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: Notification of Policy Change-Physician Administered Drug Reimbursement Rates
The Centers for Medicare and Medicaid Services (CMS) recently approved an update to the District of Columbia (DC) Medicaid State Plan. The State Plan Amendment allows the Department of Health Care Finance (DHCF) to modify the reimbursement methodology for physician-administered drugs.
Background
DHCF conducted a comprehensive review of the existing reimbursement methodology for physician-administered drugs. Under the previous reimbursement methodology, the "Buy & Bill" providers were reimbursed at 80% of the Medicare Part B reimbursement rate for the ingredient (drug/biologic/biosimilar), except for chemotherapy drugs - which were reimbursed at 100% of Medicare Part B reimbursement rates. Recognizing the financial challenges faced by healthcare providers, DHCF acknowledges that the previous reimbursement rates were insufficient, often falling below the acquisition cost. This discrepancy has, in some cases, rendered the provision of services financially unsustainable, creating a disincentive for providers to offer care to beneficiaries. Consequently, this situation has posed a significant barrier to beneficiaries seeking timely access to essential treatments.
New Policy
DHCF recently received CMS State Plan approval to increase the reimbursement rates for all physician-administered drugs to 100% of Medicare reimbursement rates under the “Buy & Bill” policy. This adjustment aims to better align reimbursement with the actual costs incurred by providers, promoting financial sustainability and, ultimately, improving access to care for DC Medicaid Fee-for Service beneficiaries. This change will have a positive impact on the healthcare landscape, addressing the challenges faced by providers and facilitating more accessible and timely care for beneficiaries. The SPA that reflects this policy change is available at: DC-23-0012.pdf (medicaid.gov).
Policy Effective Date
The effective date of the change is October 1, 2023. All previously submitted claims, impacted by the publication of this transmittal, will be reprocessed by February 29, 2024.
Contact
If you have questions, please contact Amy Xing, Reimbursement Analyst, Office of Rates Reimbursement and Financial Analysis, Department of Health Care Finance (DHCF) at amy.xing2@dc.gov or (202) 481-3375.