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
You're Not Dreaming - Prior Auth Reform Passes the DC Council
November 7, 2023, is a day DC physicians have wanted to see for a long time. That is because today prior authorization reform has passed the DC Council.
B25-124, the Prior Authorization Reform Amendment Act, passed via the Council's consent agenda at its legislative meeting. With the second vote to pass, the bill is considered passed by the Council and will now go to the Mayor for her signature.
This bill is not perfect and it will not solve every prior auth issue in the District. But when it goes into effect, it will allow DC to join 40 other states who have passed some restrictions on prior authorization.
MSDC thanks Councilmember Brooke Pinto and the other council members who introduced and supported the bill. We also thank MedChi DC, other DC physician organizations, the American Medical Association, DC Hospital Association, DC Primary Care Association, DC Behavioral Health Association, and other healthcare organizations that helped advocate for this legislation.
The bill will now go to the Mayor who will hopefully sign the bill. Once she signs it - or it goes into effect without her signature - the bill will go through a Congressional review period. After that, the legislation can go into effect. We anticipate this will be in the early spring of 2024.
Our advocacy work is not yet done. The legislation applies immediately to private insurers but must be funded to apply to Medicaid. MSDC and partners will continue to push for funding for the bill in the DC budget. MSDC will also seek technical corrections and updates in future bills to adapt to the changing healthcare environment and address if/when insurers avoid the bill's requirements.
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