recommendations, was unanimously adopted by the Steering Committee on August 5, 1966, and on that date submitted to the Advisory Council.

Recognizing the urgency of the situation, the Council, after two lengthy special meetings, approved the Plan on September 6, 1966, and submitted it to the Director of Public Health. The Department of Public Health carefully reviewed every portion of the Plan, and it was submitted by the Director with his recommendations to the Board of Commissioners. Following approval by the Commissioners, the subcommittees have more recently been concerned with the development of recommendations essential for restricting services within budgetary limitations.

The goal of the Plan, in conformity with Federal requirements, is truly comprehensive. It endeavors to provide adequate medical care for the needy in the District of Columbia, and it does meet the letter and intent of P.L. 89-97. It includes the full range of services within available resources necessary for the prevention of illness and premature death, the correction or limitation of disability, and the treatment of all illnesses and the provision of maximum rehabilitation of all eligible persons with impairments.

Implementation of the Plan requires total application of medical knowledge and the use of all our health resources. The Plan specifies that services must be readily available to every eligible person; that the services meet quality standards; and that they be provided in a sympathetic and dignified manner. The emphasis is focused on medical care as part of a comprehensive plan for services for the needy, not just the payment of a medical bill.

The Plan conforms to the Federal requirements of Title XIX by establishing a single District of Columbia medical care program to replace the several District provisions for medical care for the needy now covered by Titles I, IV, X, XIV, and XVI of the Social Security Act. The Plan also contains a provision to supplement the basic health insurance benefits for aged persons under Title XVIII of the same Act. It represents a genuine effort to comply with Federal requirements by expanding the amount, duration, scope, and quality of comprehensive medical care services now provided to the medically needy by the Department of Public Health.

Private health and medical resources and facilities will be used to the greatest extent feasible. The growth and utilization of nursing homes and home health services will be encouraged in order to reduce the burden on acute hospital beds and to be able to provide the maximum amount of high quality medical care within budgetary limitations.

The Council and the 100 members of the Committee on Medical Care and Hospitals are convinced that the Plan is an essential component of the multitude of services necessary to achieve the leadership position long advocated for the Nation's Capital. The early implementation of the services proposed under the Plan will also help to alleviate long simmering community tensions. Furthermore, the Plan with its heavy emphasis on ambulatory medical care will conserve both human and economic resources,

The Public Health Advisory Council is deeply concerned about the continued loss of thousands of dollars of Federal funds available since January 1, 1966. This is a harsh indictment which the Council feels cannot be overlooked. Twenty-six States and two Territories have already activated their programs and have been receiving Federal matching funds. The Council members are equally disturbed by the lack or inadequacy of existing health resources and facilities which will be eased with the implementation of the Plan. The protection of the health of the needy who will be covered by the Plan is a responsibility which cannot be avoided. In fact, the Plan for Medical Assistance for the District of Columbia for the first time provides the mechanism which will help to raise the level of health of the entire community.

The District of Columbia Public Health Advisory Council earnestly urges favorable consideration and expeditious enactment of H.R. 3972.

Dr. KERR. I want to thank you for the opportunity to bring to you as Chairman of the District of Columbia Advisory Health Council their position on H.R. 3972 and H.R. 6818. The Council consists of 21 residents of the District appointed by the Commissioners and their responsibility is to study and advise the Director of Public Health on the total health needs and programs in the District of Columbia.

To do this the Council is broken down into six standing committees and these vary in size depending upon the areas of responsibility and numbers from about 14 to about 100. It consists of about 743 individuals in the community that work under the direction of the Advisory Council to help the Health Department in the development of a total program for meeting all of the health needs of the community. Shortly after Public Law 89-87 was signed by President Johnson, the District Department of Public Health was designated as the agency to administer the plan for medical assistance under title XIX. The Department then asked the Advisory Council for assistance in developing the plan. At that moment the Standing Committee on Medical Care and Hospitals consisted of only 14 people and we felt it would be a little bit presumptuous of them to develop a plan of the magnitude required under title XIX.

So this committee was expanded to include about 100 people with eight subcommittees with areas of responsibility such as eligibility and physicians' services, hospitals, and extended care facilities. These subcommittees were under the direction of the Chairman of all of the eight subcommittees maintained by the steering committee.

They met for many months and finally last summer developed a plan which complies with the Federal requirements under title XIX. This plan was approved by the Health Department and also met the approval of the District Commissioners.

