(Washington, DC) – Today, Mayor Muriel Bowser called on Congress to maintain the District’s Federal Medical Assistance Percentage (FMAP) at its current level. The Mayor, Councilmembers, and health care leaders emphasized that changes to DC’s FMAP will have severe impacts on the city’s entire health care system.
“Congress must reject any proposal to reduce DC’s Federal Medical Assistance Percentage. We’re not just talking about percentages and formulas – we are talking about people’s real ability to go to the doctor, to access life-saving care. A cut of the District's Medicaid FMAP rates to 50% would result in a staggering $2.1 billion loss in funding for our hospitals, universities, and community providers. A loss of that magnitude will be felt by everyone who accesses care in DC,” said Mayor Bowser. “If the proposed change takes effect, it will devastate our health care systems in Washington, DC.”
FMAP determines the share of Medicaid costs covered by the federal government. Since the 1997 Revitalization Act, Congress has set DC’s FMAP at 70% to reflect the District’s unique financial constraints. DC performs the functions of a city, county, and state, but lacks the revenue-generating tools traditionally granted to states. For example, DC cannot tax the income of the more than 60% of workers who commute into the city from surrounding jurisdictions, an option available to other states. Congress, under then-Speaker Newt Gingrich, set the higher FMAP rate to acknowledge this constraint on the District’s ability to raise revenue for programs like Medicaid.
“Cuts to Medicaid funding will hurt everyone who lives in, works in, and visits our nation’s capital,” said Jacqueline Bowens, President and CEO of DC Hospital Association. “Cutting Medicaid would lead to reductions in services at hospitals, weaken preparedness for emergencies, and threaten public safety by jeopardizing police, fire, ambulance, education, substance abuse, mental health, and homeless services.”
If Congress reduces DC’s FMAP to 50%, the District will lose over $2.1 billion in total program funding. This would affect critical services including:
- $67 million in lost Medicaid reimbursements for DC Fire and EMS
- $10 million in cuts to the Special Education Transportation Department
- Reductions in funding for hospitals, clinics, schools, and long-term care providers
“The Medicaid cuts that have been proposed would put essential health care services for children at risk,” said Michelle Riley-Brown, president and CEO of Children’s National Hospital. “As an independent, top ten children’s hospital nationally, Children’s National cares for more than 250,000 children every year from all 50 states, DC and Puerto Rico. Medicaid covers more than half of our patients and is a critical foundation for all the high-quality and highly specialized services that we provide. It is essential to protect the District’s Medicaid funding to avoid these severe consequences for patients and families in our community and across the country.”
Over 285,000 DC residents rely on Medicaid for their health coverage, including 95,000 infants and children, 28,000 seniors, and 27,000 people with disabilities. A cut of this magnitude would devastate the District’s health care infrastructure, threaten jobs, and delay or deny care to residents, workers, and visitors alike.
“Cutting the District’s FMAP rate would decimate our Medicaid program and destabilize the entire regional healthcare system,” said At-Large Councilmember Christina Henderson. “Thousands of District residents will lose health care coverage, emergency department and specialty care wait times will dramatically rise for everyone, and we will see more severe illness and premature death across the region. A cut in FMAP would erase all the gains we’ve made in public health over the past two decades.”
These cuts come as DC already faces a $175 million Medicaid shortfall in FY26 and a $1.01 billion drop in projected revenue due to recent federal workforce reductions.
The District shares Congress’s commitment to being responsible stewards of taxpayer dollars. Under Mayor Bowser’s leadership, DC has controlled costs by implementing some of the most advanced Medicaid waste and fraud prevention tools in the nation, using provider ID requirements and automated residency checks to target potential cases of fraud. Additionally, DC has achieved 29 consecutive balanced budgets, 28 consecutive clean audits, fully funded pensions, and has 52 days of cash on hand.
Congress must preserve DC’s FMAP and ensure the nation’s capital can continue delivering critical health services.
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