jonetta rose barras: Are aspects of DC’s much-touted healthcare system on the verge of collapse?

When MedStar Washington Hospital Center in DC announced the closure of one of its two postpartum maternal units over the summer, alarms understandably went off throughout the government and advocacy community. In the District and in many other parts of the country, maternal mortality disproportionately strikes Black women. Several years ago, Mayor Muriel Bowser, hoping to gain control over the problem, invested millions of public dollars in programs and created a Maternal Mortality Review Committee. She even convened a National Maternal and Infant Health Summit.

Nonetheless, on the March of Dimes 2025 maternal health report card, DC received an “F” for preterm conditions; on a nationwide ranking, the District was listed 45th, ahead of only six states and Puerto Rico. Its performance worsened from the previous year in that category and every other, including infant mortality, severe maternal morbidity and maternal mortality. 

“Women are going to die,” warned one medical professional, who, like several others I spoke with, requested anonymity out of concern for their job and for their relationship with the DC government. That person, who is licensed in DC and five states, predicted that without adequate facilities, some women will give birth in the emergency room. “That is no place to deliver a baby.”

“I don’t see anyone doing anything about this,” added the professional, citing frustration about a lack of corrective action by DC officials. 

At-large Councilmember Christina Henderson, chair of the Committee on Health, held a July 8 oversight hearing on the issue. Other legislators offered comments. That is to say there’s been much hand-wringing, but maternal health remains a crisis in the District.

Truth be told, the failures of the DC’s health system go well beyond pregnant women. Large segments of the nearly 300,000 poor and working-class residents enrolled in Medicaid or one of the government’s locally financed insurance programs — and therefore reliant on coordination that’s supposed to be provided through several managed care organizations (MCOs) — are increasingly receiving inadequate or substandard services, according to independent evaluations and my conversations with medical professionals.

For years, District leaders promised to enhance access to healthcare, eliminate inequities, and improve the overall health of the city’s most vulnerable residents. Instead, the departure in July of one of the three primary MCOs, evaluations of the remaining two conducted by the National Committee for Quality Assurance (NCQA) and even official testimony by a senior government executive suggest an indisputable deterioration — maybe even collapse — of the multibillion-dollar system.

“There has been so much turnover with the MCOs over the years. Every time it happens, it’s so much more difficult,” explained a manager at one Federally Qualified Health Center (FQHC), a type of facility commonly known as a community clinic. “It’s hard and sort of exhausting for everybody involved, and now we are down to two.”

“On a lot of levels, it’s the same group getting hit multiple times,” said the clinic manager, citing single adult males — including those who are experiencing homelessness — as among the most affected by the changes. 

Several years ago, DC’s health officials and its Interagency Council on Homelessness thought they had found one way to bring them some relief. They began using Medicaid to cover the cost of case management for those in permanent supportive housing. 

“Housing was healthcare and healthcare was housing,” explained the manager. 

The federal government covers 70% of the cost for DC’s Medicaid program. The change saved local dollars but also meant a better response to the needs of previously unhoused individuals and fragile families.

A draft of the Interagency Council’s new report, which I was allowed to see, proposes building on the success of that effort, noting that one lesson learned since the publication of its previous strategic five-year plan, Homeward DC 2.0, is that “people who experience homelessness are more vulnerable than originally assumed,” with “many complex health needs — especially older single adults.”

In January, as Medicaid changes imposed by the federal government in the One Big Beautiful Bill begin to take full effect, that same population may feel the hammer again. They may be forced to work at least 80 hours per month in order to continue to receive Medicaid, jeopardizing their healthcare access if they don’t comply. 

A similar work requirement is already being imposed on residents who receive certain benefits through the Supplemental Nutrition Assistance Program, known as SNAP. For a while, the District used local funds to forestall the impact of the federal mandate. Now, however, the city is facing fiscal challenges and some of the requirements are being implemented. Individuals already meeting the new SNAP rules will likely be considered compliant for Medicaid. Meanwhile, there are exemptions for people with various disabilities, including those with substance use or mental health disorders.

“We know a lot of people [on Medicaid now] are going to end up being uninsured,” continued the clinic manager, who expects to try to find a funding source to help pick up the slack. 

The full impact is likely to show up next spring, when clients have been unable to obtain recertification, the manager said. “We may not feel the brunt of it until March.”

Recent MCO evaluations make apparent that staying on Medicaid won’t necessarily guarantee quality healthcare, however. Consider that MedStar Family Choice — the MCO whose parent company is MedStar Health, the same organization that closed down the postpartum units — received a rating score of 2.5 out of 5, according to NCQA. 

Family Choice received poor marks in patient care, childhood immunizations, cancer screening, and asthma and diabetes control, among other areas of care. More specifically, it was given 1 star for coordination of “well care for a child in the first 15 months of life”; 1 star for the first 15 to 30 months of life; 1.5 stars for women’s reproductive health; and 1 star for prenatal checks. 

Most of the categories relate to maternal health and mortality and to infant mortality problems. According to the March of Dimes, in 2023, 55 children died in DC before their first birthday; the mortality rate among babies born to Black mothers was 1.5 times the overall rate in DC.

When rating the overall plan and services, Family Choice members gave it 2 stars. Unsurprisingly, the MCO has a provisional accreditation because it is operating under a “corrective action” plan issued by the DC Department of Health Care Finance. The next evaluation by accreditors is slated for December.

