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
Changes in School Immunization Requirements for School Year 2023-24
Revised Compliance Definition
The District of Columbia follows the immunization recommendations of the federal Advisory Committee on Immunization Practices (ACIP). As soon as children are old enough that a vaccine is recommended, that vaccine is considered “due.” DC’s Immunization Information System (DOCIIS) provides information about which vaccines are currently due, as well as when vaccines will be due in the future.
Beginning in the 2023-24 school year, once a student is due for a vaccine, that student will be considered non-compliant with DC’s school immunization mandate. DC Health will no longer differentiate between “due” and “overdue” in the determination of compliance. As a result of this change in the definition of compliance, the number of students considered non-compliant will initially increase. However, the change will simplify assessment of compliance and bring DC into closer alignment with other jurisdictions.
Limiting Temporary Exclusion.
In the 2023-24 school year, only non-compliant students in grades pre-K 3, Kindergarten, 7, and 11 will be eligible for temporary exclusion. These grades were selected because they occur soon after age bands in which vaccines are first recommended. Most students in these grades will not “age into” non-compliance during the school year.
Example
ACIP recommends that children receive their first dose of MenACWY at 11 or 12 years of age; in this age range, children are considered “due” for this vaccine. Previously children were considered non-compliant only after reaching their 13th birthday, which is when the vaccine would be marked as “overdue.” Beginning in the 2023-24 school year, children who have not received this vaccine will be considered non-compliant when they reach their 11th birthday. However, while most children reach their 11th birthday during 5th or 6th grade, they will not face temporary exclusion from school until entering 7th grade.
If you have questions about the change in compliance definition, contact doh.immunization@dc.gov.
If you have questions about enforcement of the School Immunization Policy, contact OSSE.schoolhealth@dc.gov.