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 Testimony at MCO Hearing
Today, MSDC President Dr. Dock Winston and Advocacy Committee Chair Dr. Klint Peebles testified before the Committee on Health at the Managed Care Organizations (MCO) roundtable. The roundtable explored how the MCOs are covering care in the District for the Medicaid population.
Dr. Winston's testimony focused on the issue of "downcoding" and the negative impact of downcoding on affordable care.
Downcoding is not just a billing tactic; it is a barrier to care. It forces physicians to spend hours appealing denials instead of seeing patients. It destabilizes independent practices that already operate on thin margins. And most importantly, it harms patients who risk losing access to thorough, comprehensive visits.
See Dr. Winston's testimony here.
Dr. Peebles testimony focused on MCO's compliance with the recently enacted prior authorization legislation.
The Prior Authorization Reform Amendment Act was an achievement to help provide equitable care to residents of the District. But without vigilant oversight, its promise risks being undermined. On behalf of our patients and the physicians who serve them, I urge this committee to continue demanding accountability and transparency from MCOs.