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
How does UnitedHealthcare Dual Complete impact my patients?
Content provided by UnitedHealthcare Community & State District of Columbia
UnitedHealthcare offers a Medicare Advantage plan in the District of Columbia known as UnitedHealthcare Dual Complete® (PPO D-SNP), a Dual Special Needs Plan (D-SNP), for individuals who are eligible for both Medicaid and Medicare.
In 2023, UnitedHealthcare will offer three Medicare Advantage plans in the District of Columbia: UnitedHealthcare Dual Choice, UnitedHealthcare Dual Choice One, UnitedHealthcare Dual Choice Unity. D-SNP eligible enrollees can include low-income individuals and people with disabilities who are 21 and older. Individuals must qualify for Medicaid and Medicare separately. While most qualify for Medicare once they reach 65, some younger adults with disabilities also qualify.
Enrollees can continue to access core Medicare benefits along with Part D (pharmacy) benefits and targeted clinical programs and services. Additionally, the plan offers supplemental benefits and services that are not typically available through Original Medicare or Medicaid at no extra cost. These may include:
Dental coverage
Dental services including emergency care visits, covered exams, cleanings, X-rays, fillings, crowns, bridges, root canals and extractions and dentures
OTC+ Healthy Food
$80 a month on a prepaid card for over-the-counter (OTC) and covered groceries in-store or online
Prescription drug coverage
$0 copay or coinsurance for all covered generic and brand name prescription drugs at a network pharmacy
$0 prescription drug deductible
Routine vision care
$0 copay, 1 routine eye exam every year and 1 pair of standard lenses and frames every year. Standard lenses that are covered in full include single vision, lined bifocal, lined trifocal, lenticular, and Tier I (standard) progressive lenses.
OR
Contact lenses instead of standard lenses and frames every year
AND
$250 allowance toward the purchase of frames (fitting and evaluation may be an additional cost) or contact lenses (fitting and evaluation may be an additional cost).
Routine hearing coverage
$0 copay for a routine hearing exam and coverage for a wide selection of hearing aid styles.
Routine transportation
Enrollees are eligible for $0 copay for 24 one-way rides to or from approved locations, such as medically related appointments, gyms, and pharmacies. Once the 24 visits are utilized, enrollees may be eligible for additional transportation visits to approved locations under their Medicaid Benefit for routine & urgent provider appointments, follow-up visits, hospital discharges and urgent care services.
Renew Active® Fitness Program
Get a free gym membership to participating fitness locations, digital workout videos and live stream classes, access to the Fitbit® Community for Renew Active, an online brain health program from AARP® Staying Sharp®, local classes and events and more.
UnitedHealthcare at Home
The UnitedHealthcare at Home in-home visits support the care our enrollees are already getting from their regular doctors. A UnitedHealthcare at Home advance practice clinician, such as a nurse practitioner or physician assistant, visits the enrollee in the home.
Personal Emergency Response System (PERS)
In an emergency, the PERS system quickly connects the enrollee with a trained operator. The operator can give assistance over the phone and send help if needed. PERS is a life-saving benefit that’s available 24 hours a day.