jonetta rose barras: Finally, new Medicaid managed care contracts

DC residents, especially those who are either Medicaid recipients or DC Health Care Alliance members, should be elated that the seemingly endless managed care procurement finally ended this week. In a 10-2 vote, the DC Council approved three Medicaid managed care organization (MCO) contracts totaling $8.8 billion over the next five years. That money is slated to be divided among AmeriHealth Caritas DC Inc., Amerigroup DC and MedStar Family Choice. 

There is a mandated 90-day transition period. The contracts are not scheduled to take effect until February 2023. While those companies are considered insurers, the decisions they make and the strength of their network of doctors and medical professionals affect the actual health care of 250,000 individuals, many of whom are low-income or working-class people suffering from chronic diseases. 

The legislature’s arrival at the finish line was no easy feat. Mayor Muriel Bowser and her team — including Deputy Mayor for Health and Human Services Wayne Turnage — engaged in contracting shenanigans for nearly two years. They brazenly violated local procurement laws, ignored the ruling of the DC Contract Appeals Board (CAB) and deliberately misled the council throughout all of 2021. 

Earlier this year, the Bowser administration — attempting to honor an agreement with the council to deliver new MCO contracts by June — botched a procurement, resulting in a bifurcated process. That led to six complaints being filed by three bidders with the CAB, and an equal number of rulings. 

Dissatisfied with those decisions, CareFirst BlueCross BlueShield Community Health Plan engaged Georgetown Public Affairs (GPA) — founded by former at-large Council member David Catania — to undertake an expensive and unprecedented lobbying campaign on behalf of its spurned client. Had it succeeded, the effort might have also advantaged another GPA client — Cityblock Health DC, which is a CareFirst subcontractor. GPA’s lobbying included advertisements on news websites like The Washington Post, radio stations and social media platforms that urged residents to call and write DC elected officials demanding they retain CareFirst as a Medicaid MCO. The campaign sought to discredit Amerigroup, which in 2020 was the prime victim of the administration’s abuse of the procurement process. 

Neither Catania nor CareFirst responded to my email requesting a comment on their failed lobbying campaign and the council’s vote. Jenny Edelstein at Cityblock Health’s New York City headquarters referred me to CareFirst.

Adrian Jordan, Amerigroup DC’s president, called the latest procurement process “comprehensive and fair.” In an email response to me, he said the selection of Amerigroup DC was a recognition of the company’s “record of improving the health of the individuals we serve.”

“We are eager to get started on the important work of building upon our existing community partnerships, addressing the social drivers of health and integrating critical behavioral health services to Medicaid recipients in the District,” he added.

Given the vote on the MCO contracts, The DC Line’s readers might conclude that October has been a banner month for this columnist. After all, the council also passed legislation that affected several other issues I have written about: The Stormiyah Denson-Jackson Race and Gender Economic Damages Equality Amendment Act of 2021 was twice introduced by Ward 8 Council member Trayon White. He and Council Chair Phil Mendelson also helped push through emergency property tax relief for River East at Grandview condo homeowners, many of them low-income, working-class Black women.

Stormiyah was a 12-year-old student at the SEED Public Charter School in Ward 7 who, while in her dormitory, killed herself; the psychologist there knew she was having suicidal ideations but never revealed that to her mother. The family filed a lawsuit, which subsequently revealed the cavalier approach that the city’s Public Charter School Board had taken to enforcing DC laws designed to protect children like Stormiyah. SEED eventually settled the case for an undisclosed amount of money. 

Passage of the Denson-Jackson bill, named in memory of Stormiyah, does bring some satisfaction. It would prohibit the use of race, ethnicity or gender to reduce the calculations of lost earnings in personal injury cases. 

However, the property tax relief bill fails to adequately resolve the enormous financial burden being carried by Ward 8 homeowners whose plight first came to my attention in February 2021. The District failed to thoroughly inspect construction of the Talbert Street SE development, which was partially financed through a city loan.

The homeowners, realizing only after they moved in that they had been swindled, sought assistance from the DC Office of the Attorney General, the DC Department of Housing and Community Development and the DC Department of Consumer and Regulatory Affairs. They eventually were forced to move when engineers determined it was too dangerous for them to stay; the city provided some relocation and rental assistance. The homeowners continue to pay mortgages that the District should have assumed through its Housing Production Trust Fund, allowing them to buy new houses or condos. 

In other words, the council’s tax relief is way too little. So, too, is the Housing Authority Accountability Emergency Amendment Act of 2022, advanced by at-large Council member Elissa Silverman (with AG Karl Racine) and co-introduced by 11 of her colleagues; it was passed unanimously — although Ward 7’s Vincent Gray didn’t make Tuesday’s meeting. He was in the hospital recuperating from a fall in his home bathroom.

It’s election season. What politician would decline to get behind a bill that purports to address the scathing report recently issued by the federal Department of Housing and Urban Development, which outlines major management deficits that have resulted in nearly 2,000 units going vacant as everyone is decrying the absence of affordable housing? 

The Housing Authority Accountability Act is far too timid. DCHA needs new — not recycled or re-trained — leadership. It also needs aggressive oversight, as I have suggested — not the kind that will be provided by a lackluster council committee chair. Hopefully, Silverman and Racine will deliver on their promise of a more substantive package within weeks; at-large member Anita Bonds, chair of the Committee on Housing and Executive Administration, has vowed to introduce a reform bill as well. I’m not optimistic that real changes will pass the council.

I know what you may be thinking: “There is no pleasing her.” There may be some truth there.

The MCO contracting fiasco may be resolved — for now, anyway. But the scene wasn’t very pretty. The questions asked by a few council members, including Bonds, made it appear they hadn’t done their homework. Others — namely Gray, who chairs the council’s Committee on Health; Ward 1’s Brianne Nadeau; and Ward 2’s Brooke Pinto — bought into GPA’s lobbying campaign, which was built on exaggerations and misinformation. Catania’s company has been on a $12,500 monthly retainer as the lobbyist for CareFirst, according to its report filed with the Board of Ethics and Government Accountability. GPA is also collecting $12,500 a month from Cityblock, which began its work with CareFirst soon after CareFirst was awarded its Medicaid managed care contract in 2020. 

Cityblock has been moving aggressively into the Medicaid health market across the country. Initially, the firm seemed to be a small player in a multi-trillion-dollar industry. But in December it reported a valuation of $1 billion. Will that be affected by the CareFirst loss? Will Catania take a financial hit? 

Who knows? Mum’s the word.

What probably is of greater concern, now that the contracting issues have been resolved, is whether Alliance members and Medicaid recipients will receive the high-quality health care they need and deserve. Only time will tell.

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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.