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 Alert on Varicella Cluster
On January 9, 2023, DC Health surveillance identified a cluster of varicella (chickenpox) cases among an unvaccinated group of people living in the District of Columbia. As of January 23, 2023, a total of 7 cases have been reported across 4 families. Ages ranged from infant to young adults and all cases have been mild so far without complication.
With the success of varicella vaccination programs in the United States, cases of chickenpox have become far less common. However, people lacking immunity can still catch chickenpox if they are exposed. Immunocompromised people, infants, people aged 15 and older, and pregnant women are at risk for more severe disease and have a higher incidence of complications. The purpose of this email blast is to create a heightened level of awareness and remind providers to consider chickenpox in their differential diagnosis. To ensure timely identification and public health follow-up of cases, the District of Columbia Department of Health (DC Health) asks that providers assist us in our surveillance by doing the following: 1) Review clinical presentations of chickenpox and testing recommendations as needed, and 2) Promptly reporting suspected or confirmed cases to DC Health. Providers should continue providing education on the safety and efficacy of the chickenpox vaccine, and strongly encourage vaccination of eligible patients. Below are some helpful reminders about varicella and instructions on case reporting.
REMINDERS AND RESOURCES
- The incubation period for varicella is 10 to 21 days, averaging 14 to 16 days after exposure.
Varicella can be spread from person to person by direct contact, inhalation of aerosols from vesicular fluid of skin lesions of acute varicella or zoster, and possibly through aerosolized respiratory secretions.
A person with varicella is contagious beginning one to two days before rash onset until all the skin lesions have crusted.1
- Review clinical presentations of chickenpox.
More information can be found here.
- Most diagnoses are made clinically; however, testing is available from most commercial laboratories if needed.
VZV (Varicella Zoster Virus) DNA by PCR (polymerase chain reaction) tests from a clinical specimen, ideally scabs, vesicular fluid, or cells from the base of a lesion is the preferred method for varicella diagnosis. PCR is also useful for confirming breakthrough varicella. Other methods, such as DFA (direct fluorescent antibody test) and culture, are available for diagnosis but are less sensitive and specific than PCR.2
Serology testing can be helpful, especially when identifying past infection, but providers should be aware of its limitations for confirming current infections. More information on testing can be found here.
- Review current vaccine recommendations, contraindications, and alternatives for those who cannot be vaccinated (e.g., immunoglobulin).
Varicella Vaccine Recommendations
Managing People at Risk for Severe Varicella.
REPORTING
Promptly report suspected or confirmed varicella cases to DC Health by emailing doh.epi@dc.gov
AND
Submit a Notifiable Disease and Condition Case Report Form online using DCRC: dccovid.force.com/provider/s/login.
For more information, or to report suspected varicella cases, please contact the
Division of Epidemiology – Disease Surveillance and Investigation:
Phone: 1-844-493-2652 | Fax: (202) 442-8060 | Email: doh.epi@dc.gov