The New Healthy DC Plan is Covering Enrolees Effective 1/1/26

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.

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

The New Healthy DC Plan is Covering Enrolees Effective 1/1/26

Jan 21, 2026, 08:40 by The DC Health Benefits Exchange

Ask your patients if their insurance has changed then check it - thousands of DC residents have changed their insurance and do not realize the consequences.

Nearly 16,000 DC residents were automatically moved from DC Medicaid into a new program called Healthy DC Plan on January 1, 2026 when Medicaid eligibility changed December 31, 2025. See below for critical information and please share this information with your facility and medical office staff who work checking patients in for appointments or confirming insurance

DC residents losing Medicaid were automatically enrolled into a Healthy DC Plan.

DC residents with AmeriHealth Caritas and Medstar Family Choice Medicaid MCOs were automatically transitioned into a Healthy DC Plan with the same insurance company. DC residents with Wellpoint Medicaid MCO were automatically enrolled into the CareFirst BlueCross BlueShield Healthy DC Plan.

All Healthy DC Plans mailed each enrollee a new member ID card. Even Healthy DC Plan enrollees with AmeriHealth Caritas or Medstar Family Choice have a new card with a new Healthy DC Plan ID number.
A Medicaid ID number CANNOT be used to confirm Healthy DC Plan enrollment.
The Medicaid portal CANNOT be used to confirm Healthy DC Plan enrollment.

Where can I confirm enrollment for Healthy DC Plan?

You can access the provider portals for the three insurance companies offering Healthy DC Plan below. If you do not have a patient’s new Healthy DC Plan ID number, you will need to call the insurance company’s provider customer service.