"It is imperative that our constituents, and those who seek care within our jurisdictions, have reliable access to health care," "Cuts to Medicaid will have devastating impacts regionally and nationwide, decreasing the availability of providers and services, forcing millions of American families to lose coverage, and increasing wait times for patients in need. Moreover, cuts threaten our region’s health centers, hospitals, nursing homes, home and community-based care providers, and behavioral health providers."

Dear Chairman Guthrie, Ranking Member Pallone, Chairman Carter, and Ranking Member DeGette:

We write in strong opposition to the proposals contemplated in the FY25 Budget Resolution to cut Medicaid. It is imperative that our constituents, and those who seek care within our jurisdictions, have reliable access to health care. Cuts to Medicaid will have devastating impacts regionally and nationwide, decreasing the availability of providers and services, forcing millions of American families to lose coverage, and increasing wait times for patients in need. Moreover, cuts threaten our region’s health centers, hospitals, nursing homes, home and community-based care providers, and behavioral health providers. These indispensable providers serve low-income, military-connected, and disabled children and adults, and play a unique role in our nation’s capital.

We write with particular concern regarding proposals to reduce the Federal Medical Assistance Percentage (FMAP) for the District of Columbia. Such a change would be catastrophic, destabilizing the health care system of the Washington, D.C. metropolitan region and beyond and impacting the hundreds of thousands of constituents who live, work, travel through, or receive care in D.C. each day. Notably, this includes Members of Congress and their staff, members of the administration, visiting dignitaries, and their families, as well as families across the country who rely on D.C.’s specialized care. We all depend on and expect our nation’s capital to have a quality, responsive health care system. Efforts to weaken that system through cuts to Medicaid undermine the stability and resilience our region requires and would have reverberating effects across the country.

In 1997, a Republican Congress passed the National Capital Revitalization and Self-Government Improvement Act of 1997 (Revitalization Act), which established the current 70 percent D.C. FMAP and transferred certain functions and costs from the D.C. government to the federal government. Congress passed the Revitalization Act in part because it recognized that it imposes unique revenue limitations on D.C., which operates as a state, county, and city. Congress imposes three main revenue limitations on D.C.: D.C. cannot tax income earned in D.C. by nonresidents, depriving D.C. of more than $3 billion in revenue per year; D.C. cannot permit buildings to exceed certain height limitations; and D.C. cannot tax its sizable federal property.

As it currently stands, other jurisdictions are entitled to a higher FMAP than D.C. The Consolidated Appropriations Act, 2023 set the FMAP for American Samoa, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands permanently at 83% and set the FMAP for Puerto Rico at 76% through FY 2027. Five states (Mississippi, West Virginia, Alabama, New Mexico, and Kentucky) have FMAPs that are higher than D.C.

Reducing D.C.’s FMAP would weaken care for all in the Washington, D.C. metropolitan region, regardless of insurance status. Medicaid supports nearly a quarter of D.C.’s population, including 3 in 7 children and 4 in 5 nursing home residents. For example, proposals to reduce D.C.’s FMAP from 70 percent to 50 percent would create a $1.1 billion annual hole in local funds and ultimately result in a total loss of $2.1 billion per year in program funds to local hospitals, universities, and providers. This equates to a 40 percent cut in funding directly impacting health care providers. Hospitals in the region project at least $232 million in uncompensated care due to D.C.’s FMAP reductions, with at least one medical system expecting to close altogether. Impacts would reverberate across fire and emergency services, police recruitment and retention, and behavioral health resources and threaten the ability of hospitals and other safety net providers to stay open. Community-based providers in Virginia and Maryland risk being overwhelmed, as demand rises from D.C. residents seeking timely care.

Further, without corresponding funding or infrastructure support, it would be challenging for the rest of the region to shoulder the responsibility for regional emergency response. D.C.’s four Level I trauma centers, including those at Children’s National Hospital and MedStar Washington Hospital Center, provide vital care for patients in major incidents or emergency situations, including those involving Members of Congress, federal employees, and visitors. Reducing D.C.’s FMAP would have a particularly disproportionate impact on the provision of trauma and specialty capacities, principally for burn and pediatric patients.

Reductions to D.C.’s FMAP would adversely limit regional access to life-saving and specialized pediatric care. We note with particular alarm the potential impacts on Children’s National, which provides specialized care to patients from all 50 states, including West Virginia, Pennsylvania, Florida, and North Carolina. 73% of hospital stays and emergency department visits at Children’s National are covered by Medicaid. Reductions in Medicaid funding would likely result in the hospital making significant cuts to primary care, behavioral health, and outpatient subspecialty services, with families having to travel further to obtain such care or going without it. Further, local federally qualified health centers (FQHCs) anticipate that a change to D.C.’s FMAP would result in a loss of coverage for more than 33,000 adult health center patients and a loss of $58 million in payments, leaving them unable to serve over 24,000 of their current patients.

Reductions to D.C.’s FMAP would be catastrophic for our local providers and pose grave challenges to ensuring patients in the mid-Atlantic region and beyond receive necessary care. As you consider potential policy options through Budget Reconciliation, we urge you to strongly oppose all cuts to Medicaid and to protect the current FMAP for the District of Columbia.

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