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
Health Committee Marks-up Copay Accumulator Bill
The Committee on Health got out its red pen and marked-up the District's copay accumulator bill today.
This is a big step for the MSDC priority bill to passage.
The legislation (B25-141, seen here) requires insurers to apply discount coupons and cost-saving measures to patient copays. This helps patients save money for expensive medical treatments. Insurers in other states had disallowed these savings to count toward copays, which meant more out-of-pocket costs for patients.
Next up for the bill is being agendized by Council Chair Phil Mendelson in a future Council Legislative Meeting. If it is approved twice by the Council, it goes to the Mayor for her signature.
The bill had two major changes in the version that passed the committee. First, the bill does not apply when a generic or interchangeable biologic product is available at a lower cost unless there is a documented medical reason for the specific drug. Second, the bill clarifies its alignment with IRS regulations on high deductible health plans.
If you are interested in contacting the Council on this legislation, contact Robert Hay for more information.