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
DHCF Ends X-Waiver Requirement to Prescribe SUD Medications
The Director of the Department of Health Care Finance (“DHCF”), pursuant to the authority set forth in Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6)) and An Act To enable the District of Columbia to receive Federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (D.C. Law 25-1; D.C. Official Code § 1-307.06), hereby gives notice of the adoption, on an emergency basis, of an amendment to Chapter 27 (Medicaid Reimbursement for Fee For Service Pharmacy Services) of Title 29 (Public Welfare) of the District of Columbia Municipal Regulations (“DCMR”) and the intent to adopt the these rules as a final rulemaking not less than thirty (30) days after the date of publication of this notice in the District of Columbia Register.
The emergency and proposed rulemaking makes changes to Section 2710 (Claims Reimbursement Requirements for Pharmacies) and Section 2799 (Definitions) to align District policy with recent federal policy changes regarding controlled substances. In section 1262 of the Consolidated Appropriations Act, 2023, enacted December 29, 2022 (P.L. No 117-328; 136 Stat. 4459), Congress eliminated the “DATA-Waiver Program.” This program required providers to have a waiver (called DATA-waivers or X-waivers) to prescribe medications, such as buprenorphine, to treat substance use disorder. As such, the District has required licensed prescribers to include their X-DEA identification number from their waiver on prescriptions for certain controlled substances. Because no X-DEA numbers will be issued or required under the new federal policy, the Department of Health Care Finance has decided to repeal the current requirement that a prescriber provide their X-DEA number in order for a prescription for a covered controlled substance to be reimbursable under the District’s Medicaid fee-for-service program.
Subsection 2710.4 has been updated to remove the requirement that a prescription must include the X-DEA number of the licensed prescriber for buprenorphine and naloxone drug preparations. Subsection 2799.1 is also amended to remove the definition of “X-DEA number” as it is no longer referenced in Chapter 27.
Emergency action is necessary for the immediate preservation of the health, safety, and welfare of District Medicaid beneficiaries. This rule is being enacted on an emergency basis to expand the number of providers eligible to receive Medicaid reimbursement for prescribed drugs such as buprenorphine that treat substance use disorder in order to mitigate the effects of the opioid epidemic.
The emergency rulemaking was adopted by the DHCF Director on June 21, 2023 and became effective on that date. The emergency rules will remain in effect for one hundred and twenty (120) days or until October 19, 2023, pursuant to Section 6 of the District of Columbia Administrative Procedure Act, approved October 21, 1968 (82 Stat. 1206; D.C. Official Code § 2-505(c) (2016 Repl.)), unless superseded by further emergency or final rulemaking.
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