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
Study: Expanded Patient Record Access Leads to More EHR Inbox Messages
When the 21st Century Care Act regulations were written, the medical community was concerned about the unintended consequences of unfettered access by patients to their electronic records. A new study published in the JAMA Open Network suggests these changes may be leading to burnout for healthcare providers.
The regulations for the Act require immediate electronic access for patients to their test results, medication lists, and clinical notes. This access may be even before their physician or medical institution reviews it, which may lead to confusion and misinterpretation.
The study, seen here, suggests as much based on messaging to provider inboxes. The study examined health results on the patient portal at Vanderbilt University Medical Center between January 2020 and April 2021. CURES Act compliance began January 2021, so the study included pre- and post-CURES best practice.
Prior to January 2021, patients viewed 10.4% of their test results before their clinician. After CURES implementation, that number jumped to 40.3% of patients viewing their results prior. The result was more EHR messages. Pre-January 2021, a median of 77.5 messages were sent within 6 hours of viewing the test results by patients. After CURES, the number jumped to 146 within 6 hours of viewing the results.
While the authors acknowledge the dataset is limited, they also point to the potential burdens on clinician wellbeing. The authors write:
Improved availability of data to patients represents a marked transformation in patients’ opportunity to take ownership of their health care. However, the benefit associated with immediate release of test results may be overshadowed by unintended consequences to patient well-being and clinical workload. Additional consideration of the timing of test result release to patients and clinicians is necessary to ensure that results are made available to patients while maintaining the opportunity for clinicians to apply their expertise and interpretation.
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