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
How to Ensure Your Practice is Paid for Medicaid Services
Please see below from DC Medicaid
As you are aware, DHCF is transitioning to a new fiscal agent / claims payment vendor – Gainwell - on March 2, 2026. Beginning March 2nd, Gainwell will be responsible for:
- Adjudication and payment of valid health care claims;
- Operating the call centers for provider inquiry and Electronic Data Interchange (EDI) technical support; and
- Provider, beneficiary, and other provider inquiry web portal functions.
Provider training sessions kicked off on January 6, 2026, and will continue through the transition period. To register for training, providers must access the MMIS Learning Center at https://mmislearningcenter.myabsorb.com as referenced in the introductory training email providers received from Gainwell.
Last week, Gainwell sent a letter to providers with an overview of what to expect with the transition and the steps providers need to take starting February 2, 2026, to register with the new system. It is imperative that providers register prior to March 2nd – if providers fail to register with the new system, they will not be able to submit claims and receive payment. A sample of the letter is attached for your awareness, and I ask that you amplify the letter and its messaging with your members. Your support will help ensure a seamless transition.
I also want to call to your attention to the impact on the payment cycle once the new system goes live. There will be a one-week delay in payment when the new system goes live. Specifically, there will be no payments made on Friday, March 6, 2026. The first payments from the new Gainwell system will occur on Friday, March 13, 2026. Providers should plan accordingly if they are accustomed to weekly payments.
As of Tuesday, the new Gainwell portal is live and can be accessed at https://medicaid.dc.gov. If you look under the Provider tab, you will find the links to provider training and more information. Below recaps the key dates starting this month going forward.
January 6th: Provider training sessions kicked-off
January 20th: Portal go-live (https://medicaid.dc.gov)
February 2nd: Provider registration opens
March 2nd: System go-live
March 13th: First payment from the Gainwell system
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