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
Councilmember Mary Cheh introduces Copay Accumulator Bill
On December 6, Councilmember Mary Cheh introduced B24-0557, the Copay Accumulator Amendment Act. The bill was co-introduced by Councilmembers Lewis George, Nadeau, Silverman, and Gray.
The bill would amend the Specialty Drug Copayment Limitation Act to require health insurers to apply discounts, financial assistance, payments, product vouchers, and other reductions in out-of-pocket expenses made by or on behalf of a member when calculating a member's coinsurance, copayment, cost-sharing responsibility, deductible, or out-of-pocket maximum for a covered benefit.
B24-0557 is a one of MSDC's top legislative priorities and an issue the Society has worked on since last year. As insurers continue to cost shift to patients, the Society is concerned our patients will face financial hardships in paying for prescriptions, especially prescriptions for more costly drugs or conditions. As Councilmember Cheh notes in her introduction:
When consumers are unable to afford health care, primarily costly prescription drugs, they are often forced to ration the medication or forgo use altogether, leading to worse healthcare outcomes, and even risk of advance disease or death.
MSDC thanks Councilmember Cheh and the co-introducers for putting forward this bill. We look forward to testifying at a future Committee on Health hearing and helping pass the legislation so DC can join more than ten states in protecting patients on this issue.
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