Update, July 30, 4:15 p.m.: The D.C. Council has introduced a resolution of disapproval for the contracts, extending the review period by 35 days to September 3, 2020. The disapproval notice — introduced by Chairman Phil Mendelson, Ward 5 Councilmember Kenyan McDuffie, and At-large Councilmember Robert White — essentially buys the Council more time to review the proposed contracts.

In a statement sent to DCist, McDuffie said the process is worthy of stricter scrutiny, given the concerns about what impact the contracts will have on the city’s Medicaid recipients who get reassigned to different health care providers.

“The COVID-19 public health emergency has underscored the urgency to better understand how health disparities in the District are created, and in many ways, exacerbated by hasty government action or inaction. Because so many outstanding questions remain, the Council has an obligation to ensure these concerns are fully addressed prior to any of the proposed contracts moving forward,” McDuffie said in the announcement. “My top priority is in ensuring that District residents, especially our most vulnerable, get the appropriate coverage they need and deserve, especially in light of an ongoing public health emergency.”

Without the new measure, the contracts would have been approved July 30.

Original, July 30, 10:17 a.m.:

Earlier this month, D.C.’s Department of Health Care Finance announced plans to move forward with sweeping changes to the city’s Medicaid program, which provides health care coverage to more than 275,000 District residents, including many of the city’s low-income residents and those with disabilities.

The changes represent nearly $1.5 billion in new contracts with three managed care organizations, and would switch about 20,000 residents currently enrolled in traditional Medicaid — also known as “fee-for-service” — to privately managed care plans.

If approved, the new contracts will be awarded to AmeriHealth Caritas (which currently holds one of the city’s existing contracts), MedStar Family Choice, and CareFirst BlueCross BlueShield Community Health Plan (which recently acquired D.C.-based Trusted Health Plan, also a current contract-holder).

Patients in fee-for-service plans, in which providers are reimbursed for their services directly by the D.C. government, currently account for about 23% of Medicaid recipients, but 55% of total program costs, per DHCF.

Supporters say switching these patients to managed care plans will save the city millions in health care spending, and that the reforms will put an end to mismanaged funds and add accountability to the program.

While the department is calling the changes a “major milestone,” community leaders are warning that the changes are happening too fast and with little public input.

Particularly, some residents are worried that a center like the CareMore Health facility at the Hechinger Mall in Northeast — which serves thousands of Medicaid members through insurance provider Amerigroup — could lose its contract in the transition, switching patients to new doctors and case managers. These residents say the CareMore has provided primary care, mental health services, and emergency procedures under one roof for many patients in wards 5, 7, and 8 for the past few years, as it sits along the X2 bus route and is near the free D.C. Streetcar.

Sydelle Moore, vice-chair for ANC5D, which represents the Trinidad, Ivy City, Carver-Langston neighborhoods, says that the upcoming changes aren’t ideal for patients with limited transportation options. Any change that could send them to physicians who are farther away during the COVID-19 pandemic is cause for concern, she says.

The city has been transparent about its plans for changing the Medicaid program, says Moore, but she’s bothered by the timing.

“I think the major difference is when they designed that five-year plan, there was not a global pandemic,” Moore tells DCist. “We just want to make sure that people continue to receive the care that they need from the doctors they already know. That’s not always the case throughout life, but certainly in the middle of a pandemic, that’s much more of a priority.”

Gordon-Andrew Fletcher, chair of the Ward 5 Democrats, wrote a letter this week to the D.C. Council asking for a more thorough review of the proposals.

“With all members of the Medicaid and Alliance program being reassigned, there are no guarantees there will be continuity of care with their current health providers,” Fletcher writes in the letter, obtained by DCist. “Given the large number of lives who will be impacted by these changes in their health care (potentially reassigned multiple times if the various protests are upheld) and the value of the award totaling nearly $1.5B, we feel the Council should thoroughly review this contract.”

The DC Line’s Jonetta Rose Barras wrote a column raising concerns about the switch on Wednesday, citing MedStar’s spotty business history with the District’s Medicaid program and other worries from the health care community:

“In the middle of a deadly global health pandemic, DC Mayor Muriel Bowser’s administration has decided to shake up the city’s system for delivering health care to poor residents who are on Medicaid. Many of them are people of color and are part of the population hardest hit by the novel coronavirus …

Some in the health care community, including clinic directors, are worried about what the switch might mean for their stable of doctors. Equally important, several managed care providers have filed complaints with the DC Contract Appeals Board (CAB) citing irregularities in the procurement process.

It’s a mess.”

The contracts would go into effect Oct. 1, the start of the District’s new fiscal year. Barras writes that “this is all wrapped in heavy politics,” alleging that Ward 7 Councilmember Vincent Gray has tied MCO requirements to the new 136-bed hospital at St. Elizabeths East that the Council just approved. (Gray didn’t immediately respond to a DCist request for comment.)

These concerns aren’t new. The city outlined its 5-year plan last year, and patient advocates warned that there could be issues associated with shifting Medicaid members to private plans, as Washington City Paper reported. Specifically, health officials warned that fee-for-service patients with highly specialized needs wouldn’t be able to move as freely through the health care system.

“People with disabilities often have complex medical needs and may be seeing multiple providers or specialists,” Erin Loubier, senior director for health and payment innovation at Whitman-Walker Health, told City Paper. “The possibility that their important list of providers is not all in-network with the MCO is very real and very possible.”

But Wayne Turnage, deputy mayor for the Department of Health and Human Services and DHCF’s director, told City Paper that there were issues with the current plan — like Medicaid patients using the emergency room as a primary care physician. “We have been, for some years, talking about moving the fee-for-service population under the umbrella of managed care to give them access to the same kinds of care coordination that other members in the program have access to,” he said at the time.

Turnage told DCist in an email that the reforms will extend benefits to Medicaid recipients who have higher morbidity levels, worse health outcomes, and higher health care costs than those who are in MCOs.

One concern is that the patients would be put in a lottery-like system that randomly assigns Medicaid recipients to new plans. But Turnage has a number of responses to that idea: a version of this process has been in place sine the 2007 inception of Medicaid-managed care in D.C., it’s similar to most state Medicaid plans, and members can request new assignments.

“With this new contract, we will reduce the need for member transfers because all plans will be required to contract with all hospitals, clinics, and large physician practice plans,” Turnage said in a testimony to the D.C. Council, which he provided to DCist.

The contract proposals were introduced by Council Chairman Phil Mendelson at the request of Mayor Muriel Bowser on July 17, and they’ll be deemed approved July 30 unless a resolution for disapproval is introduced by the Council. On Wednesday, the Committee on Health held a roundtable with public testimony from health care workers, including the CEO of Amerigroup — but some say the process is worthy of deeper scrutiny.

“I respectfully request the Council not decide who wins or loses in this contract, but to spend more time allowing for community, stakeholder and industry comment into the largest health contract the Council will review,” Fletcher, chair of the Ward 5 Democrats, wrote in his letter to the Council. “A 10-day passive review of this critically important program that supports our most vulnerable residents is a disservice to those who rely on Medicaid and the Alliance program for their health needs.”