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
Over 120 Physicians Sign Letter Asking for Prior Auth Hearing
MSDC sent a letter to Committee on Health Chair Vincent Gray on June 14 asking for a hearing on B24-655 before the summer recess. Signing the letter were over 120 DC physicians and healthcare providers representing 21 different zip codes.
The letter was sent because the committee announced a hearing on June 27 to consider four different bills. One of them is MSDC-endorsed B24-557, the Copay Accumulator Amendment Act, on which MSDC and a number of other organizations will be testifying for. As of now, the prior authorization bill is not on the agenda, despite an overwhelming desire from the community for a hearing on this important issue.
B24-655 would enact a number of commonsense reforms adopted by numerous other states when it comes to prior auths. The bill would require a medical reason for the prior auth, ensuring appropriate medical professionals are doing the utilization reviews, set a standard time for insurers to honor the issued prior auths, and more. The bill is modeled after American Medical Association (AMA) model language and has been reviewed by MSDC and numerous other medical associations. The legislation would be the most positively impactful bill for medicine in years.
Physicians, healthcare providers, and patients interested in getting involved can visit msdc.org/priorauth to learn more. MSDC encourages everyone interested to testify on behalf of B24-557 on June 27 and, if it is added, B24-655.
The text of the letter is below:
Sincerely