Health Equity
Medicaid Enrollment Touches 39% of the Residents of The District of Columbia; DC’s 70/30 FMAP is Vital for the Maintenance of Health & Human Services
A reduction in the District’s FMAP would not lead to long-term government savings and would have a ripple effect throughout the entire health system in the DMV, crippling access to care for not only Medicaid beneficiaries but also all those who live, work, and visit the District of Columbia, including members of Congress and their staffs.
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Why does DC receive an Enhanced FMAP Rate?
The DC FMAP rate of 70% established by the Revitalization Act resulted from bipartisan analysis, discussion, and negotiation by Congressional leadership aiming to balance fairness with the District’s restricted ability to generate revenue. Congress recognized that the District of Columbia faces unique financial challenges due to its non-state status and the significant amount of federally-owned land within its boundaries. The District is unable to tax non-residents’ earnings, so these workers pay no taxes to support the infrastructure and services, such as roads, public safety and emergency services that they benefit from in the District. The District is also unable to tax up to 40% of the real property within its borders due to statutory restrictions.
Why are we concerned about DC's FMAP now?
Members of Congress have proposed reducing the DC FMAP to the statutory minimum for all other states, which is currently 50% (but could be reduced even more). Such a change would impact every physician and every practice, regardless of type, location, and payers contracted. Even practices who take no insurance will not be able to send patients for specialist care, hospital admissions, or other types of care.
What can MSDC members do?
- If you know a member of Congress or staffer, reach out to them and share how DC cuts will hurt your patients.
- Share your relationships and outreach with hay@msdc.org so we can help coordinate advocacy efforts.
- Email hay@msdc.org if you would like to be paired with a physician member of Congress office and trained by MSDC staff on how to reach out.
Resources
- DC FMAP cut fact sheet
- California Medical Association fact sheet on Medicaid cuts
- MSDC and healthcare association letter to Congress arguing against DC FMAP changes.
- MSDC original story on Medicaid changes.
News, Statements, and Testimony on Health Equity Issues
DC Opioid Deaths Increased in 2019
While many states are beginning to see a small decline in opioid-related deaths due to prescription reforms, the District and cities like Baltimore are showing an uptick due to numerous factors. A major factor is the presence of fentanyl especially in heroin laced with the opioid. The District saw 281 fatal overdoses in 2017, then saw a decline, but could again be seeing an upswing. The projected number of deaths for last year is 260.
The upward trend comes amidst implementation of the Mayor's Live.Long.DC plan to address the major reasons for substance use disorder. MSDC applauded the plan's reduction in the use of prior authorization in Medicaid plans for OUD treatments but provisional data suggests numerous other factors are driving the death rate higher.
The report also comes at the beginning of the Council's budget process. With the Council currently undergoing executive department performance reviews then budget allocations, the opioid crisis undoubtedly will come up in budget discussions. At the Committee on Health hearing on January 31 for the Mayor's Commission for Healthcare Systems Transformation, CM Vince Gray noted the numbers represent a "trend moving in the wrong direction".
MSDC and its members remain committed to working with the District government and private stakeholders to reduce the number of opioid deaths and addictions in the District.
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