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
MSDC and Many Many Others: Reform Prior Auth
On Wednesday, the DC Committee on Health held a hearing on B25-124, the Prior Authorization Reform Act.
The bill would enact common-sense reforms like reasonable waiting periods for prior authorization appeals, requirements for locally licensed physician utilization reviews, and limitations on what can receive a prior authorization.
Of the twenty plus witnesses, an overwhelming majority spoke in favor of the bill's concepts. MSDC President Dr. Susanne Bathgate and President-Elect Dr. Ashesh Patel both testified in person representing the Society. Dr. Bathgate's testimony focused on how prior authorizations were impacted her pregnant patients, with clinically recommended care being denied or delayed:
If the authoritative organization in this field, the American College of Obstetrics and Gynecology, has determined, based on appropriate research and gathering of data, that all patients should have access to these levels of genetic screening, prior authorization should not be required if this is a benefit covered by their insurance.
Dr. Patel's testimony focused on the impact of prior authorizations on his own practice:
Every week, I need to deal with PA approvals, adding to my administrative burden (as a solo practitioner in the District) and puts a strain on my relationships with my patients because pharmacies and insurance companies make my patients believe I am at fault for them not being able to get their medicines instead of the actual culprit: the insurance companies.
Also testifying was American Medical Association president Dr. Jack Resnick. Dr. Resnick focused on his own prior auth experience and gave a national perspective to the issue:
Every practicing physician will tell you that it is not unusual for a care disruption due to prior authorization to negatively impact a patient’s health—whether it is a permanent loss of function when an patient with arthritis temporarily loses access to their medication; a shoulder surgery that could have been avoided had they not had to wait weeks for an MRI; an emergency room visit for a pancreatitis flare after going two weeks without authorization for long-acting insulin, or cancer progression when chemotherapy takes months to get approved. Physicians know we must reform the prior authorization process for our patients.
The ability to testify in writing is open until June 7; if you want to make your opinion known on this issue, email hay@msdc.org to learn how. The next step for the bill would be a markup, which allows it to be considered by the entire Council. MSDC is unsure if and when it will be marked up but we are working hard to keep it top of mind for the Council.