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
AMA Survey: Payers Failing to Fulfill Prior Auth Promises
In 2018, the medical and payer communities announced a voluntary agreement to reform the prior authorization process. Four years later, a new survey shows the payer side is failing to live up to its agreements.
In the survey released Tuesday (see here), over 1,000 physicians were interviewed about the impact of prior authorization on their practice. The results show that some promised reforms are just that - promised. For example:
- 9% (not a typo) of respondents reported "contracting with health plans that offer programs that exempt providers from [prior authorizations]"
- 65% (prescription) and 62% (service) of providers reported it is difficult to determine if their order requires a prior auth request.
- 26% of doctors reported their EHRs enable electronic prior auths for prescriptions
- 88% of doctors still say prior auths interfere with their continuity of care for patients.
“Authorization controls that do not prioritize patient access to timely, optimal care can lead to serious adverse consequences for waiting patients, such as a hospitalization, disability, or death,” AMA President Gerald Harmon, M.D., said in a statement. “Comprehensive reform is needed now to stem the heavy toll that continues to mount without effective action.”
MSDC is leading an effort in the District to force change in the prior authorization process. Bill B24-655 would align the District with reforms seen in many other states and outlined as best practice by the AMA. MSDC is pushing the Committee on Health to hold a hearing on B24-655 to allow patients and providers to share their stories. If you would like to get involved in MSDC's effort, visit msdc.org/priorauth or contact hay@msdc.org.