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Healthcare

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Councilmembers Grosso and Nadeau seek clarity on services for transgender youth in CFSA's care

On Oct. 4, Councilmember David Grosso, chairperson of the Committee on Education, and Councilmember Brianne K. Nadeau, chairperson of the Committee on Human Services, sent a letter to the Child and Family Services Agency (CFSA) seeking clarification of its policies regarding the provision of medical services to transgender youth in the agency’s care.

“The governor of California recently signed legislation in that state…setting the appropriate care for youth in foster care to receive gender-affirming health care, including mental health care. Media outlets praised the state as being the first to ensure these rights for transgender youth,” the two councilmembers wrote. “However, it is our belief that this should have already been policy in the District of Columbia based on the provisions of our Human Rights Act and its interpretation, particularly with regards to the Mayor’s Order from February 27, 2014 prohibiting discrimination in health insurance based on gender identity or expression.”

CFSA Director Brenda Donald responded to Grosso and Nadeau on Oct. 19, reaffirming its commitment to provide youth in its care with all appropriate medical and mental health services, including related to maters of sexual orientation and gender identity.

“In the District of Columbia, youth in the care of CFSA have a right to be provided with timely, adequate, and appropriate medical and mental health services from health care professionals, which includes medical care, behavioral health care, and counseling,” Donald wrote.

“CFSA’s practice is to support and ensure that transgender youth obtain and have access to gender-affirming healthcare, gender affirming mental healthcare, and any other support and services they might need. Should a youth express an interest in undergoing gender reassignment surgery with their social worker, health care professional, or foster parent, CFSA would treat such request as we would any medical request. The agency will refer the youth to the appropriate medical and mental health services, establish what is medically covered, and determine the best way forward to ensure that all medical needs are met. If a youth requests reassignment surgery, CFSA must ensure that the youth receives the appropriate mental health support. The Department of Health Care Finance (DHCF) will cover sex reassignment procedures for beneficiaries with an established diagnosis of gender dysphoria.”

Read the full letter to CFSA, and their response to Councilmembers Grosso and Nadeau, below.

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Grosso exchange with Department of Health Care Finance on Medicaid for returning citizens

Earlier this year, Councilmember Grosso's staff began researching policy issues for D.C. residents who are Medicaid recipients and become incarcerated. According to the National Council of State Legislatures, D.C. and many other states terminate an individual's Medicaid when that person is sentenced to prison--but under Medicaid rules, the government could also suspend the individual's Medicaid until their release. Grosso wrote to Director Wayne Turnage of the Department of Health Care Finance (which handles D.C.'s Medicaid policies) about this issue, and got a very informative letter in response. This included the revelation that DHCF had recently amended this policy to the best practice of suspending, not terminating, Medicaid. Good news for public health and public safety. You can read the letters below:

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Grosso Calls on Supreme Court to Uphold Women's Reproductive Rights

For Immediate Release
March 2, 2016
Contact: Keenan Austin
(202) 724-8105

Grosso Calls on Supreme Court to Uphold Women's Reproductive Rights

Washington, D.C.--Today, the Supreme Court of the United States will hear oral arguments in Whole Woman's Health v. Hellerstedt, a case that challenges the constitutionality of a Texas law that would effectively close many clinics that provide abortion services in that state. Councilmember David Grosso (I-At Large) made the following statement in advance of the oral arguments:

"Today I stand with millions of people across the country who want to see the Supreme Court make the right decision and protect access to abortion services. Whole Woman's Health v. Hellerstedt revolves around the question of whether Texas law H.B. 2, and myriad others around the country, places an undue burden on access to abortion services. If allowed to go forward, the Texas law would close the majority of abortion providing clinics in the state, placing significant obstacles between a person seeking to terminate a pregnancy and access to such services.
 
