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
What Wins The Physician Community Got in the HORA Revision Bill
MSDC, the Physician Voices for Patient Safety Coalition, and the DC "house of medicine" have been working tirelessly since November to remove concerning provisions from B25-545. The bill updates the Health Occupations and Regulations Act, better known as the DC law overseeing health licensing and regulation. The bill contained numerous scope of practice expansions for numerous allied health professionals, plus made worrying changes to the make-up of the Board of Medicine. Yesterday, the Council passed the bill on its final reading.
MSDC and the coalition met with Councilmembers, sent letters, rallied our memberships, and spoke up about many of the changes and why removing physicians from the center of the care team would be dangerous to DC healthcare. While we did not win every request, below are some of the major wins you, your medical society, and the physician coalition had in the bill:
- Originally, the Board of Medicine would be composed of many fewer physicians and add up to four allied health providers as voting members, essentially equating physicians with other allied health professions on the oversight Board. The bill as passed changed to only add 2 physician assistants as voting members while only reducing the physician seats by one, maintaining a physician majority on the Board.
- Podiatrists in the original bill would have seen major scope expansion, including the ability to treat wrists and soft tissue in the hand, soft tissue from the ankle to the knee, and oversee the administration of anesthesia. The bill as passed removes this and only allows podiatrists to administer local anesthesia.
- Optometrists would have seen major scope expansion, including prescribing authority, treatment of medical conditions, and more. All optometrist scope expansions were removed.
- The bill originally required laboratory technicians to be licensed for the first time. That requirement - opposed by MSDC, the Hospital Association, and Pathologists - was removed.
- Athletic trainers and physical therapists would have been classified as medical providers and had certain tests and treatments permitted unsupervised. These were reduced in the final bill and DC Health given more regulatory oversight over the professions.
This legislation was a major effort by the physician community, and this plus the new prior auth law shows the power of the physician voice in DC.
Yet the work is never done. Join us June 17 for Council Visit Day to meet Councilmembers and their staff, and speak to the Council on important medical issues before the Council (like the gun violence mandatory CME legislation).