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
Prior Auth Reforms for Medicare Advantage, Work to Be Done With Private Insurers
On April 5, CMS released a final rule on Medicare Parts C and D that, among other changes, reformed the program's prior authorization process.
This is a great win for physicians and practices who see Medicare patients, but does not impact the private insurance market. That is where B25-124 comes in, and what MSDC is working on before a May 24 hearing.
The final rule seems to incorporate provisions supported by the American Medical Association and MSDC, including:
- Only using prior auths to confirm diagnoses to ensure medical necessity of services.
- Establishing a Utilization Management Committee to review clinical coverage criteria
- Allowing prior auth approvals to be valid throughout duration of treatment
These changes plus announcements by some insurers to voluntarily reduce prior auth requests seem to suggest progress in prior auth reform. Physicians, however, must put in place permanent changes now for all patients to ensure this progress.
The Committee on Health is having a hearing on comprehensive reform legislation on May 24. Visit msdc.org/priorauth to learn how you can make a difference for your patients.