As ACA Open Enrollment Begins This Week, Norton Introduces Bill to Increase Federal Reimbursement to D.C. Medicaid Program

WASHINGTON, D.C.—With the 2015-2016 open enrollment period for the Patient Protection and Affordable Care Act launching this week, Congresswoman Eleanor Holmes Norton (D-DC) today introduced a bill to relieve the District of a portion of Medicaid costs it has uniquely borne for years. Norton's bill would increase the federal government's reimbursement for Medicaid costs from 70 to 80 percent. Raising the federal government's contribution to 80 percent would make the District's contribution to Medicaid equal to the contribution paid by New York City in 2012-2013. The District pays for 30 percent of Medicaid, more than any U.S. city. Medicaid is financed mostly by the federal government and the states, but the District is a city with no state to contribute to it.

"My bill would increase the federal government's Medicaid reimbursement for D.C. to match the level it pays to New York City," Norton said. "The District should certainly contribute no more to Medicaid than the New York City, which has a huge tax base."

The bill would complete what Norton started with the National Capital Revitalization and Self-Government Improvement Act of 1997, when she got Congress to pay 70 percent of the District's Medicaid costs, rather than the crippling 50 percent it had been paying, which had been partly responsible for the city's economic crisis in the 1990s.

Norton's full introductory statement is below.

Statement of Congresswoman Eleanor Holmes Norton
On the Introduction of
The District of Columbia Medicaid Reimbursement Act of 2015
November 4, 2015​

Mr. Speaker, today, I introduce the District of Columbia Medicaid Reimbursement Act of 2015 as open enrollment begins this week for the Patient Protection and Affordable Care Act. That important legislation, among other things, expands eligibility for Medicaid to reduce the number of Americans without health insurance. My bill increases the federal government's reimbursement for a portion of the District's Medicaid costs from 70 to 80 percent. In 2012-2013, New York City, the jurisdiction that powers the economy of New York State, contributes a 20 percent share for Medicaid costs, while the state pays 33 percent, less than the District's federally mandated 30 percent contribution.

Medicaid is financed mostly by the federal government and the states. However, 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 the New York City 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.

Under the National Capital Revitalization and Self-Government Improvement Act of 1997 (Revitalization Act), Congress recognized that state costs are inappropriate for any city to shoulder. To address this unfairness to the District, the Revitalization Act transferred certain, but not all, state responsibilities from the District to the federal government, including the cost of prisons and courts, and increased the federal Medicaid reimbursement to the District from 50 to 70 percent, partially relieving this burden. The city continues to carry many state costs, however.

In 1997, a formula error in the Medicaid Disproportionate Share Hospital allotment reduced the 70 percent Federal Medical Assistance Percentage 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. However, this amount did not reimburse the District for the years the federal error denied the city part of its rightful federal contribution.

I urge my colleagues to join me in supporting the bill.