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
Issues on 719A Form (Prior Authorization) for DC Medicaid patients
Physicians who take care of DC Medicaid patients faces significant challenges for all sorts of reasons and at different levels. There’s the inherent difficulty of medical management coupled with patients dealing with social determinants of health, and physician and staffing shortages among others. Then there’s the administrative burden bought about by rules and policies issued by the DC Department of Health Care Finance. One of which is the required 719A (prior authorization) form for all services and DMEs that is prescribed to a patient.
As an example, it had been a practice that any patient who needs a continuous supply of DME like incontinence and DM testing supplies needs to have a 719A form filled out monthly. For a practice like ours here at the Internal Medicine Clinic at Medstar Washington Hospital Center where majority of our patients have the Medicaid insurance, it is quite a burden having to repeatedly process these forms. In fact a survey among local hospital IM practices confirms that this is a significant issue persistently bogging them down.
With the help of MSDC though its Advocacy Committee, we were able to meet up with representative from DHCF and made clarifications on rules of issuing 719A forms. DHCF has now made an official clarification to physician practices and DME providers that such monthly 719A form is not required but can only be done every 6 months.
We were also able to bring up the issue of getting the 719A paper form into some electronic version and DHCF is now working with their IT department to see how this electronic form can be streamlined to help with this work flow.
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