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
Fed's Prior Auth Reforms Mirror DC Law
CMS's announcement yesterday of new reforms to the Medicare Advantage, Medicaid, and Affordable Care Act plans' prior authorization rules are a huge step in reducing physician paperwork burden. They also mirror legislation passed by DC and supported by MSDC last year.
Among other changes, the new rules would require coverage for urgent treatments within 72 hours and seven day for non-urgent treatments. Insurers will also need to publicize prior authorization denial rates and justifications for denials. Changes will mostly be in place by 2026. However, the changes do not apply to all drug prescriptions.
These reforms were similar to those included in then-B25-124, the Prior Authorization Reform Amendment Act. That legislation applied to the private insurance market and (as of February) implements shorter turnaround times, more insurer disclosures and reporting, and more protections for patients' treatments from process abuse. The DC law did require funding in the District budget to apply to Medicaid and Alliance programs, although it is unclear how the new CMS requirements change this calculus.