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
Dual Eligible Special Needs Plans Help Coordinate Medicare and Medicaid Benefits
Content provided by UnitedHealthcare Community & State District of Columbia
A Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan designed for people who are eligible for both Medicare and Medicaid. Currently, nearly 3.8 million individuals are enrolled in a D-SNP across the 45 states offering them. While 12 million individuals across the U.S. qualify for enrollment in a D-SNP, many are not enrolled.
Individuals who are dually eligible for Medicare and Medicaid are more likely to experience challenges in accessing health care services, lower quality of care, and below-average health outcomes when compared with the general population. Sixty-two percent of individuals who are eligible for a D-SNP manage chronic conditions and 64% have a mental health diagnosis. Centralizing care from Medicare and Medicaid through a D-SNP makes health care easier to navigate.
Integrated Care Coordination Supports Complex Medical and Social Needs
D-SNPs have extensive care coordination requirements that enable more integrated, effective care and continuity for this diverse, high-needs population. This allows the managed care organization to assess comprehensive needs, identify health issues before they worsen, and implement a person-centered care plan that offers timely, coordinated services and improved health outcomes.
The care manager is able to specifically tailor the care plan to meet the individual’s needs while accessing both Medicare and Medicaid benefits. This improves both the care experience and health outcomes for members.
This coordination lowers costs by removing duplicative and unnecessary services and ensuring that members receive the care they need when they need it.
2023 Changes Enhance Opportunities for Holistic Care Planning
Starting in 2023, the Centers for Medicare & Medicaid Services (CMS) will require plans to add new questions related to housing stability, food security, and transportation access for members’ Health Risk Assessments. These social determinants of health must be addressed in the individual’s plan of care. The new rules create opportunities for states to monitor quality ratings more completely and to align D-SNPs more closely with their Medicaid programs.