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.
.png?sfvrsn=9ac2d21b_0 "What Medicaid Cuts Actually Cost")
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, Medical Community Letter Asks for Regional Expedited Licensure
MSDC, joined by seven associations and 36 medical practices, sent a letter Monday to DC Health Director Dr. LaQuandra Nesbitt asking the department for a regional expedited licensure process.
During the public health crisis, DC Health emergency regulations permitted healthcare providers to treat patients in the District if they were in good standing in their home state and practicing within their license. This allowed health systems to refer patients to non-DC specialists and providers of all types to practice telemedicine. When the public health emergency declaration ends, these providers would be unable to continue care for DC patients unless they applied for a license, a process that would take months.
The letter - seen below - asks DC Health to create a process whereby a physician or healthcare provider (1) that meets DC licensure requirements and (2) is in good standing in Maryland and/or Virginia can apply for an expedited license. The online process would permit the provider to receive their license more quickly, thus allowing for easier continuity of care. Both Virginia and Maryland have statutory language that permits regional physicians to apply for an expedited license.
MSDC will continue to push for this issue with the Bowser Administration and Council to make practicing medicine in the District more convenient for physicians, the care team, and patients.
_________________________
June 7, 2021
LaQuandra Nesbitt, MD
Director, DC Department of Health (DC Health)
899 North Capitol Street NE
Washington, DC 20002
Dear Dr. Nesbitt –
The COVID-19 pandemic has shown the value of regional licensure to address the District’s health needs. During the public health emergency, the Mayor and your department waived some licensure requirements that allowed our practices and facilities to operate flexibly to address the pandemic and keep the District safe.
The licensure waivers have helped us staff our practices and see our patients regardless of location. The pandemic has shown that expedited licensure processes for local providers is essential for keeping the District safe and healthy. A return to rigid licensure requirements for local healthcare providers would burden our community at a time when residents expect the highest standard of care.
Both Maryland and Virginia have statutory language permitting physicians in the other state to apply for an expedited license. This process requires the applicant to meet licensure requirements in their state and creates a separate application process that allows them to receive a license more quickly. We urge DC Health to create an expedited regional license process to permit physicians and other healthcare providers in good standing in our area to receive a District license more quickly. Such a process would permit Maryland and Virginia healthcare providers who meet DC licensure requirements already to submit a separate, smaller application with a faster approval timeline.
We have attached language from Virginia and Maryland as a guide on how such regulations or legislation could be constructed.
As practices who provide care for a large percentage of the District population, we urge you to take this step now or in tandem with the Council to bring the District in line with Maryland and Virginia.
Sincerely,
Medical Society of the District of Columbia
Organizations
DC AAP
DC ACP
DC Section, American College of Obstetricians and Gynecologists
District of Columbia Chapter of the American College of Emergency Physicians
District of Columbia Society of Anesthesiologists
MedChi DC
National Hispanic Medical Association
Practices
A Squared Primary Care, LLC
Ashesh D. Patel, MD, FACP
Barnard Medical Center
Barry J. Landau, MD
Brian Crowley, MD
Catherine May, MD
Columbia Associates in Psychiatry, PC
Constance E. Dunlap, MD
Cronin Dermatology and Skin Cancer Center
Daniel Hicks, MD, DLFAPA, FAPM
Daniel J. Levine, MD
David M. Goldstein, MD
DC Internists
Diane Shrier, MD
Edwin C. Chapman, MD, PC
Gerald P. Perman, MD
GW Medical Faculty Associates
Ira Dosovitz, MD
J Desiree Pineda, MD, PLLC
John Zinner, MD
Judith Nowak, MD
Kelly L. Cozza, MD, DFAPA, FACLP
Lise Van Susteren, MD
Maheen Patel, MD, PLLC
Mid-Atlantic Permanente Medical Group
Palisades Pediatrics
Rania Gupta, MD, FAPA
Richard A. Chefetz, MD
Richard K. Kim, MD, FAPA
Robert J. Hedaya, MD
The Ross Center
Sara Imershein, MD, PLLC
Shira Rubenstein, MD
Shugarman Psychiatric & Counseling
Susan D. Rich, MD, MPH, DFAPA
Well-Minded, LLC
CC: The Honorable Phil Mendelson, Chair of the Council of the District of Columbia
The Honorable Vincent C. Gray, Chair of the Council’s Committee on Health
Leave a comment