District of Columbia Medicaid Fairness Act
Term Dictionary
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- Congress.gov Legislative Glossary - Comprehensive congressional terms
- NVFC Congressional Terms Glossary - Concise, easy-to-understand definitions
The gist
Phases out DC's guaranteed 70% federal Medicaid match by 2030, forcing the District to pay a bigger share of healthcare for its low-income residents.
Who wins, who loses
Wins: federal taxpayers and Republicans who argue DC gets preferential treatment over states.
Loses: roughly 270,000 DC Medicaid enrollees, DC's budget, and hospitals serving low-income patients.
What it does
Amends Section 1905 of the Social Security Act governing the Federal Medical Assistance Percentage (FMAP).
Keeps DC's match at 70% through fiscal year 2026.
Drops it to 65% in 2027, 60% in 2028, 55% in 2029.
Starting fiscal year 2030, DC uses the standard state formula (likely around 50%).
Why should I care?
Supporters say DC shouldn't get a sweeter deal than states like Texas or Mississippi, which have poorer residents but lower federal matches. Critics argue DC has no voting representation in Congress and can't raise taxes like a state, so cutting the match could shrink coverage for teens on Medicaid and the Children's Health Insurance Program (CHIP). Where do you land? Vote below and use "Tell Your Rep" to make sure your voice reaches Congress.