AmeriHealth Caritas of DC, the other MCO, scored higher. It received 3.5 out of 5 stars. Don’t think that’s cause for celebration, however. According to the report, AmeriHealth received only 2 stars for patient experience and 2.5 in the area of treatment, a broad category that includes asthma control and ensuring adherence to medication regimens for those with behavioral health issues.

It received only 1 star for the ease with which members were able to get appointments, preventative care, tests and treatment. This is the MCO to which Wayne Turnage, DC’s deputy mayor for health and human services, transferred the more than 50,000 Medicaid patients who had been served by Wellpoint before the city forced the company out of the program.

Don’t expect the city to demand more from AmeriHealth or MedStar. The last time that happened, MedStar threatened to stop seeing other MCO members.  

As for AmeriHealth, the plan’s director is a former DC government employee who later worked for DC Chartered Health Plan, founded by Jeffrey Thompson. Back in 2010, Thompson was part of a shadow campaign that helped propel Vincent Gray’s mayoral victory; Thompson and a couple of others subsequently went to jail. The presence of cozy relationships between government and its contractors suggests favoritism — and cronyism rarely goes hand-in-hand with program effectiveness.

I sent an email to Turnage, through the mayor’s office, requesting a comment about the NCQA evaluations. He did not respond. Susana Castillo, the mayor’s communications director, didn’t get back to me after promising to do so when I sought her assistance in reaching Turnage.

I also asked Henderson for an interview as chair of the council’s Committee on Health; she wrote in her email reply that her schedule did not permit her to speak about the evaluations with me by my deadline. I sent a subsequent email, asking if she might provide a written statement. She did not respond to that follow-up request.

“The system does not work,” said Dr. Edwin Chapman, who has long had a medical practice east of the Anacostia River. He blamed the structural framework in place in the District for the closure of several hospitals and the severe loss of primary care physicians.

“Our private for-profit system is a for-profit system. It is designed to make money and not to take care of patients,” continued Chapman, who expressed disappointment that Henderson — despite his many appearances before her committee and his decades of providing care to DC residents — has never been to his office to fully understand the issues he deals with as a physician or the needs of his patients.

Chapman noted that billing practices known as “downcoding” — widely used by the MCOs, especially AmeriHealth — have denied him and other providers needed resources for the care of patients with multiple medical issues. Many of his clients have complex diagnoses, including addiction to opioids like fentanyl; mental health disorders; and chronic diseases like hypertension, diabetes and heart disease. More than a few of his patients also lack permanent housing.

He said that complex patients like his amount to about 2% of the general patient population in DC but account for as much as 30% of healthcare costs. Chapman observed that the challenges he encounters in serving these patients in the current system are typical for providers like him.

Ironically, two hours after my note to Henderson, which mentioned Chapman’s concerns, she issued a press release highlighting her introduction that day of the Transparency in Downcoding Amendment Act of 2026 — co-introduced by Council Chair Phil Mendelson and eight other councilmembers. The bill is designed to “protect clinicians and patients from health insurers automatically reducing reimbursement for care provided solely based on a diagnosis code.”

“Increasingly, insurers are using automated systems, algorithms and artificial intelligence to make these decisions, sometimes without a clinician reviewing the patient’s medical record or the information submitted by the treating provider,” Henderson said in the prepared statement. “This practice undermines clinical judgment, creates administrative burdens and unfairly disadvantages clinicians who care for patients with complex or chronic conditions.”

Henderson’s legislation comes three years after Chapman’s initial plea for help. He sent an email thanking her for the proposal.

The bill won’t eliminate DC’s systemic healthcare access and delivery flaws. It won’t eliminate the Medicaid work mandate. It won’t reopen the closed maternal unit at MedStar. And it certainly won’t improve overall MCO performance. Henderson knows that, as does Turnage.

Speaking earlier this year, during budget deliberations, Turnage, the architect of the city’s current Medicaid financing and delivery model, acknowledged it “had not produced the results we anticipated. … [T]he system continues to struggle in ensuring that insured residents are receiving the right care, at the right time and in the right place.

“For the most senior members of the program, there is little evidence to support the view that health plans are appropriately managing their members’ care, helping to avoid significant care issues and higher cost to the system,” Turnage wrote in his prepared testimony. 

“The problems we identified more than 10 years ago continue unabated — the excessive use of the emergency room for low acuity illnesses … and the rise of avoidable hospital admissions and readmissions.”

Turnage said he has directed his team to work with representatives of federally qualified health centers to “reimagine how we might better organize case and care management for Medicaid — possibly moving this function and the funding from the MCOs … locating the activities with some or all the FQHCs who are on the ground delivering care.”

In other words, Turnage, one of the highest-paid executives in the DC government, admitted his failure, essentially saying, “Oops.” Further, in that appearance before the council, he suggested the DC government consider returning to a health access and management system comprised of clinics and centers — like the one that was in place in 2010 when he was hired by then-Mayor Gray, and the one that Turnage in effect dismantled over the past 16 years.

His proposal also comes after shuffling tens of thousands of poor, working-class and unhoused DC residents, many with serious chronic diseases, among multiple MCOs. It also comes after the District has shelled out billions of taxpayer dollars to those companies, even as they have consistently demonstrated an inability to improve the healthcare of the city’s most vulnerable population.

Please tell me I am not the only person who is hoping that he doesn’t make it into the next mayoral administration.

jonetta rose barras is an author and DC-based freelance journalist, reporting and commenting on national and local issues. She can be reached at thebarrasreport@gmail.com.

This piece is our 2026 contribution to the D.C. Homeless Crisis Reporting Project in collaboration with other local newsrooms. The collective works are available at bit.ly/DCHCRP.