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
MSDC President to Council = Get License Reciprocity Done
MSDC President Dr. Susanne Bathgate told the DC Committee on Health today that regional medical license reciprocity needs to get done on time - or the Council should step in to make it happen.
Why now: The comments were part of Dr. Bathgate's testimony before the committee during its oversight hearing on the medical licensing boards.
Status: The Board of Medicine has publicly stated it has a goal of launching DC/Maryland/Virginia medical license reciprocity by this summer. This comes after years of pressure by the Medical Society for DC and its neighbors to create a process where a physician in good standing in one state can more quickly be licensed in the other two.
The three states all had provisions in statute to permit this, but the implementation and coordination was lacking.
In her testimony, Dr. Bathgate spelled out the importance of this issue and told the Council it had a role to ensuring DC Health implemented this on time. Her entire testimony is below.
The big picture: Post-2020, telemedicine and regional patient populations are not going away. Allowing quicker licensing for area physicians saves time, money, and stress for the regional healthcare system.
What else? Dr. Bathgate also testified on:
- Changing harmful language on license applications dealing with wellness and addiction treatment
- Adding customer service staff to licensing boards
- Removing the LGBTQ cultural competency CME requirement
February 28, 2023
Councilmember Christina Henderson
Chair, Committee on Health
1350 Pennsylvania Ave NW
Washington, DC 20004
Dear Chair Henderson,
The Medical Society of the District of Columbia (MSDC) is the largest medical organization representing metropolitan Washington physicians in the District. We advocate on behalf of all 11,000 plus licensed physicians in the District and seek to make the District “the best place to practice medicine”.
I thank you for holding this hearing for oversight of the various health licensing baords. I want to begin by saying that the Board of Medicine, which we work closest with, is responsive to the Medical Society and our members. We have partnered on various issues throughout the year – most recently the 2022 medical license renewal – and valued our working relationship.
We especially appreciate the respect given by the Board to our Physician Health Committee, which advocates for and supports physicians dealing with addiction. We know post-2020 that physician addiction and suicide is on the rise, and the Committee is available to provide additional support to the Board. However, an increase in referrals and expert assistance cannot be accommodated without a corresponding grant or funding source within the department.
MSDC is concerned about the following and encourages the committee to consider them during the budget process:
1. Change harmful language around wellness and addiction. The Mayor’s Healthcare Workforce Task Force included a recommendation in its draft report to limit, “‘fitness for duty’ questions during application and renewal cycles” such that they only apply to current impairment to practice safely. The Dr. Lorna Breen Heroes Foundation has identified the District as one of the states who licensure language can harm physician wellness by forcing unnecessary disclosure of past impairment and wellness treatment. We urge the Board of Medicine and, if necessary, the Council, to remove this offending language.
2. Implement regional license reciprocity as soon as possible. The Board of Medicine has shared regional reciprocity should be online in the summer of 2023. The Council must keep the Boards to this timeline and ensure the DMV license reciprocity process is fully operational, including IT Infrastructure. MSDC has long championed the need for area physicians licensed in one state to easily apply for a license in the other without totally redoing their applications. We also firmly believe a regional license should be less expensive than going through the regular license.
3. Staff up customer service support. During license renewal times, MSDC stands up its own license renewal center and takes calls and emails from members helping the through the process. We even arrange office hours for members to come in and sit down to complete their applications with us. We did this not only as a service but because it is hard to call and get answers to questions about licensing and relicensing. The DC government should look at how it funds customer support personnel for the boards.
4. Work with Council to remove the LGBTQ cultural competency CME requirement. MSDC and its members believe that content-specific mandated CME is wrong, as government through the licensing process should not dictate what learning is essential to the practice of medicine. The mandatory two hours of LGBTQ cultural competency remains a requirement due to Council legislation. We urge the Council to repeal the requirement, not because we oppose LGBTQ cultural competency education, but because it is another mandate for all physicians regardless of practice type.
Please reach out to the MSDC office if our membership can be of assistance on these or any issue. We look forward to working with you and the Committee to make the District the best place to practice medicine.
Sincerely,
Susanne Bathgate, MD
President, Medical Society of DC