[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[Extensions of Remarks]
[Page 28628]
[From the U.S. Government Publishing Office, www.gpo.gov]




      THE DISTRICT OF COLUMBIA MEDICAID REIMBURSEMENT ACT OF 2009

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                       HON. ELEANOR HOLMES NORTON

                      of the district of columbia

                    in the house of representatives

                      Thursday, November 19, 2009

  Ms. NORTON. Madam Speaker, I introduce the District of Columbia 
Medicaid Reimbursement Act of 2009 today to raise the federal medical 
assistance percentage (FMAP), or contribution of the federal government 
from 70 percent to 75 percent, and to reduce the District's unique role 
as the only city, except for New York, that pays any portion of 
Medicaid, an expense 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 the share of Medicaid costs typically 
borne by entire states is a major component of the District's 
structural deficit and a threat to the financial stability of the city 
itself, according to the District's Chief Financial Officer (CFO). 
Today, in the midst of an unprecedented recession and of structural 
change in the U.S. economy, this burden is not sustainable. 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.
  In 1997, as part of the Balanced Budget Act, Congress recognized that 
state costs were too high for any one city to shoulder. To alleviate 
the resulting financial crisis in the District, Congress increased the 
federal Medicaid contribution to the District from 50 to 70 percent, 
and took responsibility for some, but not all, 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 DC'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. Now, with health care before the 
Congress, the time has come to close the loop on this leftover issue.
  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 DC 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.
  The DC Medicaid Reimbursement Act of 2009 is the eighth in the ``Free 
and Equal DC'' 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 at least make the city no worse off than the 
only other city that contributes to Medicaid.
  I urge my colleagues to join me in supporting this increase that will 
help my city's most needy residents.

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