[Congressional Record (Bound Edition), Volume 153 (2007), Part 13]
[Extensions of Remarks]
[Pages 18652-18653]
[From the U.S. Government Publishing Office, www.gpo.gov]




INTRODUCTION OF THE DISTRICT OF COLUMBIA MEDICAID REIMBURSEMENT ACT OF 
                                  2007

                                 ______
                                 

                       HON. ELEANOR HOLMES NORTON

                      of the district of columbia

                    in the house of representatives

                        Wednesday, July 11, 2007

  Ms. NORTON. Madam Speaker, I introduce the District of Columbia 
Medicaid Reimbursement Act of 2007 today to raise the Federal medical 
assistance percentage, FMAP, the Federal contribution from the Federal 
Government from 70 percent to 75 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, according to the 
District's Chief Financial Officer, CFO.
  The District's CFO reports that rapidly increasing Medicaid costs put 
the city at risk. In FY2005, 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 cities which have 
lost significant populations, has 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 in this majority African-American 
city.
  The D.C. Medicaid Reimbursement Act of 2007 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 by allowing a 25 percent city 
contribution, rather than the current contribution that is even greater 
than New York City's.
  In 1997, as part of the Balanced Budget Act, Congress recognized that 
State costs were too costly for any one 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 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 FY2000 forward. I appreciate that in 2005, 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. However, 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

[[Page 18653]]

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.

                          ____________________