Health care services for DC’s Medicaid patients under threat

Access to public health care services for 250,000 D.C. residents could end if MedStar kills its remaining Medicaid and Alliance contracts this fall.

In a statement, Mayor Muriel Bowser blamed the development on the D.C. Council.

“I am aware that many of the 250,000 District residents who receive their health care through the District’s managed-care program now face a loss of access to the critical services offered by the MedStar Health System,” she said.

“When the Council, by a 7-6 margin, refused to support a reasonable exemption that would have allowed MedStar’s managed care organization to complete the procurement process, circumstances were created that now threaten the very access to treatment for managed care enrollees at all MedStar hospitals, clinics, their specialty care physicians and its rehabilitation hospital.”

Bowser said all D.C. residents would be impacted, citing “unacceptable waiting periods in crowded hospital emergency rooms, difficulty securing primary care visits, and lengthy 3- or 4-month delays for specialty care appointments.”

The mayor added that she will announce her proposal in the coming days to continue the Medicaid and Alliance program.

“We will keep fighting for these residents to prevent a chaotic and abrupt disruption,” she said.

At-large D.C. Council member Christina Henderson said that she changed her vote to support the mayor’s proposal because she saw what was happening with the Delta variant in other jurisdictions and other countries. She called the situation with MedStar Health a “mess.”

“And I knew that this would be even more of a mess, asking thousands of individuals to change their health insurance plan in the middle of a new surge of COVID cases, especially when we’re talking about a population of individuals who are among those who are most likely not to be vaccinated,” Henderson said.

Ambrose Lane Jr., chair of the Health Alliance Network, called the whole thing a “fiasco” that jeopardizes the health care of Black and brown poor residents of D.C., adding that this would also have a devastating effect on the immigrant population.

He wrote in an email that his organization “believes that this may violate Title 6 of the Civil Rights Code. We are also looking into filing a complaint with the Department of Health and Human Services Office of Civil Rights.”

Lane told WTOP that the mayor and the District have several options, including looking at the certificates of need that MedStar has on file and what those say in terms of MedStar’s obligation to service Medicaid residents.

“If it turns out that it’s in their certificate of need, then the city has the ability to suspend their operations under those certificates of need because those certificates of need were violated,” Lane said.

He said that D.C. gave MedStar too much leverage over its health care system, “if it can threaten to not provide services” for those on Medicaid.

“It appears that MedStar is unhappy with the fact that they lost their bid to keep their Medicaid managed-care contract after the District’s Contract Appeals Board ruled that [the Department of Health Care Finance] violated District law when it awarded them the contract and the D.C. Council refused to step in to change the law retroactively,” Lane wrote.

Wayne Turnage, deputy mayor of Health and Human Services, sent a letter to Ward 7 Council member Vincent Gray and several other members of the council Friday warning about the threat to health care access.

“This morning, Karen Dale, the CEO for AmeriHealth, informed me that the MedStar Health System … sent her organization a notice of termination for all medical services that the health plan currently purchases from MedStar,” Turnage wrote.

He said the notice had an effective date of November 2021 and confirmed it with a MedStar official. According to Turnage, that official also said CareFirst will get the same notice but with an earlier effective date.

“What this means is that if the current contracts between the health plans and MedStar expire without renewal, no enrollee in DHCF’s managed care program will have access to any MedStar hospital, clinic, rehabilitation facility or their expansive specialty care suite of physicians,” Turnage wrote. “The only services that will be available through MedStar will be qualifying emergencies that are handled through the Emergency Department.”

The deputy mayor added that MedStar accounts for more than 38% of the utilization in D.C.’s health system and more than a third of the $304 million spent on hospital services in 2018. Turnage said the numbers are virtually unchanged for 2019 through 2020.

WTOP’s Luke Lukert, Scott Gelman and Abigail Constantino contributed to this report.

Will Vitka

William Vitka is a Digital Editor and reporter for WTOP.com. He's been in the news industry for over a decade. Before joining WTOP, he worked for CBS News, Stuff Magazine, The New York Post and wrote a variety of books—about a dozen of them, with more to come.

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