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
2022 Looks to Be A Very Busy Year in Physician Advocacy
If you are a physician interested in advocacy or meeting with the DC Council, this will be a great year for you.
As we enter the second year of the Council cycle, MSDC sees a number of critical issues that likely will be discussed on the Council's agenda. There are many reasons for this but a key one is the backlog in issues delayed because of COVID concerns. With the Council operating remotely and needing to address numerous COVID-related legislation, issues that may have been discussed normally in the first year of a cycle are delayed to this year.
(To see a summary of this article, please enjoy this video of a presentation by MSDC Advocacy Committee Chair Dr. Klint Peebles)
First is a likely scope of practice discussion. DC Health has spoken openly about their intent to introduce a bill overhauling the Health Occupations Regulatory Act (HORA), the statute governing how medical professionals practice. DC Health has asked all the licensing boards in their jurisdiction to submit comments on changes needed. While legislative language has not been released, we anticipate there will be language of interest for DC physicians. The MSDC Board and Advocacy Committee have discussed preparations for analyzing and responding to the bill.
Second is long overdue insurance reforms. Councilmember Mary Cheh introduced a bill in late 2021 on copay accumulators. The bill would prohibit insurers from applying savings and discount programs to deductibles, meaning fewer savings for patients. MSDC is a strong supporter of this legislation and looks forward to a hearing on it to argue why this is needed legislation. We are also hearing prior authorization reform legislation could be considered as well.
Third is continued progress towards regional medical licensure or reciprocity. This took a major step forward in December when the DC Board of Medicine voted to recognize Maryland and Virginia's medical license requirements as substantially equivalent. That opens the door to DC creating through regulation a reciprocity process for Maryland and Virginia licensed physicians in good standing. MSDC has also heard the Council is interested in this issue and may take action on regional reciprocity based on the experiences of COVID-19 and the healthcare workforce.
Fourth is the budget process, an annual area of interest for MSDC. This year's budget will be different than last year's. A major reason is there is unlikely to be a major injection of federal relief funds like there was in 2021, which delayed that budget process. While the District's economy is sound, there will be hard decisions that need to be made on funding priorities.
Finally, we will potentially see action on other items on the MSDC agenda as well as new issues introduced and debated. How can you prepare as a local physician or medical student?
- Keep track of "bills of note" on the MSDC website
- Read our Advocacy Curriculum articles to learn more about the process
- Reach out and share how you want to get involved!
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