It’s been a bitter yearslong fight over insurance coverage for a third of D.C. residents.
And after a lengthy debate about the procurement process and whether insurers would be able to provide the best care for the District’s low-income patients, the D.C. Council approved contracts for new insurers on Tuesday,
“I am encouraging my council colleagues to vote no on the MCO (managed care organization) declaration resolutions, so we ensure District residents are presented the best health care options through a transparent and error-free procurement process,” council member Vincent Gray said in a statement.
The council ultimately voted 10 to 2 to approve Medicaid coverage contracts with insurers AmeriHealth, Amerigroup and MedStar. The five-year contracts are worth around $8 billion.
The debate between council members focused on the procurement process, which examined bidders’ past performance.
The District’s procurement office tied a numbered score to each insurer. Both Amerigroup and CareFirst received a score of 66, but only Amerigroup was awarded.
D.C.’s chief procurement officer explained that the two scores were given during different procurement cycles, meaning they were not actually tied. Amerigroup and AmeriHealth were awarded based on the first procurement solicitation.
A second solicitation was then created because D.C. Medicaid is required by law to have three insurers. During that bid, CareFirst competed against MedStar, which had a score of 74. The process involved numerous appeals in front of the Contract Appeals Board, which ultimately chose those three insurers.
Some council members were still unsatisfied.
“Following the process, crossing every T and dotting every I sometimes leads to bad results. And that’s why final accountability for those results rests with us. That’s why what happens to our people on Medicaid rests with us,” said council member Brianne Nadeau. “I say let’s send this back and get better outcomes for our patients.”
Other members of the council said this came only after a targeted advertising campaign from CareFirst.
“We all want to make sure we have the best care for residents,” said council member Robert White. “We have to realize we up here are not experts on health care or conducting procurements. That’s why we are not the ones who should pick winners and losers.”
It was another bump in an already rocky journey in securing the city’s Medicaid insurers. In 2020, during the procurement process, a Contract Appeals Board judge found that MedStar did not meet the requirements to earn the Medicaid contract it was awarded and called the contract ineligible.
It led the council in October 2021 to extend contracts, as the District took nine more months to rebid and complete the procurement process all over again.