Norton Introduces Bill to Give D.C. Equal Medicaid Treatment

WASHINGTON, DC – With the third anniversary of the enactment of federal health care reform law on Saturday, Congresswoman Eleanor Holmes Norton (D-DC) today introduced the District of Columbia Medicaid Reimbursement Act, to relieve the District of a portion of Medicaid costs it has uniquely borne for years. The bill is particularly important for the District today in light of the new health care reform law, which, among other things, expands Medicaid eligibility to reduce the number of uninsured Americans. Medicaid is financed mostly by the federal government and the states. However, the District, a city that has no state to support it, must alone absorb the state portion of Medicaid. For example, the District pays for 30 percent of Medicaid. New York City pays less than 25 percent, since a 2005 state law reduced its contribution from 25 percent. The District certainly should pay no more than New York City's pre-2005 contribution and therefore Norton's bill would raise the federal contribution to the District's Medicaid program to 75 percent. The bill would complete what the Congresswoman 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.

The bill is part of Norton's series of bills to end the unequal treatment of the District of Columbia and its residents. She said, "As the Revitalization Act before it, the bill addresses the untenable situation of a city, especially one with congressionally imposed revenue limitations, paying state costs. D.C. equality is more than voting rights, budget autonomy, equal respect and treatment for our soldiers, and a statue in the Capitol. It also means removing old practices that deny the city equal shares."

Norton's introductory statement follows.

Statement of Congresswoman Eleanor Holmes Norton

On the Introduction of

The District of Columbia Medicaid Reimbursement Act of 2013

March 19, 2013

Mr. Speaker, as we approach the third anniversary of the enactment of the Patient Protection and Affordable Care Act, March 23, 2013, which, among other things, expands eligibility for Medicaid to reduce the number of Americans without health insurance, I introduce the District of Columbia Medicaid Reimbursement Act of 2013 today to increase the federal government's reimbursement for the District of Columbia's Medicaid costs from 70 to 75 percent. Medicaid is financed mostly by the federal government and the states. However, the District, a city that has no state to support it, must alone absorb the state portion of Medicaid. For example, the District pays for 30 percent of Medicaid. New York City pays less than 25 percent, since a 2005 state law reduced its contribution from 25 percent. The District certainly should pay no more than New York City's pre-2005 contribution and therefore my bill would raise the federal contribution to the District's Medicaid program to 75 percent. Considering the expansion of Medicaid eligibility under the new health care reform law, effective 2014, now is the time to make the District's Medicaid burden more equitable.

Under the National Capital Revitalization and Self-Government Improvement Act of 1997 (Revitalization Act), Congress recognized that state costs are too high for any city to shoulder. To address this unfairness to the District, the Revitalization Act transferred certain state responsibilities from the District to the federal government, including 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 my 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 federal contribution, and, in any case, of course, was not intended to eliminate the District's structural deficit, which this bill partially addresses.

The bill is part of my series of bills for equal treatment of D.C. The series of bills addresses inappropriate and often unequal restrictions placed only on the District, and no other U.S. jurisdiction.

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

Published: March 19, 2013