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, AMA Issue Joint Statement Supporting Prior Auth Reform Bill
For Immediate Release
April 5, 2022
Physicians Advocate for Removal of Health Insurance Barriers to Care in District of Columbia
Survey finds prior authorization requirements delay care and harm patients
WASHINGTON – The American Medical Association (AMA) joined the Medical Society of the District of Columbia (MSDC) in supporting a bill to reform the health insurer-imposed approval processes for medical procedures, treatments, and drugs. In a letter delivered today to the Council of the District of Columbia’s Committee on Health, the two physician organizations urged immediate action on the Prior Authorization Reform Act of 2022 as a critically needed measure to rein in bureaucratic insurance requirements that delay and disrupt patient access to necessary medical care in the District of Columbia.
Survey data released in February by the AMA show that more than nine in 10 physicians (93%) reported care delays while waiting for health insurers to authorize necessary care, and more than four in five physicians (82%) said patients abandon treatment due to authorization struggles with health insurers.
Despite a 2018 commitment from the health insurance industry to streamline prior authorization processes for patients, physicians report that the burden is dramatically increasing, causing a variety of problems for their patients and their practices. In fact, more than one-third (34%) of physicians reported that prior authorization led to a serious adverse event, such as hospitalization, disability, or even death, for a patient in their care.
To help ensure that District patients get the care they need in a timely manner, the Prior Authorization Reform Act of 2022 was introduced by Councilmembers Mary Cheh, Charles Allen, Anita Bonds, Janeese Lewis George, and Vincent Gray. The reform bill would realign what has become a very broken system by introducing new transparency and clinical validity requirements to ensure patients have access to care.
“Prior authorization is one of the biggest impediments to patient care, and this legislation would allow physicians to treat their patients without unnecessary paperwork and delays,” said MSDC President Kirstiaan Nevin, M.D.
“Providing quality care to patients is the top priority of physicians, but waiting for a health plan authorization can delay and disrupt patient-centric care with a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles,” said AMA President Gerald Harmon, M.D. “Almost four years after agreeing with physicians on needed improvements, the health insurance industry has made little progress toward those goals. Failure of health insurers to achieve agreed-upon improvements illustrates a clear opportunity for District councilmembers to rein-in prior authorization requirements that adversely impact patient health.”
In the face of inaction by health insurance companies, it is time for District councilmembers to streamline prior authorization requirements so patients can receive the treatment they need, when they need it. For more information visit: www.fixpriorauth.org.
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Media Contacts:
Robert J. Mills
American Medical Association
Email: robert.mills@ama-assn.org
Pia Duryea
Medical Society of the District of Columbia
Email: duryea@msdc.org
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