The awarding of the District’s nearly $3 billion Medicaid contract remains in limbo until D.C. Mayor Muriel Bowser formally submits her recommendations for D.C.’s selected managed care organizations to the D.C. Council for approval.
Managed care organizations (MCO) CareFirst BlueCross Blue Shield, Amerigroup DC, AmeriHealth Caritas and MedStar Family Choice District of Columbia each hope to be awarded the contract to serve the 230,000 residents who count as Medicaid patients.
Medicaid, a federal government health insurance program, services poor and low-income Americans, with seniors and those with disabilities included in some cases. The council selects the managed care organizations that will service the recipients due to its responsibility to approve District government contracts over $1 million. Ultimately, three of the four MCOs will be chosen for the Medicaid contract. And while a final decision has not been made of who be chosen, observers note Amerigroup and AmeriHealth appear to be favored with Med Star and CareFirst vying for the third position.
The D.C. Medicaid process for this year’s contract which will remain in place for five years, has been mired in contention for nearly a year due to complaints lodged by MCOs about being treated unfairly during the process. Their complaints include technical errors faced when submitting their paperwork for approval.
Three MCOs, CareFirst, MedStar and AmeriHealth, have taken the procurement process to the Contract Appeals Board for review. Meanwhile, Bowser missed a June 28 deadline to submit the new contract to the council.
In a July 21 letter, D.C. Council Chairman Phil Mendelson (D), along with Council members Robert White (D-At Large), Brianne K. Nadeau (D-Ward 1), Janeese Lewis George (D-Ward 4) and Elissa Silverman (I-At Large) questioned why the contract hadn’t been submitted. In a response via Twitter, Deputy Mayor for Health and Human Services Wayne Turnage wrote, “to be clear, the results of the current procurement are under protest with the Contract Appeals Board (CAB), so without special permission from the CAB, the Department of Health Care Finance cannot move forward with the new contracts until the protests are resolved.”
In his July 29 letter responding to the council members’ concerns, George Schutter, who leads the D.C. Office of Contracting and Procurement, backed Turnage, saying, “in partnership with the program agency and District leadership, [we] determined it was in the best interest of the District and the beneficiaries to await the results of these three CAB decisions to minimize disruption to the beneficiaries resulting from any possible change in provider plans.”
Bowser said she agrees with the agency leaders’ stance regarding the contract.
“The fact that there is this delay isn’t unusual,” Bowser said. “This is a difficult contract to execute. We support waiting until there is a ruling by the Contract Appeals Board before we send the contract to the council.”
Bowser said Medicaid recipients should have a clear sense of who will be serving them and that can be best facilitated after the appeals process. She said she doesn’t know which MCOs will get the contract or the council submission timeline.
White serves as the chairman of the Committee on Government Operations and Facilities and will play a major role in the eventual awarding of the MCO contract. He said, “the executive can’t execute or implement the contract before the Contract Appeals Board ruling. But by law, the executive is able to send contracts to the council for review and doesn’t have to wait until the CAB issues a decision.”
“In fact, the executive used that process last year for existing MCO contracts, which [Schutter] recognized in the letter he sent to me and other council members on Aug. 11,” he added.
White said he doesn’t have a favored MCO provider but has problems with the present procurement process.
“My goal with procurement, as with all procurements, is to ensure that decisions are made through an independent, fair, transparent, legal and expeditious process,” he said. “Unfortunately, the MCO procurement has repeatedly failed to meet that standard over a period of years. Most recently, the administration agreed to send contracts to the council for review by June 2022 to avoid further extensions and that has not yet happened.”
White said the MCO procurement process needs reform or at least further investigation.
“The administration’s lack of transparency means that, at this point, the council doesn’t know what the issue is,” he said. “If the executive didn’t follow the legal procurement process, that would likely be a valid basis for a protest or appeal. But currently, we don’t have anything of substance that we can rely on to say they didn’t.”
White said alternatively, the process functions the way it should within the law and if a problem arises with the way it operates, reform might be needed. He said if the administration disagrees with the outcome, then “that is not a valid reason to hold up the legal procurement process.”
“Our residents see what happens when we disregard the legal process and it is those with the least resources who stand to lose the most in this situation with the MCOs,” he said.