The goal of the plan, in accordance with Federal requirements is truly comprehensive. It endeavors to provide adequate medical care for the needy in the District of Columbia and it does meet the letter and intent of Public Law 89-97. It includes the full range of services within available resources necessary for the prevention of illness and premature death, the correction or limitation of disability, and the treatment of all illnesses and the provision of maximum rehabilitation of all eligible persons with impairments.

The implementation of the plan requires total application of medical knowledge and the use of all our health resources. The plan specifies that the services must be readily available to every eligible person: and that the services meet quality standards; and that they be provided in a sympathetic and dignified manner. The emphasis is focused on medical care as part of a comprehensive plan for services for the needy, not just the payment of a medical bill.

The plan conforms to the various Federal requirements to have a unified program for the medically needy in the community and it represents a genuine effort to comply with the Federal requirements by expanding the amount, duration, scope and quality of comprehensive medical care services now provided to the medically needy by the Department of Public Health.

Private health and medical resources and facilities will be used to the greatest extent feasible. The growth and utilization of nursing homes and home health services will be encouraged in order to reduce the burden on acute hospital beds and to be able to provide the maximum amount of high-quality medical care within budgetary

limitations.

The Council and the 100 members of the Committee on Medical Care and Hospitals are convinced that the plan is an essential compo

nent of the multitude of services necessary to achieve the leadership position long advocated for the Nation's Capital.

The early implementation of the services proposed under the plan will also help alleviate long-simmering community tensions. Furthermore, the plan with its heavy emphasis on ambulatory medical care will conserve both human and economic resources.

The Public Health Advisory Council is deeply concerned about the continued loss of thousands of dollars of Federal funds available since January 1, 1966. This is a harsh indictment which the Council feels cannot be overlooked. Twenty-six States and two territories have already activated their programs and have been receiving Federal matching funds.

The Council members are equally disturbed by the lack or inadequacy of existing health resources and facilities which will be eased with the implementation of the plan. The protection of the health of the needy who will be covered by the plan is a responsibility which cannot be avoided. In fact, the plan for medical assistance for the District of Columbia for the first time provides the mechanism which will help to raise the level of health of the entire community.

The District of Columbia Public Health Advisory Council earnestly urges favorable consideration and expeditious enactment of H.R. 3972.

Thank you.

Mr. Dowdy. Mr. Horton, do you have any questions?

Mr. HORTON. Do we have the Commissioner's plan before the committee?

Mr. Dowdy. I don't believe it has ever been made available to us. Mr. HORTON. Doctor, is it your intention, or the intention of someone that would be testifying today to present the plan that was developed by your group?

Dr. KERR. That can be made available to you very quickly, sir. Mr. HORTON. I realize the legislation does not set forth the plan as such.

Dr. KERR. Yes.

Mr. HORTON. I think it would be helpful for the committee to have in the record the plan that was developed by your group.

Dr. KERR. Yes. I'm sure you understand, Congressman Horton, that the implementation of the plan is entirely dependent upon H.R.

3972.

Mr. HORTON. I understand that, but I think it would be helpful for our consideration if we had before us the proposal that was presented by your study group.

Dr. KERR. I'm sure this can be made readily available to you from the Health Department.

Mr. HORTON. With regard to the present situation in the District, will you describe what that is?

Dr. KERR. The present situation is the medical care for the various categories, the categorical aid programs, the aid to dependent children, the blind, the disabled; those are all different. They are different types of medical care programs and have different standards. At the present, with this plan, the standards for the total medical care plan for the community covers all of these categories. So it is one plan instead of about six different ones.

Mr. DOWDY. I understand that Assistant Corporation Counsel William Robinson is here, and I think we have asked for a copy of whatever plan the District of Columbia has. Did you bring a copy of it with you?

Mr. ROBINSON. I have my personal copy. I'll be glad to put this into the record.

Mr. DowDY. Could you loan that to Mr. Horton?

Mr. ROBINSON. Yes [handing the copy to Mr. Horton].

Mr. HORTON. Give me 5 minutes and I'll study it. [Laughter.] The situation that you now have in the District is the implementation under the so-called Kerr-Mills proposal?

Dr. KERR. You are getting into a detail, Congressman Horton, that I will have to turn to someone from the Health Department to answer. Is that all right?

