DC Medicaid patients wait on MedStar contract resolution

Entrance of Washington Hospital Center

The main entrance at Washington Hospital Center. (Medill DC - Washington Hospital Center/Flickr)

Two hundred and fifty thousand D.C. residents on Medicaid are waiting for resolution of a dispute between Mayor Muriel Bowser and D.C. Council regarding Medicaid contract renewals. If a deal isn’t reached by Sept. 30, those low-income residents may not have the same access to doctors within the large MedStar care provider network.

D.C. contracts with MedStar, AmeriHealth, and CareFirst to provide three choices of health insurance — called “managed care plans” — to Medicaid enrollees. D.C. residents with low-income health coverage can choose MedStar as their insurance company and then access the same company’s doctors. Medicaid enrollees choosing the other two managed care plans have also been able to access MedStar-affiliated providers. However, that access is now under threat.

Since at least as far back as 2017, Bowser and D.C. Council have fought over lucrative contracts for Medicaid managed care. In December 2020, a review board of government contracting ruled that D.C. improperly awarded MedStar one of those three slots during the most recent bidding. However, during 2021, the mayor’s administration did not perform the court-ordered review of that contract. 

This summer, the council passed a law requiring that contract reevaluation and booting MedStar’s insurer off the menu for Medicaid recipients October 1. Even though D.C. would be able to move MedStar enrollees to the other two managed care plans, only CareFirst members would get access to MedStar doctors. MedStar threatened this summer to exclude AmeriHealth members if the former lost its managed care contract, according to the Washington Post

Mayor Bowser and councilmembers have exchanged additional rebuttals in recent weeks. If nothing is resolved, the status quo places 65,000 AmeriHealth members at risk of losing their doctors and some additional residents — more than 160,000 — in limbo as they get transferred from the MedStar insurer out to either AmeriHealth or CareFirst.

Street Sense Media Deputy Editor Gordon Chaffin was a Medicaid recipient enrolled with MedStar’s managed care plan until last week. In calls to the company’s customer service representatives, those officials did not promise that Medicaid patients would have continued access to MedStar care providers. Representatives said that MedStar physicians would do their best to refer Medicaid patients to other providers.

Issues |Health, Mental|Health, Physical

Region |Washington DC

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