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
Mayor Bowser Issues Emergency Order Addressing MedStar's MCO Status
On Wednesday, DC Mayor Muriel Bowser issued an emergency order ordering the Deputy Mayor of Health and Human Services to address the contractual dispute that would see MedStar not accept non-emergency Medicaid patients.
The order, seen here, directs Deputy Mayor Wayne Turnage to, "take such actions and implement such measures as may be necessary or appropriate to protect the health and safety of persons in the District of Columbia". The basis of the emergency order is the ongoing pandemic public emergency.
MedStar Family Choice was one of three insurers chosen for the District's managed care contract in 2020. However, a contract protest led to MedStar's removal as one of the MCOs this year. In August, MedStar informed the other two MCOs that it was terminating its contract with them, meaning Medicaid and Alliance beneficiaries would not have in-network access to MedStar facilities except for emergency room admissions. The Mayor's order in essence would extend that MedStar MCO contract for nine months past the September expiration date.
On Thursday, MSDC joined the DC Hospital Association, DC Primary Care Association, DC Behavioral Health Association, and DC Health Care Association in a joint letter to the Mayor and Council. The letter does not take a position on the contract dispute but rather urges both branches of government to work together on a long-term solution. The letter states:
We are still in the midst of the COVID-19 pandemic and it’s more important than ever to make certain there is no disruption for Medicaid beneficiaries and District residents who need access to all the essential primary, specialty and hospital care services and related support services. As the City’s largest group of health care providers, we recognize firsthand the lingering impact and negative consequences that limited access and delayed care can have on a patient’s health outcome. We can ill afford to create any barriers that will interfere with current or future health care visits, screenings, procedures, hospitalizations, or other necessary services. All patients, regardless of their health care plans, must have access to health care services when and where they need them. We must remain committed to addressing health care inequity and reduce barriers to care, not increase them.
The Deputy Mayor's office recently shared it is exploring reopening the contracting process to add substance abuse and behavioral health services to the contract. MSDC is planning a webinar on the ongoing MCO process and will share details when it becomes available.
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