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 Physicians Prior Auth Push Gets Response
On Monday, DC physicians sent a letter to the Committee on Health asking for a hearing on DC's prior auth legislation.
Since then, MSDC has heard unofficially a hearing could come as soon as the District budget is done.
The MSDC letter (seen below) outlined key reasons why B25-124 is critical to improving the health of medicine and District residents. The letter's ask is to hold a hearing on the issue, which the Council did not do in 2022.
Committee Chair CM Christina Henderson is a co-introducer of the legislation and co-introduced the 2022 version of the bill.
MSDC will have more updates in the weeks to come, but now is your chance to get involved. Email hay@msdc.org to get timely updates and tips, and sign-up for MSDC's advocacy session in April.
March 10, 2023
The Honorable Christina Henderson
Chair, Committee on Health
Council of the District of Columbia
1350 Pennsylvania Ave NW
Washington DC 20004
Dear Chair Henderson,
We, the undersigned physicians and healthcare professionals, urge you to hold a hearing on prior authorization legislation before the Council recess this summer.
According to a recent Axios article, 40 states are considering legislation to reform prior authorization practices. The Mayor’s Healthcare Workforce Task Force includes a draft recommendation to reform the practice to prevent healthcare worker burnout and improve retention. Nationally, the movement is to reform a practice that harms patients and hinders care, and the District needs to be a part of this movement.
A recent American Medical Association (AMA) physician survey on prior auth showed that 93% of physicians report care delays because of prior authorization. The same survey showed that physician offices spend 13 hours each week (almost two business days) dedicated to prior auth paperwork.
These delays impact our residents and patients daily, leading many to wait unnecessarily for their treatments or choose to abandon them altogether.
We ask you to hold a hearing on this bill because you and your colleagues need to hear our stories about how prior authorizations negatively impact physicians across the District. We look forward to continuing to share our stories and working with your office to pass this legislation in 2023.
Sincerely,
[80+ physician names withheld for privacy]