Healthcare Alliance.  The Healthcare Alliance offers District residents under 200% of the Federal Poverty Level (who are not eligible for Medicaid or other insurance) "virtual insurance."  CIC is working to support the successful implementation of the Alliance.

Goal 4:  Engage Policy Makers and Voters in Health Care Reform

  • Obj. - Conduct Briefings with DC and Congressional Policy Makers.  Over the last year, CIC engaged the City Council, DC's Congressional Representative, the Mayor's Office and DC voters in healthcare reform issues.  CIC's voter engagement efforts have paid off.  The Mayor announced at his December 2002, Citizen Summit Follow-up that healthcare has become one of the top issues of concerns for DC residents.

  • Obj. - Produce a Weekly Television Program on DC Healthcare Reform Issues.  The Health Justice Cafe (HJC) weekly television program has been airing to educate voters on healthcare reform issues and to recruit members for, the Health Justice League (HJL).  The director of the DC Covering Kids program is the shows host.  The activity has been stopped.  It was found that the program had little impact and exhausted numerous resources.

  • Obj. - Educate and inform Policy Makers and Voters through the CIC Website.  CIC web pages have been developed for the DCPCA website.  The website allows policy makers and voters to learn more about the CIC health reform issues and gives them ways to get involved.  Voters sign-up for the HJL on line, and get current information on the status of reform issues.  See www.dcpca.org

 

        →Back to Top

        Program Design

The work of CIC is done through the DC Primary Care Association and is guided by a 21 member Task Force.  The Task Force is made up of representation from safety net clinics, hospitals, the city council, the Mayor's policy office, and other public and private organizations working on healthcare reform in the District of Columbia.  The Task Force is co-chaired by the Director of the Department of Health, the Chief of Neurosurgery, Howard University Hospital, and the District of Columbia Council's Chair of the Human Services Committee.  In addition, several members of the Mayor's original Health Care Commission serve on the CIC Task Force to ensure that Communities in Charge builds the work of the Commission which included:

  • Medicaid expansion as a tool for decreasing the uninsured

  • Development of a stronger community-based primary care system, including facilities management, information systems, and technical assistance

  • Improvements in the performance of Medicaid outreach and enrollment

  • Better coordination between prevention, primary care, hospitals, and long-term care

In 2001 drastic changes occurred in the landscape of the District's healthcare system.  Financial and mismanagement prompted the District to close its public hospital and public health clinics.  In it's place, the Mayor created a public-private partnership to strengthen the healthcare safety-net system and ensure that all residents up to 200% of poverty receive quality healthcare services regardless of their ability to pay (the DC Healthcare Alliance).  The birth of a new public health system coupled with the loss of tobacco settlement monies earmarked to fund healthcare reform, prompted CIC to modify some of its objectives.

Delivery System

DC Communities in Charge is as concerned abut delivery as it is about insurance.  Our delivery system is fragmented; prevention, primary care and home-based services are inadequate both in quality and quantity.  A large amount of uncompensated care is provided in emergency rooms, making it difficult to secure tertiary and non-emergency hospitalizations for the uninsured.

After researching various national standards of care models, DC Communities in Charge worked with community providers to develop performance standards that were implemented for DC.  Recognizing the current status of many of the providers that make up the District's safety net, performance standards were developed for "DC Qualified Health Centers" that also incorporated a technical assistance component.

It is essential to preserve the medical homes that communities historically rely on for a number of services.  These, mostly small, private non-profits have historically absorbed about two-thirds of all the uncompensated care in the city and would now receive assistance from the government as well as become eligible for Enhanced Medicaid reimbursements for all of the "wrap-around" services they provide such as social work, transportation services, etc.  Legislation has been developed and the city has committed to fund the program in the 2002 budget.

