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
The Prior Authorization Reform Amendment Act of 2023 Introduced by DC Council
On February 7, Councilmember Brooke Pinto introduced The Prior Authorization Reform Amendment Act of 2023. Based on last year's legislation introduced by then-Councilmember Mary Cheh, the bill borrows heavily from the American Medical Association's model legislation that incorporates best practices from across the country.
In her office's release on the legislation, the Councilmember said, "No District resident should suffer or have their condition worsened because of unreasonable delays from their health insurance. This legislation regulates and holds health insurers accountable so DC residents can receive needed medical care in consultation with their health care provider in a timely manner.”
The legislation was co-introduced by Health Committee Chair Christina Henderson, Hospital and Health Equity Committee Chair Vincent Gray, Councilmember Charles Allen, Councilmember Janeese Lewis George, Councilmember Anita Bonds, Councilmember Robert White, and Councilmember Trayon White.
According to the press release, the “Prior Authorization Reform Amendment Act of 2023” will:
- Set explicit, reasonable timelines for insurers to respond to prior authorization requests and appeals. Lay out the qualifications of personnel who make these determinations;
- Clarify how insurers are to make information on prior authorization determinations available to patients and their medical providers and require that insurers accept and use a standardized method for submission and review of prior authorization requests;
- Prohibit insurers from requiring prior authorization for treatment based solely on cost;
- Require insurers honor a prior authorization granted to an enrollee from a previous insurer for at least the initial 60 days of an enrollee’s coverage under a new health plan;
- Require that employers provide timely notice to employees of medications and treatments covered under their insurer’s standard health benefit plan, but not covered under the negotiated terms of the employer’s bespoke plan.
There will be much more to come on this issue, but physicians and providers interested in learning more can visit msdc.org/prior auth or contact us at 2O2-466-18OO / hay [at] msdc.org
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