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
Does Value Based Care Mean a Higher Gender Wage Gap?
A new study released July 19 posits that the shift to value and outcomes based care may increase the female physician wage gap.
The authors, who were from Harvard Medical School and Brigham and Women's Hospital, used data from more than 1,200 primary care practices nationwide. Based on this dataset, the researchers found that female primary care physicians made 21% less than male physicians in a fee-for-service model. Using a simulation of physician pay under a capitated payment model, they studied whether value-based care models would reduce this gap. Instead, they found that the pay gap actually increased in some scenarios and generally remained the same.
The authors concluded that the risk adjustment scores disadvantaged the average female physician for a few reasons. First, on average, female physicians see younger patients who tended to be female and were more likely to be uninsured or be on Medicaid. Compared with male physicians, the female patient population had lower risk scores despite being just as likely (if not more likely) to be associated with consequences of social determinants of health.
A second factor was the number of patients. Female physicians on average tend to see patients for longer visits and thus see fewer patients during the day. This also reduced reimbursement. Only when researchers evened out the age and gender of patients did the pay gap close.
As one of the authors told Axios, "We're moving toward this value-based payment. But are we really measuring and accounting for the right things?"