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
AMA Policy Paper Shows Hike in Medical Liability Premiums
AMA research shared widely shows that medical liability premium changes in select markets portend increases across the country.
The Policy Research Perspective (PRP), seen here, analyzes data from the Medical Liability Monitor. To quote the PRP, MLM "is considered the most comprehensive source of data on MPL premiums from a national perspective". Looking at the data, the PRP notes that in the past two years, the proportions of premiums that increased year-to-year mirrored increases in the 2000s, which is bad news for medical practices.
The author states that the biggest finding for the PRP is that more MPL premiums increased in 2020 than any year since 2005. Between 2018 and 2019, 25.6% of premiums increased, followed by another 31.1% in 2020. This means the past three years saw premium increases and with the disruptions COVID-19 has brought to healthcare, it is likely 2021 will see additional increases.
The PRP looks at two states contiguous to the District, Maryland and Virginia. Premiums in Maryland increased 18.8% between 2019 and 2020, with the largest increase 20%. Virginia "only" saw a 1.3% increase in that time, but their largest noted increase was 26.7%. The author says this shows Virginia had more extremes in increases.
The author concludes the paper by noting that MPL premiums go up and down in cycles. However, 2021 will be informative as to whether rates will increase as they did in the early 2000s, which is considered the last major "hard market".
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