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 Member Profile: Dr. Sarah Hogan
1. Why do you belong to MSDC? What made you join, and what keeps you engaged?
Prior to medical school I earned a graduate degree and worked in health policy, so I came to medicine with an understanding of how policy shapes nearly every aspect of how we care for patients and how we sustain our practices. I joined MSDC because of its commitment to making DC a great place to practice medicine, and the wellbeing of our patients.
What keeps me engaged is the unique access it provides. MSDC convenes hospital system leaders, policymakers, and physicians in the same room. That kind of cross-sector dialogue is where meaningful change happens. And the colleagues I have met along the way are collaborative, generous, and exceptionally bright.
2. If you could have dinner with any historical figure (medical or otherwise), who would it be and what would you ask them?
Dr. Ana Aslan, a Romanian physician who pioneered the study of systemic and skin aging at a time when medicine had not yet framed aging as worthy of serious scientific inquiry. She built a laboratory and by the 1950s formulated topical products designed to address age-related skin changes at the cellular level. Nearly a century later, we are still defining what she started, now through the language of the hallmarks of aging.
I would ask her: looking at the global cosmeceutical and longevity medicine fields today, what question does she think remains unanswered? And if she had access to one modern tool (genomics, advanced imaging, etc.), what would she have done with it?
3. What's one piece of advice you'd give to a physician just starting their practice in the DC area?
Washington DC is a formidable market. Patients here are discerning and have no shortage of options. The regulatory environment is complex, and the cost of doing business is among the steepest in the country. Build your clinical reputation first. Invest in your brand and your operating systems. The practices that do well in this city are the ones patients trust.