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 Council Passes Audio Telemedicine and Loan Repayment Provisions
As part of a contentious debate over the District's FY21 Budget Support Act, the Council passed two provisions that will help physicians practice, especially in underserved medical areas.
The first provisions was an amendment to the Telemedicine Reimbursement Act of 2013. The original bill established telemedicine reimbursement policy but had prohibited audio, e-mail, and fax telemedicine reimbursement. The current public health emergency has shown that many residents actually need audio telemedicine because of unreliable internet connections, not having adequate video streaming technology, or other technology issues. The DC Medicaid program has seen a large number of audio telemedicine appointments during the public health emergency, especially for behavioral health appointments. The new language strikes audio telemedicine as prohibited, allowing it to continue after the public health emergency expires.
The second provision of note was the funding and structuring of the Health Professionals Loan Repayment Program (HPLRP). The program repays the education loans of medical professionals who served for a period of time in underserved medical areas in the District. The new language offers specifics for the program, including:
- The program will pay for the cost of obtaining a health professional degree including outstanding principle, interest, and related expenses of state, federal, local, and commercial education loans.
- Physicians who specialize in obstetrics and gynecology, psychiatry, or other in-need medical specialties as identified by DC Health can have 100% of their total debt (up to $200,000) repaid by the loan program over four years if they provide full-time service in Wards 7 and 8.
- The program also adds a retention incentive fund for DC Health to award, in addition to the loan repayment program.
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