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
Join the DC FMAP Sign-On Letter
Congress is considering reducing the DC FMAP from 70% to 50% (or lower). Some of the likely consequences include:
- Cuts to health care professional training programs, including residencies.
- Reduced reimbursement for all providers.
- Staff reductions at hospitals and health systems.
- Longer wait times at hospitals.
- Closures of healthcare facilities.
All physicians, regardless of practice type, will be impacted by this reduction. MSDC is circulating a physician sign-on letter that we are sending to physician members of Congress asking them to oppose these changes. Our hope is that your peers will understand how these changes could impact medicine locally, even their offices.
The text of the letter is below and on the sign-up form.
The deadline to sign the letter is May 3 by 12 PM ET. That will allow us to deliver the letter to the members' offices ASAP.
May 2, 2025
Dear fellow physician and Representative,
We, the undersigned physicians who practice and/or are licensed to practice in the District, express our strong opposition to any changes to the District of Columbia’s Federal Medical Assistance Percentage (FMAP) as part of the reconciliation process. The reduction in Medicaid revenue for health care providers and health systems in the District would have a ripple effect throughout the entire health system, 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.
As a fellow physician, you know that major changes to patient coverage lead to unintended consequences for the entire health system. Changing the FMAP for the District will have regional impacts in care and endanger access to healthcare for everyone in the District, including visitors and workers who live elsewhere. Reducing the FMAP would equate to a 40% cut in funding directly impacting health care professionals and likely would mean reductions in the healthcare workforce, service cuts for all care, and a destabilization for training for healthcare providers of many different types. Everyone who utilizes healthcare in DC would be severely impacted by this change, regardless of if they are a DC resident.
We urge you as a colleague to consider the consequences of an FMAP change in the District and support excluding this change from reconciliation language.
Sincerely,