[Congressional Record Volume 164, Number 12 (Friday, January 19, 2018)]
[Extensions of Remarks]
[Page E71]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      THE DISTRICT OF COLUMBIA MEDICAID REIMBURSEMENT ACT OF 2018

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                       HON. ELEANOR HOLMES NORTON

                      of the district of columbia

                    in the house of representatives

                        Friday, January 19, 2018

  Ms. NORTON. Mr. Speaker, today, I introduce the District of Columbia 
Medicaid Reimbursement Act of 2018, the seventh time I have introduced 
this bill. My bill would increase the federal government's share of the 
District's Medicaid expenditures, known as the federal medical 
assistance percentage (FMAP), from 70 to 80 percent. The District, a 
medium-sized American city, should not pay more than other large 
cities. For example, in 2012-2013, New York City, the jurisdiction that 
powers the economy of New York State, contributed 20 percent of the 
state's Medicaid costs, while the state paid 33 percent, less than the 
District's federally mandated 30 percent contribution.
  When the District faced financial difficulty as the only city to pay 
for state functions, Congress, with the District's consent, passed the 
National Capital Revitalization and Self-Government Improvement Act of 
1997 (Revitalization Act), which transferred from the District to the 
federal government the costs and/or operations of several state 
functions, including prisons, courts and offender supervision. The 
Balanced Budget Act of 1997, which included the Revitalization Act, 
statutorily set D.C.'s FMAP at 70 percent. The District's financial 
crisis was largely the result of the District's uniqueness as the only 
city responsible for paying for state functions, while the federal 
government also imposed unique revenue limitations on the District. All 
of the revenue limitations remain. Congress recognized that state costs 
are inappropriate for a city to shoulder, though the District has 
continued to carry many of these burdens like a state.
  Medicaid is a joint federal-state program. The FMAP statutory minimum 
is 50 percent and the maximum is 83 percent. Local funds may constitute 
up to 60 percent of a state's share. The FMAP formula is based on a 
state's per capita income relative to the national average, and the 
higher a state's per capita income, the lower the FMAP. If the District 
operated under the FMAP formula, as it did prior to the Revitalization 
Act, the federal government would pay only 50 percent of D.C.'s 
Medicaid expenditures.
  The District, a city with no state to contribute to it, must alone 
absorb the state portion of Medicaid. Thus, the District pays for 30 
percent of Medicaid, more than any U.S. city. Considering the 
difference in the size of its tax base, the District should certainly 
contribute no more than New York City's contribution to Medicaid. 
Therefore, my bill would raise the federal contribution to the 
District's Medicaid program to 80 percent, equal to that of New York 
City.
  On December 21, 2017, Representative Morgan Griffith introduced a 
bill (H.R. 4709) that would blow a massive hole in the District's 
budget by reducing the FMAP for D.C. from the current 70 percent to 54 
percent. Under the bill, beginning in fiscal year 2020, the federal 
government would pay the higher of the FMAP formula or a FMAP fixed 
percentage that decreases until it reaches 54 percent in 2027 and 
thereafter. This Griffith bill demonstrates a complete misunderstanding 
of the uniqueness of D.C.'s structure and economy and the intent of the 
Revitalization Act. I will fight to defeat this backwards bill.
  In 1997, a formula error in the Medicaid Disproportionate Share 
Hospital allotment reduced the 70 percent FMAP share, and, as a result, 
the District received only $23 million instead of the $49 million it 
was due. I was able to secure a technical correction in the Balanced 
Budget Act of 1999, partially increasing the annual allotment to $32 
million from fiscal year 2000 forward. I appreciate that, in 2005, 
Congress responded to our effort to get an additional annual increase 
of $20 million in the budget reconciliation bill, bringing D.C.'s 
Medicaid reimbursements to $57 million, as intended by the 
Revitalization Act, although this amount did not reimburse the District 
for the years the federal error denied the city part of its rightful 
federal contribution.
  In conclusion, this bill would treat the District just like the 
federal government treats other large cities when it comes to Medicaid 
reimbursement rates, and I urge my colleagues to join me in supporting 
this bill.

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