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
Prior auth bill introduced but work left to be done
As shared recently, MSDC is delighted that Councilmember Pinto and eight of her colleagues reintroduced the Prior Authorization Reform Amendment Act of 2023. This legislation would have the biggest, most positive impact on the practice of medicine in years. Among other things, the bill would:
- Require prior auths to be for medical reasons only
- Set time limits on the denial and approval processes
- Require those reviewing prior auths to be locally licensed and of relevant specialties
- Expand the amount and kind of public reporting needing to be done on insurers' sites about prior auth
The bill was introduced formally on February 7. However, Chairperson Phil Mendelson assigned the bill to the Business and Economics Committee, not the Committee on Health as hoped. While MSDC has a good relationship with Mr. McDuffie, the Chair of the Committee, we view this as healthcare and wellness legislation, not a money and business bill.
This week, MSDC President Dr. Susanne Bathgate sent a letter to Chair Mendelson, asking him to consider a re-referral. The message is copied below but Dr. Bathgate stressed that the issue last Council was considered a health issue, and should be considered as such this Council.
While we wait for a hearing announcement, what can MSDC members and physicians do?
- Learn about the bill via our section-by-section guide
- Reach out to the following Councilmembers who have not declared support for the bill: Chair Mendelson, Councilmember Kenyan McDuffie, Councilmember Matt Frumin, and Councilmember Brianne Nadeau (we can help).
- Thank the Councilmembers who have supported the bill (see here).
- Email Robert Hay to be added to the prior auth communication list
There is more to come on this issue, so stay tuned to MSDC for updates and ways to get involved.
Dear Chair Mendelson:
As President of the Medical Society of DC and Chair of the Board of Directors, we write to you today to ask you to reconsider your assignment of B25-124, the Prior Authorization Reform Amendment Act, to the Committee of Business and Economics.
We do not do this lightly, and do this not because we disrespect Chair McDuffie. Rather, we feel it is important the bill is considered by the Committee on Health because prior authorization is a healthcare, not business, issue.
At the heart of this issue is who should make medical decisions for patients. For too long, insurance companies have been allowed to delay or deny care for patients without recourse or reporting. Our members can tell stories of patients denied care across specialties and treatment. We list some of the most egregious examples on our website (e.g., a patient denied prescription birth control until they tried a generic five times).
Last Council session, this legislation was assigned to the Committee on Health. The Mayor’s Healthcare Work Force Task Force addresses this issue as a healthcare burnout and workforce issue, not an insurance business issue. Assigning the legislation to the Committee on Health allows it to be considered as a bill concerning the health of District residents and their care, which is what it is.
We thank you for your service to our patients and urge you to re-refer B25-124 to the Committee on Health.
Sincerely,
Susanne Bathgate, MD
President, Medical Society of DC
J. Desiree Pineda, MD
Chair of the Board of Directors, Medical Society of DC