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 Allies Testify to Pass Copay Accumulator Act
MSDC members Drs. Angus Worthing and Klint Peebles joined a panel of patient advocates and residents to ask the Committee on Health to pass 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.
Dr. Worthing is a rheumatologist with a practice in DC and resides in DC. He testified as to how copay accumulators negatively impact his patients by delaying care. In his comments he noted:
Just how critical are these medications? The typical person with rheumatoid arthritis using copay assistance programs has already experienced disabling joint pain, fatigue, and other symptoms for about nine months before even getting diagnosed. Then they tried older, less-expensive first-line medications for several months. For the roughly half of people who were failed by these drugs, more expensive specialty drugs usually are effective and help them get back to work, school, and caring for family. It’s heartbreaking to see the look of fear and anxiety on my patients’ faces when they can’t afford the medications that rescued them from the pain they had for months or years until they started drugs that worked for them.
Dr. Peebles also focused on the negative impact copay accumulators have on his patients affording their medication. As a dermatologist, he noted, he sometimes needs to prescribe costly, long-term treatments for conditions that impact lifestyles and wellbeing of patients. Coupons for medications can make these prescriptions affordable, but copay accumulators backload costs and push patients to abandon these treatments when they see a large bill for their medication made larger by the fact that insurance companies count their savings against them.
Joining the physicians were representatives from the ALS Association, HIV + Hepatitis Policy Institute, the Arthritis Foundation, and the National Psoriasis Foundation. Those organizations testified to what they had seen in other states and what they themselves experienced when insurance companies refused to recognize coupons or count payment assistance programs against patients.
The next step for B24-557 is for a markup in the Committee on Health. MSDC will be watching closely but welcomes physicians to speak up and speak out on this important issue. For more information, contact our office.