To amend title XIX of the Social Security Act to amend the Federal medical assistance percentage for the District of Columbia for fiscal years after 2019, and for other purposes.

Mr. Speaker, today, I introduce the District of Columbia Medicaid Reimbursement Act of 2018, the seventh time I have introduced this bill. My bill would increase the federal government's share of the District's Medicaid expenditures, known as the federal medical assistance percentage (FMAP), from 70 to 80 percent. The District, a medium-sized American city, should not pay more than other large cities. For example, in 2012-2013, New York City, the jurisdiction that powers the economy of New York State, contributed 20 percent of the state's Medicaid costs, while the state paid 33 percent, less than the District's federally mandated 30 percent contribution.

When the District faced financial difficulty as the only city to pay for state functions, Congress, with the District's consent, passed the National Capital Revitalization and Self-Government Improvement Act of 1997 (Revitalization Act), which transferred from the District to the federal government the costs and/or operations of several state functions, including prisons, courts and offender supervision. The Balanced Budget Act of 1997, which included the Revitalization Act, statutorily set D.C.'s FMAP at 70 percent. The District's financial crisis was largely the result of the District's uniqueness as the only city responsible for paying for state functions, while the federal government also imposed unique revenue limitations on the District. All of the revenue limitations remain. Congress recognized that state costs are inappropriate for a city to shoulder, though the District has continued to carry many of these burdens like a state.

Medicaid is a joint federal-state program. The FMAP statutory minimum is 50 percent and the maximum is 83 percent. Local funds may constitute up to 60 percent of a state's share. The FMAP formula is based on a state's per capita income relative to the national average, and the higher a state's per capita income, the lower the FMAP. If the District operated under the FMAP formula, as it did prior to the Revitalization Act, the federal government would pay only 50 percent of D.C.'s Medicaid expenditures.

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 New York City's 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.

On December 21, 2017, Representative Morgan Griffith introduced a bill (H.R. 4709) that would blow a massive hole in the District's budget by reducing the FMAP for D.C. from the current 70 percent to 54 percent. Under the bill, beginning in fiscal year 2020, the federal government would pay the higher of the FMAP formula or a FMAP fixed percentage that decreases until it reaches 54 percent in 2027 and thereafter. This Griffith bill demonstrates a complete misunderstanding of the uniqueness of D.C.'s structure and economy and the intent of the Revitalization Act. I will fight to defeat this backwards bill.

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

In conclusion, this bill would treat the District just like the federal government treats other large cities when it comes to Medicaid reimbursement rates, and I urge my colleagues to join me in supporting this bill.