District of Columbia Medicaid Fairness Act (HR 5815)

Summary

The District of Columbia Medicaid Fairness Act (HR 5815) is a bill introduced in the U.S. House of Representatives on October 24, 2025. The main purpose of this legislation is to address the inequitable treatment of the District of Columbia in the Medicaid program by granting the District the same federal Medicaid funding match rate as U.S. states.

Key Provisions

• Amends the Social Security Act to provide the District of Columbia with the same federal medical assistance percentage (FMAP) for Medicaid as is provided to the 50 U.S. states.
• The current FMAP for DC is lower than the average state, resulting in the District having to contribute a larger share of Medicaid costs compared to states.
• This bill would increase the federal Medicaid matching funds provided to DC, reducing the District's financial burden for the program.
• Applies the new FMAP rate retroactively to fiscal year 2021, requiring the federal government to provide additional Medicaid reimbursements to DC for prior years.

Impact

• The increased federal Medicaid funding would benefit the approximately 300,000 DC residents enrolled in Medicaid, improving access to healthcare services.
• It would also provide budgetary relief to the District government, which currently has to allocate a larger portion of its own funds to Medicaid compared to U.S. states.
• Supporters argue this change is necessary to address the historical inequity in how DC is treated in the Medicaid program compared to states.
• If enacted, the bill would take effect immediately upon becoming law, with the retroactive FMAP increase applying starting in fiscal year 2021.