jonetta rose barras: Mayor Muriel Bowser causes delay of some Medicaid managed care services, again

It’s unsurprising that many of the District’s poor and working-class residents — and their advocates — lack faith in Mayor Muriel Bowser to act in their interests. There have been myriad occasions where she seems to have ignored their needs, favoring to respond to political considerations. 

The Medicaid managed care saga may provide some of the strongest evidence. Since December 2020, Bowser and her sidekick, Deputy Mayor for Health and Human Services Wayne Turnage, have pushed through contracts and contract extensions for their friends and allies while blatantly violating local procurement laws, breaching agreements with the DC Council, and disadvantaging Medicaid and Health Care Alliance members.

The most recent example of Bowser’s dispassionate, cavalier approach came this week. Rather than act expeditiously to implement new MCO contracts approved by the council in October, she and her team have dragged out the process. Further, they waited until just a few days before the legislature’s final session to seek yet another extension of agreements with three existing contractors: AmeriHealth Caritas District of Columbia Inc., MedStar Family Choice Inc. and CareFirst BlueCross BlueShield Community Health Plan. 

The combined cost for those extensions through March 2023 is projected to be $451,688,249.67, according to the resolutions filed by the mayor with the DC Council.

In a contract summary accompanying the proposal, Bowser’s Office of Contracting and Procurement (OCP) asserted that the continuation of “these established contractors is crucial in sustaining continued care, therapies and other services required for Medicaid managed care, Alliance and [Immigrant Children’s Program] enrollees until such time as the post-award protest of the long-term contracts [has] been resolved.”

“Disruption of these managed care services would result in delayed or eliminated access to vital and critical health care services, subsequently imperiling the overall health of District residents. It is in the best interest of the District to ensure that a delay or gap in services does not occur in the performance of the managed care contracts by proceeding with the three current MCO contractors through emergency contracts until the pending protest has been resolved.”

While two of the companies included in the extension will subsequently receive a long-term agreement, CareFirst will not. It has been fighting that fact for much of the year. It filed several complaints with the DC Contract Appeals Board (CAB) when it was kicked out of the competition for the new MCO agreement. Those issues were resolved. Later, however, the company filed another two protests, which remain outstanding.

But Bowser and her team are the ones to blame for the current morass. They have been playing politics with people’s health care for years while exacerbating the delays associated with any so-called “protests.”

Some council members are unwilling to buy into Bowser’s finger-pointing and be fooled thrice by her. Consequently, Council Chair Phil Mendelson, Council Chair Pro Tempore Kenyan McDuffie and at-large Council member Robert White, who has oversight of OCP, have filed joint resolutions of disapproval.

“Our goal is to get the executive to stop this nonsense,” Mendelson told me during a telephone interview earlier this week while he was on a short break from the council’s final legislative meeting of Council Period 24. 

White said, via email, that he was “very concerned that the administration did not file a motion to expedite [with the CAB]. That [concerned] me enough to file a motion to disapprove the contract extensions. 

“If the council sees prompt progress on the transition to the previously approved contracts, I’ll withdraw the disapproval resolution,” he added.

Mark Poindexter, the general counsel for the CAB, confirmed via email that there are two pending protests — both filed by CareFirst. The CAB “anticipates issuing decisions in these matters no later than next week, well within the 60-business day statutory deadline for resolving protests before the Board set forth in D.C. Code sec. 2-360.08(d).”

Undoubtedly, the administration calculated that with the council going out for holiday recess on Dec. 23, legislators would have no time to act. The requested extension, therefore, would get passive approval as of Dec. 30.

That was the same strategy Bowser used for a previous extension. Is the jig up?

Seemingly, yes. The resolution of disapproval filed by Mendelson, McDuffie and White extends the clock until Feb. 2.

“I am outraged by how the system has been played” by the executive, Mendelson told me. He recounted Bowser and Turnage’s actions since 2020. In the fall of that year, the CAB ruled that the administration during its procurement for a new MCO contract had violated local rules and laws. The CAB ordered Bowser to re-evaluate the various bids and scores, ensuring that the top three would be subsequently selected.

