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 and Coalition Partners Send Letter in Support of Copay Accumulator Legislation
On the day of its committee hearing, MSDC and coalition partners sent a letter to Chair Vincent Gray supporting B24-557, the Copay Accumulator Amendment Act. The legislation is strongly supported by MSDC as a way for patients who rely on specialty drugs to treat their conditions, and who may have high out-of-pocket costs or high deductibles they are required to meet.
The legislation was introduced last year by Councilmember Mary Cheh and four colleagues. The bill would require health insurers to apply discounts, financial assistance, payments, product vouchers and other reductions in out-of-pocket expenses made by or on behalf of a member when calculating the member’s coinsurance, copayment, cost-sharing responsibility, deductible, or out-of- pocket maximum for a covered benefit.
The text of the letter is below.
June 27, 2022
The Committee on Health
Council of the District of Columbia
1350 Pennsylvania Ave NW
Washington, DC 20004
Re: hearing on B24-557
Dear Chair Gray,
Thank you for holding this hearing on B24-557, the Copay Accumulator Amendment Act. The bill will positively impact residents who rely on specialty drugs to treat their conditions, and who may have high out-of-pocket costs or high deductibles they are required to meet.
In recent years, health insurers and pharmacy benefit managers have been implementing new programs called “copay accumulator adjustment programs” that do not count payments from copay assistance toward patients’ deductibles and out of pocket maximums. In other words, the assistance is not actually helping patients afford their high-cost treatments, forcing them to choose between their health and financial stability.
B24-557 will help residents continue to access the treatments they need by requiring that all payments made by or on behalf of a patient count toward their cost sharing obligations.
Deductibles have been outpacing inflation for over a decade and the COVID-19 pandemic has only exacerbated the financial strain that these high deductibles and out-of-pocket costs put on patients and their families. To maintain their health and quality of life, patients turn to copay assistance from manufacturers and nonprofits to afford their medications
For people with arthritis, cancer, HIV, MS, psoriasis, and other chronic conditions, specialty medications are often the only effective treatment options available. The specialty medications required to manage these complex conditions are consistently placed on the highest cost-sharing tier of health plan and pharmacy benefit manager formularies. When facing high out-of-pocket costs, patients do not use their medications appropriately, skipping doses to save money or abandoning treatment altogether. Unfortunately, patients who stop using their medications due to high costs end up having more emergency room visits and negative health outcomes, which increases overall health care costs.
Insurance carriers and pharmacy benefit managers have said that copay accumulator adjustment programs reduce health care spending by encouraging patients to try cheaper alternatives; however, when patients do not have access to the medications they rely on, health care spending increases. A vast majority of copay assistance is used for treatments that do not have a generic alternative. Patients often do not realize their copay assistance was not counted toward their deductible or out-of-pocket maximum until they are told they owe hundreds or thousands of dollars at the pharmacy.
B24-557 will ensure residents who rely on specialty medications can continue to access their treatments through the help of copay assistance. This is especially important as deductibles continue to rise. We understand that there are many factors contributing to the cost of health care, but patients should not be punished for using copay assistance to help them afford the treatments they need.
We urge you to help DC join 14 other states that passed legislation on copay accumulators and protect residents’ health.
Sincerely,
MSDC
American Diabetes Association
Aimed Alliance
ASCO
Chronic Disease Coaltion
DC Rheumatology
Hemophilia Association of the Capital Area
Hemophilia Federation of America
HIV + HEP Policy Institute
Lupus and Allied Diseases Association
Alliance for Patient Access
ALS Association
Arthritis Foundation
Washington Psychiatric Society