In D.C., we are lucky to have some of the strongest protections of a woman's right to make decisions about her own body, despite continued interference by Congress. In 2014, the D.C. Council passed my Reproductive Health Non-Discrimination Amendment Act to stop employers from retaliating against employees for their reproductive health decisions, which Congressional Republicans unsuccessfully sought to block. I will continue to fight the Congressional rider that prohibits the D.C. government from spending local tax dollars on abortion services, creating barriers to access for our poorest residents. And I will continue to advance legislation to safeguard reproductive rights, like my bill that ended shackling of pregnant women and girls in D.C. detention facilities.
 
On a personal level, my wife and I make regular contributions to the D.C. Abortion Fund in an effort to help mitigate the impact of the Congressional rider. Similarly, in response to state laws passed to obstruct women's access to abortion, we also contribute regularly to Fund Texas Choice, a group that funds travel for women who do not live near an abortion provider, after over a dozen closed in Texas due to the new legislation.
 
No matter the Supreme Court's decision on Whole Woman's Health v. Hellerstedt, D.C. will remain a place where women's autonomy over their own reproductive choices will be protected."

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Grosso Statement at the AmeriHealth Behavioral Health/Physical Health Integration Summit

As you all know, one of the major challenges for effective health care delivery is the integration of services, particularly behavioral health and physical health programs. It is very rare that patients come to health clinics or providers with just one issue and if we can do our best to treat the whole person, it improves quality of care and outcomes for our residents.

I’ve brought this up in every meeting I’ve had with AmeriHealth staff and so it’s very exciting and impressive that AmeriHealth, who is new to the District, has called for this summit.

For a long time in the District, behavioral health programs were solely reliant on grant funding and therefore the services were not as expansive or as available as they should have been for all of our residents.

Many health plans did not offer coverage for behavioral health services. Providers were not accessible in all parts of the city – for example, a few years ago there was only one child psychiatrist that was east of the River. And there was little outreach to our African-American communities who were long reluctant to discuss mental health and illness even though many of those residents were dealing with incidents causing mental trauma on a daily basis.

As a result, there is a gap in the District of Columbia between our white and higher income residents and their minority and low-income counterparts when it comes to considering behavioral health and receiving proper care.

According to the U.S. Department of Health and Human Services Office of Minority Services, African Americans are 20 percent more likely to report having “serious psychological distress” than non-Hispanic Whites. Yet, young adult African Americans are less likely to seek mental health services than their White counterparts.  In fact, the depression rate among African American women is estimated to be almost 50 percent higher than that of Caucasian women.

We know that when individuals are facing mental illness or challenge, and essentially cope and suffer in silence, the problem doesn’t go away; it just tends to manifest in other physical health issues becoming more costly and problematic as time goes on. This is why I think integration of behavioral health and physical health programs are key and I’m excited that you all are here to identify integration projects and make firm commitments to implementing them in 2014-15.

We have certainly come a long way in the District in terms of behavioral health services. I sit on the Committee on Education at the Council and every time I visit a school they are not just talking about the guidance counselor anymore, we now have psychologists and family therapists along with nurses and dentists who are coming directly to the schools to provide services because we realize how important it is to take care of the health of the whole child.

This summer I visited 12 primary health clinics throughout the District. With the rollout of the Affordable Care Act and the increase demand for health care, I wanted to get an on-the-ground feel of what health access is really like in the District. What I found were successful, mission-driven health clinics that are going above and beyond to meet the whole needs of the patients they serve. While they all were borne out of a need to serve a particular community or treat a specific health issue, they’ve evolved to treat the whole person. Behavioral health services are now integrated into all of them.

We need more clinics and health providers who see this importance in the District. That is why a couple of weeks ago when I sent my budget priorities for FY15 to the Mayor, I included a request that he infuse $3 million into the health professionals recruitment fund to help our clinics and hospitals recruit more providers to work and setup practice in our neediest of neighborhoods. Treating the whole patient is the only way we are really going to move the needle in terms of improving health outcomes for patients and reducing overall costs for care.

I want to thank you all for taking time out of your schedules to have these conversations. They are imperative for District residents and the patients you all serve!

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