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
Novitas Smart Edits - Coming Soon
Novitas Solutions will be introducing Smart Edits to our electronic billing systems. This enhancement will alert providers of any claims that can be repaired prior to a denial. The messages will display on the 277CA electronic claim response report and may require the claim to be resubmitted.
Benefits of Smart Editing:
• Identify problematic claims sooner
• Receive clear notifications on how to fix claim errors
• Reduce time spent on claim resubmissions
Continue to monitor your email and the Smart Edits (JL) web page for more information on these upcoming changes.
Smart Edits - coming soon! (novitas-solutions.com)
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00275505
Part A note: Have you seen the recent emails about making sure you are reporting the valid Medicare payer ID in your electronic claim files? If not, please read the Payer ID smart edit details on the Smart Edits (JH)(JL) web page. It is important to see what is needed before April 23 to ensure your claims do not start to reject.
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