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
It is Medicaid Renewal Time!
For the first time in three years, Medicaid beneficiaries must renew their eligibility for their Medicaid coverage.
The Medicaid Renewal period officially kicked off on April 1, 2023 and will last until May 2024. During this time, every Medicaid beneficiary will complete the renewal process. If a person no longer meets the eligibility requirements, they will lose their Medicaid coverage.
Why is this important to providers? Medicaid coverage pays providers for services delivered to Medicaid beneficiaries and provides District residents with access to care.
Is there anything for providers to do to assist in Medicaid renewals? YES!
- Get the word out to your patients! We have flyers available for downloading that you can post in your office (go to https://dhcf.dc.gov/node/1648591 for the Medicaid Renewal Communications Toolkit)
- Complete requested physician order forms (POFs) as soon as possible! Some Medicaid beneficiaries must have a level of care assessment (LOCs) to renew their eligibility. LOCs can only be order by a physician / APRN. DC Medicaid’s vendor, Liberty, must have the physician / APRN-signed prescription order form (POF) before scheduling and conducting the LOC. Medicaid beneficiaries can lose their Medicaid coverage if you do not sign the POF timely. More information on the POF process is provided below:
Prescription Order Form Process Overview:
- Purpose: The DHCF Prescription Order Form is required to request an assessment for Long Term Services and Supports. Our home health regulations require a physician order for such services.
- Form: The POF was relaunched as an electronic form in 2021. The link to the form, a PDF version of the form, and instructions are all available on the DHCF website (and the form and instructions always have been).
- Electronic functionality: The “e” version of the POF may be completed and signed electronically or it can be printed, signed, and faxed to Liberty.
- Who completes it: POFs may be completed by a variety of partners (e.g., case managers, home health agencies) but they must be signed by a licensed physician enrolled with DC Medicaid. Liberty (the DHCF-contract vendor that conducts LOC assessments) in processing POFs verifies the physician’s enrollment in Medicaid.
- Who processes it: Completed POFs are submitted by fax or electronically to Liberty, who reviews it for completeness and accuracy before scheduling an assessment.
- POF withdrawals: POFs are processed and withdrawn by Liberty for a variety of reasons, most commonly due to missing or incorrect information (e.g., NPIs or Medicaid IDs), missing signatures, or other errors. In 2023, nearly 50 percent of our POFs are resulting in withdrawal, which leads to delays in assessment and costs the District.
What physicians should know:
- Medicaid beneficiaries CANNOT access PCA and other LTSS without their order for the assessment.
- They may complete a “streamlined” application to serve as an “ordering-only” physician in Medicaid, meaning they may order Medicaid services but not provide Medicaid services. This is especially helpful for physicians who mostly see our dual eligibles (e.g., Kaiser physicians). They can create an account and look for the streamlined app on www.dcpdms.com.
- Signatures are REQUIRED on the POF, whether completed electronically or by paper.
- POFs submitted without a physician signature – or signed by a physician not enrolled with Medicaid – are withdrawn and do not result in an assessment.