Initial Medicaid Implementation: The District of Columbia began its Medicaid program in July 1968. The initial implementation faced a difficult beginning as only two of the ten hospitals in the district decided to join the Medicaid program. The hospitals objected to the low payment rates as the District proposed paying 80% of the costs initially. This dispute continued for a year until a deal was reached and coverage was available in all hospitals.
Key Medicaid Political Issues: The unique state and federal relationship of the district as well as the urban dynamic of the city have presented exceptional challenges for the District’s Medicaid program. In 1996 the District and Congress came to an agreement on how the District would finance its Medicaid program. The District has the most generous eligibility in the nation with the income eligibility levels often being above 200-300% of the poverty level. The District also has several programs adjacent to their Medicaid program that provides coverage for undocumented immigrants and people at higher incomes. The FMAP is set into federal law at 70% as a result of an agreement with the federal government in 1996. For the most part, DC is treated like a state in Medicaid law with the exception of some financing rules which are complex in part because of the complex nature of the role of Congress in the District’s budget.
Medicaid Expansion Implementation: The District expanded Medicaid early beginning enrollment in 2011. The state had an existing program that did not receive federal matching levels. The early expansion of the Medicaid program allowed the District to take advantage of federal funds, greatly reducing the financial burden to the District. DC later expanded Medicaid under the Affordable Care Act with the higher federal match and integration with the state’s individual market.
General facts about Medicaid in the District of Columbia:
Medicaid program name: Medicaid
CHIP Program name: DC Healthy Families
Separate or combined CHIP: Medicaid Expansion
Medicaid Enrollment: 271,500 (2017 estimate)
Total Medicaid Spending: $2.8 billion (FY 2016)
Share of total population covered by Medicaid: 26% (2016)
Share of Children covered by Medicaid: 50% (estimate)
Share of Medicaid that is Children and Adults: 73% (2014)
Share of Spending on Elderly and people with disabilities: 59% (2014)
Share of Nursing Facility Residents covered by Medicaid: 80% (estimate)
Expansion state: Yes
Number of people in expansion: 62,600 (2016)
Work Requirement: No