DC Communities in Charge has also worked to develop a pharmaceutical access program for uninsured patients.  It is imperative that once we ensure patients access to care we also ensure their providers can properly treat patients with needed medications.  A plan has been developed which would take existing funds used at our public hospital and provide medications to all residents which currently have no means to access them.  Legislation is currently being developed for this plan.  In addition, CIC has a pilot program being initiated to provide prescription drug access to pharmaceutical companies' assistance plans for 600 District residents with no-prescription drug coverage.

We have not yet tackled long-term care problems, which will need to be included because DC's population is aging.  We are using CIC to bring those communities and others, into the healthcare reform process.

In addition to the healthcare providers, Medicaid's ability to contract for and/or provide outreach enrollment and re-certification must be improved if reform is to succeed.

     →Back to Top

        Financing & Outreach Strategies

Financing Strategy

Due to budget crisis funds were not available in 2002, and $100,000 had been committed in the 2003 budget.  Again, the budget crisis led to those funds not being available.  CIC is exploring numerous options for funding in the District's FY04 budget.  We are currently working with the Department of Health because they will need to build the capacity to monitor the providers once standards are in place.

Outreach Strategy

  • Policy makers:  Meetings, updates, letters, faxes, emails, and reports ensure understanding reform goals and financing.

  • Healthcare leaders and providers:  Meetings, updates, letters, faxes, emails and reports increase understanding, ensure reform strategies are achievable in the community.

  • Voters:  Web site, data base for email and fax information and distribution health reform updates increase participation/awareness.

  • Community:  Help promote city-wide healthcare summits to influence policy makers.

→Back to Top

        Accomplishments to Date

  • Creation of Alliance Program under Mayor's initiative.

  • Creation of DC Pharmacy Resource Center.

  • Completion of DC Medicaid enrollment survey.

  • Completion of DC demographic survey.

  • Continued to expand the District's primary care network of providers.

  • Medicaid waiver expansions approved for several target populations.

→Back to Top

       Challenges

DC has protected its Medicaid budget and not decreased eligibility criteria despite a $500 million decrease in revenue funds over the last two years.  However, budget concerns remain a critical challenge to CIC goals.  The District faces a predicted budget shortfall between $300-500 million per year through 2005.  Financial stability of Greater Southeast Community Hospital is in doubt while it undergoes bankruptcy.  It remains a major access point for many of the medically vulnerable citizens of the District and its financial troubles have absorbed much of the health policy focus from the community.  CIC in collaboration with partners, has conducted a viability study of Greater Southeast Community Hospital with recommendations to strengthen healthcare financing.

The Task Force provided technical assistance to the Department of Health to develop a program-spending plan for tobacco settlement dollars, which would have funded all CIC goals, including DCQHC, pharmacy, Medicaid expansions, and the Medicaid Training Institute.  This funding was lost when the DC Congressional Appropriations Committee ordered all of the money to be put in the reserve (rainy day) fund.  

Transition to a privatized public health system and closure of inpatient and trauma services at the city's only public hospital, DC General in 2001 divided the healthcare community and distracted policymaker and lawmakers attention from any of the reform efforts underway.  The healthcare community recognized the importance of a strong delivery system of primary care, but many in the community remain divided about future uses of the DC General site.

Despite funding challenges, CIC continues to keep the Department of Health, City Council and the Mayor's office engaged in identifying funding for healthcare reform issues.  CIC regularly consults with the Mayor's budget office, and the City's Chief Financial Officer, City Administrator and the DOH and City Council budget offices.

→Back to Top

        Contact Us

Sharon Baskerville
District of Columbia Primary Care Association
1411 K Street NW, Suite 400
Washington, DC  20005
Phone: (202) 638-0252
Fax: (202) 638-4557
E-mail: 
sbaskerville@dcpca.org
                                                                                                 Website:  http://www.dcpca.org

        →Back to Top  

 

 Communities In Charge 2002 is a program of The Robert Wood Johnson Foundation.
E-mail Webmaster with comments: webmaster@mx.com Last Modified:7/03