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
Avoid a MIPS Penalty Due to Nationwide IV Fluid Shortage
In response to AMA advocacy urging CMS to hold physicians harmless from Merit-based Incentive Payment System (MIPS) penalties as a result of the nationwide IV fluid shortage and to reopen the MIPS Extreme and Uncontrollable Circumstances (EUC) hardship exception, the agency announced that it will accept new applications to avoid a MIPS penalty. We greatly appreciate CMS for recognizing that physicians and their patients continue to face hardships due to the nationwide shortage of IV fluids exacerbated by Hurricane Helene in September 2024 and a severe winter respiratory season leading to lower supply and increased demand for these drug products.
Physicians will be able to submit an EUC hardship exception application between March 31, 2025, and April 14, 2025, to avoid a MIPS penalty of up to -9% if they were affected by the shortage. This hardship exception will apply to the 2024 performance period, which will adjust Medicare payments in 2026. To avoid a MIPS penalty, physicians who were affected by the IV fluid shortage should submit an EUC application requesting reweighting of all four MIPS categories – quality, cost, promoting interoperability, and improvement activities. Note that CMS will not reweight any performance category for which the agency has received data. However, if three performance categories are reweighted to 0% and only one performance category can be scored, then the physician or group will earn a final score equal to the performance threshold and avoid a MIPS penalty. Additionally, because the MIPS cost performance category relies entirely on claims-based measures that do not require submission from physicians or groups, we recommend requesting reweighting of this category if a physician or group needed to conserve IV fluids, use alternatives, restrict access to elective surgery or take any other measures due to the nationwide IV fluid shortage. In addition, CMS is extending the MIPS data submission window for the 2024 performance period for two weeks from March 31, 2025, until April 14, 2025, at 8 pm ET.
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