Proposed Health Care Supports in the 2027 DC Budget

Against a backdrop of rising uninsurance driven by federal eligibility changes and local program cuts, the budget proposes to reopen enrollment in the District’s safety-net health insurance program, maintain coverage for lawfully present residents losing federal subsidies, expand crisis mental health services, launch a prescription drug discount program, and invest in hospitals and community health centers.

The centerpiece of the budget’s health care strategy is the restoration and expansion of the DC Healthcare Alliance, a locally funded program providing health coverage to residents who are ineligible for Medicaid or Medicare. The 2027 DC budget invests $38.3 million in one-time funding to remove the age moratorium on new enrollees, allowing all eligible residents earning up to 133% of the federal poverty level to enroll. Between October 1, 2026, and September 30, 2027, the Mayor would resume providing the full range of medical services Alliance enrollees received prior to October 2025. These services include primary care, hospital services, prescription drugs, dental, and vision for adults aged 21 and older. They exclude non-emergency medical transportation. An additional $900,000 would restore specialty medical care for all currently enrolled adults. The budget explicitly limits this restoration to one fiscal year: after September 30, 2027, adults aged 21 and older would no longer be eligible for enrollment.

The 2027 DC budget also responds to federal changes that have stripped health insurance subsidies from lawfully present residents. The federal One Big Beautiful Bill Act (OBBBA) limited premium tax credits for certain non-citizens. An estimated 250 lawfully present residents earning below 100% of the federal poverty level lost affordable coverage in January, with another 575 expected to lose it by January 2027. The budget invests $2.5 million to provide coverage for the 250 residents who have already lost access, channeling funds through the Health Benefit Exchange. An additional $800,000 would support a grant program for federally qualified health centers to care for uninsured patients. Federally qualified health centers are community-based, nonprofit clinics serving medically underserved populations on a sliding scale.

The 2027 DC budget creates a new 988 Lifeline and Crisis Services Fund, supported by a monthly $0.15 fee on telecommunications access lines and a 2% charge on prepaid wireless transactions. In its first year, the fund allocates $2.4 million to support the District’s behavioral health crisis system. Of this amount, $1.3 million restores the Children and Adolescent Mobile Psychiatric Services program. This program dispatches clinicians to youth in acute psychiatric crises and diverts them from emergency rooms. The budget also dedicates $600,000 for community-based crisis stabilization beds offering voluntary, trauma-informed residential alternatives to emergency psychiatric care, and $500,000 to increase capacity at the Access Helpline. Additional investments include $700,000 to maintain the current community-based model of the School-Based Behavioral Health Program and 10 new special police officer positions at Saint Elizabeths Hospital.

To address high prescription drug costs, the budget establishes “ArrayRx DC,” a drug discount card program giving all District residents access to lower-cost medications through a cooperative purchasing agreement with a multi-state nonprofit consortium. The program includes residents without insurance and places particular focus on independently owned pharmacies in underserved areas.

The budget directs $14.9 million in one-time local funding for direct medical education at teaching hospitals, unlocking an additional $35.9 million in federal Medicaid matching funds. Howard University Hospital trains over half of all new Black doctors in the United States each year. It is the only teaching hospital on the campus of a historically Black university. The budget also invests $3.9 million ($16.0 million over four years) to implement prenatal and postpartum remote patient monitoring. The budget further funds the Judith Heumann Memorial Workers with Disabilities Act to build systems for reimbursing providers serving workers with disabilities.

Additional provisions include $400,000 from the opioid abatement fund for illicit drug testing at the chief medical examiner and $396,000 for an adolescent substance use disorder treatment program. The budget also includes $1.4 million to restore Healthy Steps, a program integrating child development support into pediatric primary care. Other allocations include $307,000 to implement the Medical Debt Mitigation Act and $168,000 to restore grants for mammograms, cervical cancer screenings, and sickle cell treatment for uninsured residents. The budget eliminates the mandate requiring individual and small group health plans to cover fertility services beginning January 1, 2028. This change applies only if the federal government requires the District to defray the cost. The provision avoids triggering a costly federal defrayal requirement while preserving coverage under the existing essential health benefit benchmark.

All provisions described in this alert are contingent on final passage and enactment of the 2027 DC budget and may be subject to further amendment during the legislative process.