Health Equity
Medicaid Enrollment Touches 39% of the Residents of The District of Columbia; DC’s 70/30 FMAP is Vital for the Maintenance of Health & Human Services
A reduction in the District’s FMAP would not lead to long-term government savings and would have a ripple effect throughout the entire health system in the DMV, crippling access to care for not only Medicaid beneficiaries but also all those who live, work, and visit the District of Columbia, including members of Congress and their staffs.
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Why does DC receive an Enhanced FMAP Rate?
The DC FMAP rate of 70% established by the Revitalization Act resulted from bipartisan analysis, discussion, and negotiation by Congressional leadership aiming to balance fairness with the District’s restricted ability to generate revenue. Congress recognized that the District of Columbia faces unique financial challenges due to its non-state status and the significant amount of federally-owned land within its boundaries. The District is unable to tax non-residents’ earnings, so these workers pay no taxes to support the infrastructure and services, such as roads, public safety and emergency services that they benefit from in the District. The District is also unable to tax up to 40% of the real property within its borders due to statutory restrictions.
Why are we concerned about DC's FMAP now?
Members of Congress have proposed reducing the DC FMAP to the statutory minimum for all other states, which is currently 50% (but could be reduced even more). Such a change would impact every physician and every practice, regardless of type, location, and payers contracted. Even practices who take no insurance will not be able to send patients for specialist care, hospital admissions, or other types of care.
What can MSDC members do?
- If you know a member of Congress or staffer, reach out to them and share how DC cuts will hurt your patients.
- Share your relationships and outreach with hay@msdc.org so we can help coordinate advocacy efforts.
- Email hay@msdc.org if you would like to be paired with a physician member of Congress office and trained by MSDC staff on how to reach out.
Resources
- DC FMAP cut fact sheet
- California Medical Association fact sheet on Medicaid cuts
- MSDC and healthcare association letter to Congress arguing against DC FMAP changes.
- MSDC original story on Medicaid changes.
News, Statements, and Testimony on Health Equity Issues
DC Health Releases 2019 Community Health Needs Assessment
The purpose of the CHNA, according to the department, is to comprehensively analyze the overall health status and quality of life for District residents. The assessment "serves as a resource that catalogs the District's existing assets, healthcare services and facilities, public health infrastructure, community partnerships mobilized to address priority needs, promising practices and policies, population health data, and funding opportunities.
Read the executive summary here, the description of the District's population as a whole here, and health outcomes data here.
Some of the top line data that will be of interest to District physicians include:
- DC Health considers its Substance Use target as "met", with a 13.6% increase in the proportion of persons with co-occurring SUD and mental disorders receiving treatment for both disorders (target = 12.4%)
- Areas with health indicators getting "worse" include mental health and mental disorders, injury and violence prevention, clinical preventative services (focused on patient control of diabetes), and LGBTQ health
- Maternal mortality statistics show little or no change towards meeting 2020 goals
- The District's overall population has increased by 14% since 2010 and has the third youngest population in the U.S. (median age = 34)
- The difference in lief expectancy between a Ward 3 resident and a Ward 8 resident is 16.5 years (86 v. 70.5 years)
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