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
Dr. Lisa Fitzpatrick uses her adventurous spirit to engage with patients
Dr. Lisa Fitzpatrick grew up in St. Louis, Missouri, and didn’t leave the state until she was ready for her internship in Michigan in 1992. Her internal medicine residency opened the world to her, and she has been making up for lost traveling time ever since.
She was the first person in her family to graduate from college and pursued medicine because “My mother said it was possible.” Her aptitude for science helped and when she applied to medical school, she was accepted. That acceptance opened the doors wide to an array of opportunities.
A residency program accepted Dr. Fitzpatrick in 1994 and soon after she boarded a plane for Swaziland. “It was only the second time I had been on a plane,” she confessed. It was during her residency that she chose the specialty of infectious diseases and public health. “I like the investigative approach to medicine involved in infectious diseases and how these diseases can impact the entire world,” she said. “The COVID-19 pandemic is a perfect example,” she added.
After Swaziland, she spent some time in Kenya before shifting gears when she returned to the United States for her Fellowship in Colorado. It was there that she learned to snowboard. Since high school she’d enjoyed competing in sports and in Colorado even found time to play racquetball competitively. After fellowship she was accepted into the Epidemic Intelligence Program at the CDC in Atlanta, Georgia.
Her magnum opus was the last field investigation she conducted for the Centers for Disease Control and Prevention. “We studied HIV transmission in 31 Georgia prisons. It was a multidisciplinary team that conducted computer-assisted surveys, performed genetic sequencing, conducted focus groups and reviewed clinical records and history over the course of six weeks,” she said.
The findings were not well-received. I think the study findings were an embarrassment to public officials . “We know HIV is a sexually transmitted disease. One of the findings was that guards were having sex with the inmates. Also, the prison system did not make condoms accessible, so inmates would improvise for protection and use things like plastic wrap.”
While the study results were published, the publication lacked granular detail. “Sometimes people don’t consider what they are going to do with the information when they ask for a study to be conducted,” she said. The elegancy of the sophisticated analysis is what makes Dr. Fitzpatrick most proud of this work.
In 2019, she launched Grapevine Health, a digital health media company, to build trust and improve patient engagement among Medicaid patients through delivering culturally appropriate and relatable health information. “People tend to avoid healthcare because they don’t understand it. In some circumstances, people wait until their situation is dire and it becomes too expensive, or even too late.”
The goal of the digital health media company is to be relatable to its constituents. “We focus on Medicaid patients and other underserved communities in the African American community. We are currently working within our geographic community and conducting focus groups but are looking to scale this model nationally.”
Some of her successes to date include increased vaccination rates during the COVID-19 pandemic and increased engagement among out of care diabetics with diabetes information. Grapevine’s target audience is the Medicaid audience between the ages of 35 and 65 with chronic health conditions. She hopes to improve healthcare engagement and quality of life for these patients through culturally appropriate health education delivered by trusted messengers
Infectious Diseases and epidemiology are just two of Dr. Fitzpatrick’s many interests. Her life’s goal is to become public health photojournalist and a luxury spa reviewer. Until then, she travels and reviews spas on her dime.
She also enjoys adding to the list of 41 countries she has visited. This active, outdoor adventure-seeking physician has spent 12 days biking from Hanoi to Saigon in Vietnam and lounging at the Modern Elder Academy in Baja, Mexico. On her bucket list are trips to visit friends in Brazil, Bali, Australia, and New Zealand. As she makes up for years spent in St. Louis, she has yet to visit Wyoming but plans to brush up on her snowboarding there soon.
Dr. Fitzpatrick is adamant that she will find a way to engage her audience to listen to what she has to say, and what they need to know, about healthcare. One path she will be pursuing is Stand Up Comedy and has enrolled in a stand-up class that begins in February. “People turn to social media to be entertained. I would like to add entertaining content on social media about healthcare. There is something about healthcare that makes people reluctant to make fun of it. I think we need to make jokes about our healthcare system. Maybe then people will listen.”
Dr. Fitzpatrick has been a member of the Medical Society of DC on and off for years and consistently for the past five years. She is part of the Women’s Group and enjoys being pulled into other projects on an as-needed basis.
Upon retirement, she will work toward her goal to become a public health photojournalist and help people learn about health and public health through other cultures, especially if the luxury spa opportunity never comes to fruition.
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.