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
Dr. Alicia Khan Applies Her Unique Experiences to Her Work
Much of a physician’s knowledge in their specialty and general practice is gained from their time spent in the classroom, during residency and fellowship, and throughout practice. But unique life experiences round out every physician.
Alicia Khan’s mother was a practicing OBGYN in Pakistan before she became a mother. Cultural expectations discouraged mothers from working, so when Dr. Khan’s mother had her two daughters, she stopped practicing. “My sister and I recognized early on that we were the reason that our mother stopped practicing medicine. To honor her sacrifice, we both pursued medical careers,” she said. Her sister, Dr. Hannah Goodwin is completing a Fellowship program in a Pediatric ICU.
Drs. Khan and Goodwin were raised in a Pakistani community in Rockville/Gaithersburg, Maryland. “My father was an engineer. Together with my mother’s income, they could have afforded to hire a nanny to raise us, but judgments from the Pakistani community in which we lived discouraged that. It was simply expected that mothers raised their children rather than work.” Understanding and accepting the challenges that her mother faced as a physician and mother helped define Dr. Khan’s career goals.
Her mother’s sacrifice was not the only experience that shaped Dr. Khan’s pursuits. “In college, I lost a close family friend to suicide,” she said. Here too, cultural expectations played a role. “A lot of his suffering was the result of stigma from our community. Many South Asian communities still do not accept the need for good mental healthcare. I was always aware of his mental health struggles but there was so much stigma surrounding the topic, he never accessed resources to overcome it.”
The impact of her mother’s career-ending family planning choices and losing the friend she looked at as a brother had significant impacts on Dr. Khan’s decision to focus on psychiatry, specifically women’s mental health.
In the post-Roe v. Wade era, Dr. Khan feels her services are needed more than ever. “My mother valued what the American culture offered women. She felt that her daughters would not face the same challenges that she did. With the reversal of Roe v. Wade, she feels that things have been made harder again. It is a sad commentary for the United States,” said Dr. Khan.
Still, in her 20s, Dr. Khan has set her goals on changing policies, which requires the energy, enthusiasm, and commitment she brings to the table. Her unique set of life experiences and fresh perspectives are added talents. But she also recognizes that it may not be enough. “I may bring fresh perspectives to discussions about policy, but I also understand that the more experiences I have as I advance in my career will make it possible for me to impact change.”
To that end, she continues her residency at Georgetown Hospital with plans to pursue a women’s mental health fellowship. “I enjoy speaking with patients my age,” said Dr. Khan. “And also enjoy helping young adults and adolescents. It is a difficult time for many people. They are in formative years and in great need of guidance, so it is very rewarding to work with the emerging adult population,” she added.
In the short term, Dr. Khan continues policy writing with AMA and MSDC. With the AMA she passed a policy to standardize domestic violence in emergency departments. She joined MSDC in medical school. “MSDC began a Women in Medicine group that I helped to begin and was the first student to chair it,” she said. Involvement with professional societies like AMA and MSDC helps to broaden her knowledge base and learn from the experiences of other physicians.
To women facing new obstacles that previous generations had hoped to remove, she offers advice. “Never take anything personally. In a setting where you may begin to feel incompetent, recognize that it is more about the other person than it is about yourself. Do not let someone else shape your opinion of yourself.”
To recharge, Dr. Khan, retreats to her apartment where she has realized a talent for propagating plants. “I began filling my apartment with plants during COVID. I now have plants in all stages and multiple generations of the same plant through propagation. I’m a plant grandma,” she joked.
Do you know a physician who should be profiled in the MSDC Spotlight Series? Submit a nomination to Robert Hay at hay@msdc.org for a future story. MSDC membership is encouraged for featured physicians.