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
MSDC Joins Health Associations Asking for Centralize Medicaid Credentialing
On November 19, the Medical Society of DC joined the DC Primary Care Association and other local health associations on a memo arguing for centralized credentialing.
The memo addresses the leadership of the Department of Health Care Finance regarding credentialing of Medicaid providers. Currently in the District a physician or healthcare provider needs to be credentialed by five different entities to ensure they are reimbursed for seeing Medicaid patients. This process leads to delays and gaps in care, leading providers at times to be unable to see certain Medicaid patients and cause offices to do more paperwork.
The memo (see below) asks DHCF to centralize credentialing and points to other states successfully doing just this. In addition the memo asks DHCF to implement credentialing requirements consistent with Maryland that has shown to speed up credentialing.
As local budget challenges continue and federal funding of Medicaid at current levels is unlikely in the future, it is critical that DHCF adopt now improvements to streamline the delivery of care.
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To: Lisa Truitt, Director, Health Care Delivery and Management Association, Department of Health Care Finance
From: Patricia Quinn, VP of Policy and Partnerships, DC Primary Care Association
Justin Palmer, VP, Public Policy & External Affairs, DC Hospital Association
Mark LeVota, Executive Director, District of Columbia Behavioral Health Association
Robert Hay Jr., Executive Vice President, Medical Society of DC
Veronica Sharpe, President, District of Columbia Health Care Association
Kurt Gallagher, Executive Director, DC Dental Society
Ian Paregol, Executive Director, DC Coalition of Disability Service Providers
Re: Recommendation for Centralized Medicaid Provider Credentialing
Date: November 19, 2024
CC: Melisa Byrd, Senior Deputy Director, Medicaid Director, Department of Health Care Finance
Ruth Pollard, President and CEO, DC Primary Care Association
The DC Primary Care Association, our member health centers, and our partners in the health care delivery system including the DC Hospital Association, the DC Behavioral Health Association, the Medical Society of DC, the DC Health Care Association, the DC Dental Society, and the DC Coalition of Disability Service Providers are grateful for the support of the Department of Health Care Finance (DHCF) as we work to solve issues impacting patient access and provider sustainability. As initially described in our February 2023 memo, the process to credential providers for participation in Medicaid managed care networks is burdensome, lengthy, and often opaque. Credentialing delays significantly impact our ability to address current well-documented workforce shortages, and we urge DHCF to take regulatory steps to improve the timeliness and clarity of credentialing process.
In the District, providers must submit documents to no fewer than five separate entities in order to be credentialed by all Medicaid payers. To ease provider burden, DHCF should centralize credentialing, requiring a single standardized process at the District level instead of an individual process with each MCO. Some state examples include:
1. In Ohio, a Managed Care Procurement division of Medicaid runs the Centralized Credentialing program, contracting with Maximus, Inc to serve as a single point of contact (Centralized Verification Organization or CVO) and to develop agreements for delegated credentialing arrangements with health system
2. In North Carolina, a 2018 Centralized Credentialing “concept paper” led to the development of centralized provider enrollment via the NCTracks system. North Carolina reports processing turn-around statistics on their NCTracks website.
3. In Mississippi, providers are credentialed by the Medicaid agency, pursuant to language updated in their 2022 managed care contracts and following 2021 legislation requiring a uniform process.
DCPCA and our partners at DCHA, DCBHA, MSDC, DCHCA, DC Dental, and DC Coalition also recommend that DHCF implement specific credentialing requirements consistent with Maryland’s insurance statute 15-112 that would significantly improve the credentialing process for providers including:
- Requiring notice to providers within 10 days of submission of incomplete applications and steps to remediation
- Requiring notice within 30 days of submission presumptive intent to credential, allowing provisional billing to begin
- Mandating transferal of credentialing status when providers change employer
DHCF has an opportunity to act expeditiously in support of providers facing well-documented post-pandemic workforce and fiscal pressures. We look forward to working in partnership to implement needed changes to the District’s credentialing processes before the close of 2024
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