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
Information on DC's medical debt bill
The Committee on Health will mark up B26-438, the Medical Debt Mitigation Amendment Act of 2025, on April 7. The intent of the bill is to prevent patients from going into (further) debt when receiving medical care.
The most important thing to note is the bill applies very differently if your practice is regulated as a healthcare facility by DC Health. This distinction was key, as a reminder, during the certificate of need reforms MSDC led two years ago.
If your practice is not a hospital or ambulatory surgical center, the new bill would prohibit your practice from calling in debt collectors on patients or running a debt collection-type business to secure payment from patients.
If your practice falls under the healthcare facility definition, there are a number of changes coming if the bill remains unamended:
- The facility would be required to report annually to DC Health the type and amount of financial assistance programs offered to patients.
- Each patient will have access to a financial assistance policy created by the healthcare facility.
- Payment should not be collected until a patient applies for financial assistance and it is accepted.
- The facility has the responsibility to determine a patient's need for financial assistance if they request it by using proof of income documents.
- Patients with household incomes of 200% or less of the federal poverty level can receive free care, and discounted care for patients with within 500% of the federal poverty level on a sliding scale.
- Just as above, the facility may not call debt collectors for unpaid bills.
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