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
DC Health Releases New Public Health CME Domains
The following was released by the Department of Health on March 14.
DEPARTMENT OF HEALTH
PUBLIC NOTICE
IDENTIFYING PUBLIC HEALTH ISSUES FOR CONTINUING EDUCATION
The Director of the Department of Health (Director) hereby gives notice of the topics identified as public health priorities for the purpose of the continuing education required for the renewal, reactivation, or reinstatement of health professional licenses, certifications, or registrations, issued in accordance with DC Official Code § 3-1201.01 et seq; hereafter referred to as health professionals.
With the goal of enhancing the protection and promotion of public health and in accordance with the rulemaking authority under DC Official Code§ 3-1203.02(12), the Director has promulgated rules requiring health professionals to complete at least ten percent (10%) of their required total continuing education in the public health priorities of the District as determined and published every five (5) years or less frequently as deemed appropriate. The Director has identified five (5) public health domains and provided content examples that would align with each domain. These examples are not intended to be exhaustive; however, they are designed to guide renewal applicants in identifying areas of public health that are aligned with the priorities of the public health authority but also beneficial and germane to the specific license, certification, or registration type.
1. Sexual and Reproductive Health
a. Obtaining a sexual history and discussing sexual experiences with patients
b. Adolescent sexual and reproductive health and rights
c. Cervical cancer
d. Family planning and contraception
e. Maternal and perinatal health
f. Violence against women and girls
g. Breastfeeding Promotion
2. Chronic Disease Management
a. Obesity prevention and treatment
b. Lifestyle change management
c. Disease-specific management (hypertension, diabetes, stroke, kidney disease, etc.)
3. One Health (https://www.cdc.gov/one-health/about/index.html)
a. Vector and non-vector borne diseases
b. Water quality and safety
c. Zoonotic diseases
d. Antimicrobial-resistant germs
e. Food security
f. Environmental contamination
g. Air quality
h. Impact of climatological changes on health
4. Healthcare Professional Retention and Capacity Building
a. Suicide prevention
b. Avoidance and managing burnout
c. Quality improvement
d. Substance use/misuse and substance use disorder
e. Implicit bias, cultural humility, and Culturally and Linguistically Appropriate Services (CLAS) in health and healthcare.
5. Community and Patient Safety
a. Fall and injury prevention
b. Violence prevention, including gun violence
c. Emergency preparedness for patients
d. Effects of social media
e. Infection control
f. Identifying cognitive impairment in patients
Each health professional licensing board shall disseminate the identified public health domains to its health professionals via electronic communication and through publication on its web page. Since the goal of this list is to engage and educate health professionals in the promotion and protection of public health, it is intended to be liberally interpreted by each health professional licensing board with regulatory authority over each license, certification, and registration type.
The requirement for continuing public health education may be found in specific professional rules under Title 17 of the District of Columbia Municipal Regulations (DMCR), such as section 7808.2 for audiologists (17 DCMR § 7808.2); section 6906.4 for psychologists (17 DCMR § 6906.4); section 7008.4 for social workers (17 DCMR § 7008.4). This requirement may still be under rulemaking process for certain professions and is therefore not yet in effect for those professions. To determine whether public health continuing education is required for a specific license, certification, or registration, visit the specific professional licensing board web pages at www.dchealth.dc.gov or contact the Department of Health at (202) 422-5955. Health professional regulations may be found at www.dcregs.dc.gov .
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