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 Health Updates HCP Quarantine Guidance Based on CDC Updates
As expected, DC Health on Tuesday published new guidance on monitoring, restriction, and return to work for healthcare personnel (HCP). The guidance incorporates the new Centers for Disease Control and Prevention (CDC) guidance released this weekend which shortened the isolation and quarantine periods for HCPs exposed or infected with COVID-19.
In DC, HCPs include anyone with direct or indirect exposure to patients or infectious materials, meaning the number of people considered HCPs in a healthcare setting is wide and expands beyond medically trained personnel. The new guidance again reinforces previous guidance on the need for daily screening before entering the workplace, the requirement for appropriate eye protection, and correct respirator usage.
You can read the entire guidance here.
A few items of note from the updated guidance:
- The guidance introduces layered capacity strategies in light of the Omicron variant. DC Health notes facilities must progress from conventional to contingency to crisis strategies in light of workforce shortages. Facilities must email coronavirus.hai@dc.gov to receive approval for moving beyond contingency strategies.
- The new strategies dictate how an HCP's work schedule can be modified based on the facility's status.
- HCPs with a previous COVID positive test are no longer exempt from work restrictions after exposure. However, boosted HCPs may continue to work if asymptomatic.
- During conventional capacity situations, HCPs who had prolonged exposure to a positive COVID case or who test positive themselves can be exempt from work restrictions if they are asymptomatic, are monitoring for symptoms, are tested on day 2 and day 5-7 post-exposure and have received a COVID booster. DC Health does recommend an immediate test for these individuals. Those unboosted or unvaccinated should be excluded from work for 10 days post-exposure or 7 days with a negative COVID test and no symptoms. These individuals are required to show a negative test 48 hours prior to returning.
- During "contingency" status, boosted HCPs have the same requirements. Unboosted and unvaccinated HCPs can avoid restrictions if they are asymptomatic; are tested on days 1, 2, 3, and 5-7 post-exposure; and are monitoring for symptoms.
- During a "crisis" situation, boosted HCPs exposed to COVID have no testing requirement, just a monitoring for symptoms requirement. Unboosted and unvaccinated HCPs have the same requirements as a contingency situation.
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