May 11, 2012 The Honorable Vincent C.

Gray Mayor of the District of Columbia 1350 Pennsylvania Avenue NW Suite 316 Washington, DC 20004 Dear Mayor Gray: While you worked to develop a balanced budget proposal for FY 2013, the District faced an estimated gap of $172 million between expected tax revenues and anticipated expenditures to maintain services. One way to help address that gap was your proposal to eliminate emergency benefits for DC Healthcare Alliance beneficiaries; while you kept those services on your priority list for future consideration in the event of revenue increases. The DCPCA, and the undersigned members and partners, are tremendously appreciative for your tireless effort to work with the Council of the District of Columbia and the Department of Health Care Finance to identify alternatives to eliminating this important benefit. As advocates, we were glad to see that the Council Committee on Health put forward a bold proposal for full restoration of Alliance services, and we have stressed that full restoration of the Alliance hospitalization benefit is one of our highest priorities. However, doing so must not come at the expense of any other essential health and human services program, and so we must be cautious to weigh adjustments to enrollment projections and caps at 2012 levels for programs such as the EPD and DD waiver programs. In fact it costs significantly less to serve people with ID/DD under the Home and Community-Based Services Waiver in the community rather than in less integrated, more restrictive intermediate care facilities. Moreover, the Committee on Health recommended staffing reductions in the Department of Mental Health and the Deputy Mayor for Health and Human Services which we believe would be detrimental to the Districts ability to effectively address the health and human services needs of its residents. The undersigned fully support the alternative proposal you put forward to District Council Chairman Kwame Brown on May 10, 2012 to restore hospital-based care benefits for the DC Healthcare Alliance. Your proposal does not cap essential waiver programs, eliminate critical staff, and does not cut the Non-Emergency Transportation Benefit. Your proposal shifts some costs to the Federal government for Emergency Medicaid, and creates a new and innovative local DSH-like fund for uncompensated care. Furthermore, we are encouraged to read in your proposal that a plan is in development to require hospitals to accept Alliance cards as a vehicle to allow members access to non-emergency care at any hospital in the District, and for which hospitals will be able to submit claims to the local DSH fund, rather than billing patients who we know will not be able to afford care otherwise. We remain committed to the spirit of interagency cooperation and collaboration that has characterized our long relationship with your office, the Council of the District of Columbia and the Committee on Health, as well as leadership at the DC Department

of Health Care Finance. We look forward to a continuation of that partnership as share a mission to address health disparities and achieve health equity for residents of the District, and fully support your proposal to restore the DC Healthcare Alliance.

Sincerely, DC Primary Care Association La Clinca del Pueblo Marys Center Unity Health Care, Inc. Whitman-Walker Health Cc: BB Otero, Deputy Mayor for Health and Human Services Kwame R. Brown, Chair, Council of the District of Columbia David A. Catania, At-Large Councilmember, Chair, Committee on Health