“The council and mayor argued over that for more than three-quarters of a year,” continued Mendelson, adding that rather than “perpetuate” the lengthy fight, the council “allowed [the administration] to keep illegal contracts in place.”

Mendelson acknowledged that “illegal” may be “strong language” to use.

If it wasn’t illegal and corrupt, it was — indisputably — unethical. 

Consider that when the re-evaluation ordered in 2020 by the CAB was finally conducted in 2021, Amerigroup DC scored higher than MedStar. Rather than make the change, Bowser contrived an excuse for not selecting Amerigroup. 

The council enabled the corruption by extending two of the existing contracts. Then, it awarded MedStar a sole-source agreement — all in an effort, legislators said, to ensure the city’s most vulnerable residents were not harmed.

That clearly wasn’t Bowser’s motivation. MedStar was an ally she and Turnage wanted to keep; it also helped that the parent company had threatened to pull out of the program if its contract wasn’t extended. 

Turnage then promised to “re-procure” the MCO contract, under the guise that mental health and substance abuse treatment would be folded into the new agreements, making it easier for Medicaid and Alliance patients to obtain needed assistance. “Community-based intensive mental health and substance use disorder services are available to Medicaid beneficiaries today but are provided outside of the managed care program,” he said in a prepared statement back in August 2021.

“Bringing these services into the managed care program supports better care coordination and whole person care and alleviates the need for beneficiaries to navigate multiple systems,” Turnage added.

The administration pledged to send a new round of proposed managed care agreements to the legislature in June 2022. That didn’t happen. Instead, they sought and obtained a contract extension — not just once, but twice.

When the new contracts finally came before the council in October, Bowser and her team blamed the delay on the fact that losing bidders had filed complaints with the CAB; three remained outstanding.

As the council agreed to the latest round of extensions, waiting in the wings were the three companies — AmeriHealth, MedStar and Amerigroup — that earlier this year made it successfully through the competition and were told in June they likely would share the $8.8 billion, five-year contract. 

CareFirst was the losing bidder, but it was part of the subsequent resolutions to extend the existing contracts through Oct. 1 and then through Dec. 29.

Before the council could vote on the three new contracts, David Catania — a former DC Council member and founder and managing director of Georgetown Public Affairs, which serves as CareFirst’s lobbyist — launched a nasty media campaign designed to discredit Amerigroup and advantage his client. 

Bowser did nothing to get in CareFirst’s way. She could have asked the CAB to expedite its decision, as White suggested. That would have allowed her and her team to begin the process of transitioning Medicaid and Alliance recipients to new MCO insurers. Egregiously, she instead permitted CareFirst’s action to stall that process.

“Contrary to assurances given by the executive, the city has been kicking the can down the road, allowing [extensions] for contracts from two years ago,” Mendelson said.

Even if the CAB rules that the city can move forward with the new agreements, don’t expect Bowser and Turnage to act with urgency. They will reason that they need 90 days to transition patients to the new contractors — meaning yet another extension is still needed.

The plan had been to start the new program in February. The current delays could push the new date to June or later, depending on what shenanigans Bowser and Turnage decide to engage in. Meanwhile, Bowser’s political ally, CareFirst, will continue to feed at the public trough, despite being the losing bidder in this round of competition. 

More disturbing is that Medicaid and Health Care Alliance members will feel the greatest harm. The adjusted timeline means many will not benefit from the new, improved health care service delivery that includes insurance for mental health and substance abuse treatment promised in 2021. 

It is, unsurprising, indeed, that low-income and working-class residents perceive themselves of little to no importance to the Bowser administration.

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jonetta rose barras is an author and freelance journalist, covering national and local issues including politics, childhood trauma, public education, economic development and urban public policies. She can be reached at thebarrasreport@gmail.com.