[Congressional Record (Bound Edition), Volume 152 (2006), Part 7]
[Extensions of Remarks]
[Page 9970]
[From the U.S. Government Publishing Office, www.gpo.gov]




      THE DISTRICT OF COLUMBIA MEDICAID REIMBURSEMENT ACT OF 2006

                                 ______
                                 

                       HON. ELEANOR HOLMES NORTON

                      of the district of columbia

                    in the house of representatives

                         Thursday, May 25, 2006

  Ms. NORTON. Mr. Speaker, I introduce the District of Columbia 
Medicaid Reimbursement Act of 2006 today to raise the federal medical 
assistance percentage (FMAP), the federal contribution from the federal 
government, to 75 percent from 70 percent and to reduce the District's 
unique role as the only city that pays the full local cost of Medicaid, 
a program that is carried by states and counties in our country. New 
York City, the jurisdiction that powers the economy of New York State, 
contributes a 25 percent local share to Medicaid while the state pays 
25 percent, less than the District's statutorily mandated 30 percent 
contribution. I introduce this bill because the District's continuing 
responsibility for most Medicaid costs that are typically borne by 
entire states is a major component of the District's structural deficit 
and threatens the stability of the city itself.
  The District's Chief Financial Officer reports that rapidly 
increasing Medicaid costs put the city at risk. In FY 2005, these costs 
accounted for $1.4 billion or 22 percent of the city's gross funds 
budget. Total program costs have risen 42 percent since 1999, and are 
projected to increase by another $39 million this year. Yet the 
District, unlike other large cities which have lost significant 
populations, has no state and no state economy to share this burden. 
More than 25 percent of District children and adults are enrolled in 
Medicaid compared to 12 percent in Maryland and just 9 percent in 
Virginia. On average, the District spends over $7,000 per enrollee, 
while Maryland and Virginia spend $5,509 and $5,177, respectively, 
reflecting serious health conditions that are concentrated among big 
city residents.
  The D.C. Medicaid Reimbursement Act of 2006 is the seventh in the 
``Free and Equal D.C.'' series. This series of bills addresses 
inappropriate and often unequal restrictions placed only on the 
District and no other U.S. jurisdiction. Although today's bill cannot 
address the entire structural problem that the District faces because 
the city is not part of a state, the bill would eliminate the greater 
percentage the District pays than any city by allowing a 25 percent 
city contribution, rather than a contribution even greater than New 
York City.
  In 1997, as part of the Balanced Budget Act, Congress recognized that 
state costs were too costly for anyone city to shoulder. To alleviate 
the resulting financial crisis, Congress increased the federal Medicaid 
contribution to the District from 50 to 70 percent, and took 
responsibility for a few state costs--prisons and courts--relieving the 
immediate burden, but the city continues to carry most state costs.
  In 1997, a formulaic error in the Medicaid Disproportionate Share 
Hospital (DSH) allotment reduced even the 70 percent FMAP share, and as 
a result, the District received only $23 million instead of the $49 
million due. I was able to secure a technical correction to the 
Balanced Budget Act of 1999, partially increasing the annual allotment 
to $32 million from FY 2000 forward. I appreciate that last year, 
Congress responded to my effort to get an additional annual increase of 
$20 million in the budget reconciliation bill, bringing D.C.'s Medicaid 
reimbursement payments to $57 million as intended by the Balanced 
Budget Act. This amount did not reimburse the District for the years a 
federal error denied the city part of its federal contribution, and in 
any case, of course, was not intended to meet the structural problem 
this bill partially addresses.
  The District has taken important steps on its own to reduce Medicaid 
costs through greater efficiency, and to treat and prevent conditions 
that prove costly when hospitalization or expensive treatments become 
necessary. The District Medicaid agency won federal recognition as one 
of only two Medicaid programs nationwide to exceed the federal 
government's child immunization goal for school-age children at 95 
percent, and improved its fraud surveillance, recovering $15 million in 
fraudulently billed funds. The city's novel D.C. Health Care Alliance, 
for which federal approval is pending, would allow coverage of 
residents and provide more early and preventative care, avoiding huge 
Medicaid costs when health conditions become severe and Medicaid 
becomes the only option.
  I urge my colleagues to join me in supporting this increase that will 
help my city's most needy residents.

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