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.
.png?sfvrsn=9ac2d21b_0 "What Medicaid Cuts Actually Cost")
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
What to know about DC and the 2024 election
Locally, the 2024 election is over. The implications, however, are just beginning.
MSDC staff are analyzing the results of the national and local elections, and while there is still much we do not know, there are still some things that are clear the day after this election.
DC elections
- The DC Council members up for reelection all won: Robert White (at large), Christina Henderson (at large), Brooke Pinto (Ward 2), Janeese Lewis-George (Ward 4), and Trayon White (Ward 8). In Ward 7, Wendell Felder won the election to replace MSDC award winner Vincent Gray.
- Councilmember Gray would vacate the Hospital and Health Equity Committee Chairmanship in the next Council. However, the committee may go away with Gray stepping away from the Council. Council Chair Phil Mendelson will announce in the coming weeks the committee structure for 2025-2026 which will include Chairs and committee jurisdictions. Committee on Health Chair Christina Henderson should continue having oversight of the health realm.
National elections
- Congress oversees the District through two committees: Senate Committee on Homeland Security and Governmental Affairs, and House Committee on Oversight and Accountability. The Senate Committee's subcommittee of jurisdiction is Oversight of Government Management.
- NB there will be changes as members of Congress move around due to seniority and as other committee positions come available. But based on what we know, here are the players in Congress that could oversee DC affairs.
- The Senate will be controlled by Republicans. The current Homeland Security Ranking Member (presumed Chair) is Rand Paul (KY) and subcommittee ranking member is James Lankford (OK). Senator Paul trained as an ophthalmologist but has fought many of the health policies of the Biden Administration.
- The House majority is still up in the air. The Chair of the Oversight Committee is James Comer (KY) and the ranking member is Jamie Raskin (Maryland). DC Delegate Eleanor Holmes Norton serves on the committee and 119th Congress rules could determine how active she could be.
How national election results can influence DC medicine
- Congress has a required review period for all District laws passed into law. Congress or the relevant committees can hold a vote to override a law before it goes into effect - this requires a majority in both chambers and the president signing the override bill. This means any bill passed by the Council, if it catches the eye of the Congressional majority or president, could be subject to review.
- As many know, the appropriations process allows the federal government to place restrictions or permissions for executing DC law. Long-time political people know that abortion riders and marijuana riders restricting how the District can implement policy in these areas are common. In the current Congress, proposed riders expanded to include things as mundane as no turn on red light laws. The new Congress could expand riders to prohibit DC government money from being spent on numerous health policies.
Want to learn more, stay engaged in this conversation, or be proactive on health policy in the District? Join the MSDC Advocacy Committee - our next call is tonight at 6pm. Contact Robert Hay at hay@msdc.org to learn more.