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
We want your prior auth stories
The #FixDCPriorAuth campaign continues.
As the summer heat sets into DC, it is more critical than ever to remind the Council, Bowser administration, and public that prior authorizations harm care and real reform can be passed this year. One of the most effective ways to do this is to make it clear that prior authorizations harm all kinds of patient care. Often people have one or two personal experiences with a prior auth, but they may not realize that it touches every part of medicine.
To help make clear how widespread prior auths are, send us your stories about how a prior authorization impacted you, your patient, or your practice.
We will keep you anonymous (or share your name if you want) but we will use these stories to show policymakers, the media, and the public how important of an issue this is. We will also include them on our Prior Auth Reform page.
Below are some examples we have already collected. Send your examples to hay@msdc.org:
My patient was denied access to a particular birth control pill she had been on successfully before, and my office was told she needed to try and fail on 5 different generic pills before she could be approved. - OB/GYN
I spent 90 minutes of time with the prior authorization department and an additional 30 minutes with the pharmacy and the patient all because they changed their formulary and would not "grandfather him in". - Psychiatrist
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