Mr. HORTON. Yes.

Dr. KERR. This is Dr. Ferrer. (Reinaldo A. Ferrer, M.D., Associate Director for Medical Care, Department of Public Health.)

Dr. FERRER. Will you please repeat the question?

Mr. HORTON. I was interested as to whether or not the program you now have in the District is the one that is carried on under the socalled Kerr-Mills Act.

Dr. FERRER. Currently you have medical assistance in the KerrMills program now and you have also medical assistance under District of Columbia funds. So you have in a sense two programs for the medical needy on the basis of eligibility standards, which are different for both programs.

Mr. HORTON. What are the standards now?

Dr. FERRER. For medical assistance at District of Columbia expense and public expense, the income level for a family of four is $3,360. Mr. HORTON. And that's medical assistance under the District of Columbia assistance program?

Dr. FERRER. Right.

Mr. HORTON. What generally does that provide?

Dr. FERRER. It provides a full range of services to the eligible individual that the facilities of the Department can provide.

In other words it provides medical care throughout District of Columbia General and Glendale Hospitals, and through contracts with nine community hospitals.

Mr. HORTON. And that is totally financed by the District at the present time?

Dr. FERRER. From appropriations. Yes. From local District of Columbia funds, appropriated. Under Kerr-Mills we are getting about $2 million a year from Federal funds.

Mr. HORTON. Are you familiar with the plan Dr. Kerr has been talking about?

Dr. FERRER. Yes. It has been formulated under my office. I am the Associate Director for Medical Care for the District of Columbia. Mr. HORTON. What do you estimate that will bring the District from the Federal level?

Dr. FERRER. Depending upon the different levels of eligibility. The plan proposes a $4,200 income or less for a family of four, annually. If you take it at that level, let's say we were able to get 100-percent reimbursement, it will be a maximum of about $10 million. When

you deduct the $2 million from Kerr-Mills, which we will not get under this new plan, then it comes out to about $8 million.

Mr. HORTON. So you would have an increase of approximately $8 million from Federal funds over what you now get?

Dr. FERRER. That is, if you figure at 100-percent reimbursement. This is the maximum we could get. Of course, we know that probably we won't be able to get 100-percent reimbursement, because when we talk about 217,000 persons eligible it doesn't necessarily mean that 217,000 people are actually going to use those services.

Mr. HORTON. What are the number that are eligible under the existing programs?

Dr. FERRER. We have 160,000 people eligible.

Mr. HORTON. Under the proposal?

Dr. FERRER. 217,000 people will be eligible, potentially eligible.

Mr. HORTON. And under the proposal the amount is $4,200 for a family of four.

Dr. FERRER. Correct.

Mr. HORTON. Why did you increase that eligibility amount? It is now $3,360 and you now propose to start the program at $4,200. Dr. KERR. May I answer that question, Congressman Horton? Mr. HORTON. Yes.

Dr. KERR. The history in back of that, in the subcommittee on eligibility in the development of the plan

Mr. HORTON. Now you are talking about the subcommittee of the study group?

Dr. KERR. That's right. The subcommittee of the standing committee of the Advisory Council in the development of eligibility standards felt that in an urban community such as ours, after consulting with the Bureau of Labor Standards and other standards, that it required a minimum income of $6,000 for a family of four to meet just the basic needs of living.

However, when that recommendation cleared the steering committee, the Chairman of the Study Committee, when it got into the Advisory Council, after a lot of discussion and a couple of meetings, that amount was reduced to $4,800.

Then when it went from the Health Department to the Commissioners, the Commissioners asked, "Well, how much is this going to cost?" It was priced out by the Health Department at $4,800 so it was going to take more District moneys. So they said, "We'll drop back and let's see how far we have to drop back to find out where we could put this plan into effect without requiring additional District moneys."

It was found that at $4,200 it would not be necessary for additional District moneys to be made available. That was the way in which the $4,200 figure was arrived at.

Mr. HORTON. Of course, at the present time, without the enactment of H.R. 3972, introduced by Mr. McMillan, the chairman of the committee, or H.R. 6868 by Mr. Nelsen, you would not be entitled to these additional benefits. In other words, you need this enabling legislation to take advantage of Federal statute that was enacted which benefit the other States of the Union, but would have to take special enabling legislation for the District of Columbia.

Dr. KERR. That's exactly right.