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
Making it work with Dr. Arrel Olano
Dr. Arrel Olano grew up in the Philippines and only arrived in the United States when he was a medical student seeking a residency program in 1995. “I came here for interviews with my wife, Sheila. We were both accepted to the Cleveland Clinic Hospital residency program which we began in 1996.”
Dr. Olano pursued internal medicine while his wife, Sheila, specialized in pulmonology.
The weather was the biggest culture shock. “We came from a tropical climate and then had to endure Cleveland winters. It wasn’t easy but we managed,” he said.
The struggles didn’t end there. “Sheila’s father died only three weeks into our residencies. We were in a new country with a new culture, far from home, and had to manage the loss of a parent. It was a very difficult beginning, but we managed,” said Dr. Olano.
Dr. Olano had a typical upbringing in the Philippines. “My father was a College Dean and both of my older brothers have worked in education. While my mother has formal studies in education, she pursued business and opened a bookstore,” he said.
There were no physicians in his family, but as the youngest child, he felt that it was always assumed he would pursue medicine. “I felt directed to a medical path,” he said.
When he and Sheila completed their residencies, they parted ways temporarily. “Sheila was accepted to a Pulmonary and Critical Care Fellowship at Georgetown University whereas I worked in Kentucky. For three years I commuted from Kentucky to D.C. We made it work but it wasn’t easy,” he said.
The couple had two children born in Georgetown and when the fellowship ended, the couple chased warmer weather and found themselves in Texas. “We lived in Midland, Texas, and worked at Texas Tech University for four years. It was warmer but so flat and dry. There also wasn’t a lot of diversity,” he said.
They returned to the D.C. area in 2007 and Dr. Olano began working for MedStar and Sheila with Kaiser.
Internal medicine was among his three top choices for a specialty. “I was interested in either cardiology, hematology, or tropical medicine. After spending my cardiology rotation admitting patients in the middle of the night, I realized that this wasn’t the right choice for me. I wanted to focus on tropical infectious diseases but that wasn’t a prevalent focus area in the United States. Hematology fellowship on the other hand is typically coupled with oncology, which didn’t interest me,” he explained. This left internal medicine, he has been pleased with his selection.
Throughout his early career, Dr. Olano wanted to maintain a focus on business education. “While we were in Texas, I earned an MBA and was very interested in combining teaching with the business of medicine.” Dr. Olano was recently invited to teach the business of medicine curriculum to all Georgetown University third-year students.
Dr. Olano feels that well-rounded physicians should understand every component of their practice, even if they don’t become experts. “During the business of medical studies, we teach topics such as billing, coding, and insurance. Even if a physician has a practice and employees to do this for him or her, ultimately, it’s his or her signature that is on all of the paperwork. Every physician needs some understanding of these topics. Because the nature of medicine is very reactive to the business climate and treats patients based on what they can afford and what insurance will cover, physicians need to be aware of what is going on.”
One example is the need for prior authorization for some diagnostic testing. “An MRI, for example, is an expensive test that may not be covered by all insurance, but when a physician orders it, it’s for a reason. Waiting for prior authorization delays patient care.” Through teaching the business of medicine, Dr. Olano hopes to cultivate a new generation of well-rounded physicians.
Through MedStar, Dr. Olano is a member of MSDC. One of the first issues he plans to address is the prior authorization 719A form. A paper form is required of all physicians for all orders including monthly renewals. “Only attendings can sign this form and we may need to sign up to 400 every month. It is a tremendous burden that needs to be streamlined to expedite patient care,” he said. He looks forward to continuous advocacy work with MSDC.
The couple’s two children are now grown, and both are enrolled at Villanova pursuing psychology. Nicholas is a junior earning a double major in psychology and Spanish and Juliana is a sophomore studying psychology. She will be committing to her major this school year.
The family enjoys traveling. Dr. Olano manages all the details and takes responsibility for the trips. “If there is poor weather when we travel, that’s my fault too,” he joked. They visited Portugal this past summer and look forward to spending time in New York City during the holiday season. He and Sheila are looking to travel to the Philippines in the new year to visit his mother who will be turning 80.
Locally, the couple enjoys the local food scene in D.C. and Dr. Olano is always on the lookout for the perfect tennis partner.
Do you know a physician who should be profiled in the MSDC Spotlight Series? Submit a nomination to Robert Hay, hay@msdc.org, for a future story. MSDC membership is encouraged for featured physicians.