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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.

 

What Medicaid Cuts Actually Cost

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

 

 

What MSDC Said at the DC Health Oversight Hearing

Mar 2, 2023, 13:24 PM by MSDC Staff
Dr. Bathgate testified before the Committee on Health with priorities for DC Health to consider in the coming year.

MSDC President Dr. Susanne Bathgate came back to the DC Committee on Health today to outline six priorities for DC Health in the coming year.

Why now: The comments were part of Dr. Bathgate's testimony before the committee during its oversight hearing on the department. She also testified Tuesday specifically about the licensing boards.

Background: MSDC annually testifies before the Council at the DC Health oversight hearing. It is an opportunity to thank the department for their partnership and highlight areas of focus - from a physician perspective - for the coming year.

The big picture: Much of the agency's work in 2023-2024 will be guided by the Mayor's Healthcare Workforce Task Force recommendations and the department's health equity work.

The priorities

  • Implement regional license reciprocity as soon as possible
  • Reform the certificate of need process
  • Provide grants for physician wellness
  • Publish/share workforce data
  • Support the Mayor's Healthcare Workforce Task Force
  • Resist "scope creep" when considering reforms to the HORA
   


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”.

MSDC is concerned about the following and encourages the committee to consider them during the budget process:

  1. 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.
  2. Reform the certificate of need process. MSDC is disappointed in the department’s interpretation of the District’s certificate of need process to increasingly include private practices that traditionally have not had to inquire about needing a CON. The cost of hiring attorneys to navigate a CON process is not negligible to private practices. We urge DC Health and the Council to refine the CON statute to ensure practices making nominal changes (such as hiring a replacement for a departed employee) do not require a CON. We have proposed such language to DC Health. Continuing this policy will force private practices to leave the District for Maryland and Virginia.
  3. Provide grants for physician wellness. The Mayor’s Healthcare Workforce Task Force had numerous recommendations on physician wellness. MSDC participated in an interview with the agency about healthcare burnout and solutions. At that time, we encouraged the department to aggressively fund private sector wellness initiatives. We renew our call for grants focused on healthcare wellbeing, including funding innovative and unproven (but structurally sound) programs. The problem is so big that creativity will be needed by many in the private sector to begin addressing it. We urge the budget to include money for private sector grants.
  4. Publish/share workforce data. While not mandatory, the physician survey attached to the license renewal application is a robust source of data on the District’s physician population. In previous cycles DC Health has published infographics and reports from the data; the last cycle had none. DC Health should continue to publish information from the workforce survey and, if helpful, work with private sector sources to interpret the data.
  5. Support the Mayor’s Healthcare Workforce Task Force survey. MSDC was proud to serve on this important task force and supports many of the recommendations, including the call to reform prior authorization. DC Health and the Council should work together to adopt these recommendations as soon as practical.
  6. Resist “scope creep” when considering reforms to the HORA. DC Health has been sharing that it is preparing an update to the HORA. We urge DC Health to resist what other states have done when reconsidering their health licensing laws – change scope of practice laws to reduce the requirements to practice medicine. Data has shown that patients have increased risk of harm and increased cost when allied health professionals are permitted to practice at levels currently only permitted for physicians. DC Health should resist expediency and support effective, clinically based medicine.

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