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
An Update on DC COVID Vaccination Distribution
As you are likely aware, the COVID-19 vaccine will soon be a reality. With multiple companies seeking emergency use authorization to begin distribution, formerly academic questions about the "how Americans will be vaccinated" are now becoming a reality.
As District physicians, our community will be at the forefront of distributing the vaccine as well as receiving the vaccine. While more details will become available in the coming days and weeks, MSDC is creating a brief Q&A below to update the community on where we are with COVID vaccination distribution in the District.
Resources
Draft COVID plan for the District, from DC Health
Pfizer vaccine distribution factsheet
When EUA is granted, how many doses will DC receive in the first distribution, and why?
DC Health Director Dr. LaQuandra Nesbitt shared the District should receive 6,800 doses in the first allocation from Operation Warp Speed. Federal government distributions are based on the number of state residents, so DC received a percentage of the first federal stockpile based on people living in the District.
What is the vaccine priority order in the District?
Mirroring the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommendations, the District will vaccinate the population in three phases.
1.A. Persons serving in a healthcare setting who have potential exposure to patients or infected materials, and who cannot work from home.
1.B. Essential workers and high-risk individuals
2. Unvaccinated Phase 1 populations, "critical populations", and then the general population
3. The remainder of the population
Are District residents the only people who will be vaccinated in Phase 1?
Dr. Nesbitt and Mayor Bowser have made clear that past experience with mass vaccination campaigns have shown limiting vaccinations to residents can be counterproductive. With a large percentage of workers in healthcare settings from outside the District, Phase 1 will be based on healthcare setting, not residency or title. So the Phase 1 priority will mean all individuals in the highest priority settings will be vaccinated first.
So what are the practical implications of vaccine distribution based on number of residents and phased vaccination based on setting?
The District will have to make some tough choices to make. DC Health estimates we have 85,100 workers eligible for Phase 1A. That is vastly more than the first batch from the federal government. Dr. Nesbitt in a press conference this week said she hoped some out-of-state priority workers could receive a vaccination from their home state, or that some priority workers would continue to use PPE to allow others to move ahead of them in the priority list.
How is the District preparing to distribute the vaccines?
DC Health has identified eight sites in the District that contain coolers cold enough and large enough to store the Pfizer vaccine. The Moderna vaccine does not require storage as cool. DC Health plans to use the Pfizer doses to vaccinate large hospital or system based workers who will be nearby the large coolers, while the Moderna vaccines will be used for smaller facilities.
What is the timeline to begin mass vaccinations?
DC Health is anticipating they will receive the first batch of doses in mid-December. They anticipate a lag-time to train healthcare workers before Phase 1 vaccinations begin. The general population could see available vaccinations beginning in spring 2021 under the current timeline.
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