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
MSDC President Testifies at DC Health Oversight Hearing
On March 19, 2021, MSDC President Dr. E.W. Emanuel testified on behalf of the Medical Society at the Committee on Health's DC Health oversight hearing. Below is his written testimony.
March 19, 2021
Councilmember Vincent Gray
Chair, Committee on Health
1350 Pennsylvania Ave NW
Washington, DC 20004
Dear Chair Gray,
Thank you for allowing me the opportunity to testify today at this oversight hearing. My name is E.W. Emanuel, and I am the 2020-2021 President of the Medical Society of DC (MSDC). MSDC is the largest medical organization representing metropolitan Washington physicians in the District. We advocate on behalf of all 11,000 plus licensed physicians in the District and seek to make the District “the best place to practice medicine”.
The SARS-CoV-2 public health emergency has been a major test for the District’s public health infrastructure. DC Health overall has responded heroically, and its staff has gone above and beyond to protect the residents of the District. I want to publicly thank Dr. Nesbitt, Dr. Watson, Dr. Shah, Dr. Lewis, and the many DC Health employees for bringing a public health lens to the tough decisions that have been made during the pandemic. Even where we disagree or choices made were not ideal, they were made with the best interest of District residents in mind.
While MSDC has been involved in numerous initiatives with DC Health during the pandemic, I want to highlight one area of collaboration. Recently MSDC and DC Health stood up the DC Clinician Champions Program, a program that connects physicians and community events to address questions about COVID-19 and the vaccine. To date MSDC and the DC CCP have staffed numerous community events and MSDC looks forward to expanding the program as vaccine availability expands.
Looking ahead, there are some critical issues facing medicine. Many of these areas can be addressed within the budget, and some are issues I want to raise as a point of interest for the committee.
- Make permanent the licensure flexibility permitted by the public health emergency. DC Health quickly allowed medical practices to treat patients across local state lines. This kind of flexibility was promised by the Interstate Medical License Compact, which DC Health is finally implementing. I urge the Council and DC Health to go further and permit freedom to treat patients in the District via telemedicine if (1) the healthcare provider is located in Maryland or Virginia and has a pre-existing treatment relationship, or (2) the physician is located in the District and their practice/health system needs to refer to another healthcare professional within the practice located in Maryland or Virginia. I also urge DC Health to enter negotiations with Maryland and Virginia for a “DMV” license agreement, similar to the Interstate Medical License Compact but covering these three states.
- Fully fund and expand the Health Professional Loan Repayment Program. I thank the Chair for supporting this important program, which allows physicians to practice in medically underserved areas and receive a needed financial support for standing up their practice. As we stated last year, we urge the Council to not only fully fund but consider increasing the funding, as well as expanding eligibility to physicians who work in an ambulatory clinic or hospital setting.
- Support a DC version of the Dr. Lorna Breen Health Care Provider Protection Act. Named after a physician who committed suicide during the pandemic, this federal legislation would create wellbeing programs for healthcare providers and establish a national campaign to encourage healthcare professionals to seek support due to trauma. I encourage the District to create grant programs to support healthcare professionals seeking wellbeing in light of the pandemic. MSDC has a wellbeing program and last year my colleague Dr. Laurie Duncan shared with the committee MSDC’s work. In addition, DC Health can make available data from its healthcare workforce surveys to identify gaps in healthcare professional wellbeing.
Please reach out to the MSDC office if I or our membership can be of assistance on this or any issue. We look forward to working with you and the Committee to make the District the best place to practice medicine.
Sincerely,
EW Emanuel, MD
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