---------- Forwarded message ---------
From: Ambrose Lane Jr <ambrose@xxxxxxxxxxxxxxxxxxxxxxxxx>
Date: Thu, Aug 26, 2021 at 8:01 AM
Subject: PART 2!! The Healthcare Plight of over 200,000 DC Residents
To:
Blessings everyone. Buckle your seatbelts for a deeper look.
*Last Friday, August 20, Wayne Turnage, Deputy Mayor for Health and Human
Services alerted Chairperson Gray and members of the Committee on Health
that MedStar Health System was terminating its contracts with the two
remaining Medicaid managed care plans, Amerihealth Caritas and
CareFirst/Trusted.*
*Media, Health advocates, including myself, surmised that this meant that
over 200,000 DC Medicaid covered residents-- MCO's and the DC Health Care
Alliance which insures the immigrant population, could lose coverage and
hospital access. Well, not exactly, but not far off either. **It did
appear that MedStar was unhappy with the fact that they lost their bid to
keep their Medicaid managed care contract (Medstar Family Choice) after the
District’s Contract Appeals Board ruled that DHCF violated District law
when it awarded them the contract and the DC Council refused to step in to
change the law retroactively. Instead of accepting that ruling or appealing
it, MedSTAR is now using its considerable power as the largest provider of
Medicaid to endanger the lives of the very communities it has pledged to
serve. *
*This may be true, but there may also be a more nefarious reason why they
cancelled the contracts. MONEY. AND MORE OF IT. By cancelling the
contracts, they force AmeriHealth and CareFirst (and the city) to negotiate
ANOTHER CONTRACT. In that negotiation, Medstar Health is likely to ask for
more money--a higher payment for care and services they provide to medicaid
residents, particularly at their hospitals. That means that the money the
city (DHCF) gives the MCO's, will likely have to increase, since that money
is largely (though not completely) a pass-through. The city could be on the
hook for millions of additional dollars.*
*The deadline to negotiate a new contract (90 day period) between Medstar
Health and the MCO's/DHCF is mid-November (I think the 13th or 18th).*
*Before that deadline, NO ONE WILL LOSE COVERAGE. DHCF should have begun
by now moving Medstar Family Choice members into CareFirst and
AmeriHealth. The current status of that is unknown. When it was done
before, there were town halls and resident meetings to educate residents on
the process. That hasn't occurred at all yet.*
*ONE THING TO NOTE: after Medstar medicaid residents are moved, after mid
November, they will have to use AmeriHealth and CareFirst's IN NETWORK
physicians--meaning the will likely have to change primary care
physicians--which can be VERY disruptive and disorienting.*
*ANOTHER THING TO NOTE IF NO CONTRACT AGREEMENT IS MADE by mid-November:
a) for former Medstar medicaid residents (about 65,000 residents)--THIS is
the doomsday scenario. They will pretty much be in a healthcare purgatory;
b) for CareFirst and AmeriHealth members--either Medstar Health will have
to accept the MCO payment for services, or they can accept the payment as
partial and BILL THE RESIDENT for the remaining charges, or BILL THE
RESIDENT FOR ALL CHARGES. Their choice. This leverage of purposely
cancelling the MCO Contracts to seek higher payments and more money could
also have a domino effect--prompting other Hospital systems to
request/require more money. This almost amounts to extortion of City
money.*
*Medstar Health has made promises and commitments to the city and
its residents--through it's provider agreement, which it has now violated,
and through it's approved Certificates of Need. The OAG has apparently now
referred this matter to the Inspector General. *
*AmeriGroup, the MCO that lost its contract, filed a Motion For Sanctions
against the **Deputy Mayor for the District of Columbia Health and Human
Services and Director of the District of Columbia Department of Health Care
Finance, Wayne Turnage, and against the **D.C. Office of Contracting and
Procurement (“OCP”), and the D.C. Department of Health Care Finance
(“DHCF”) claiming that "the District unlawfully disclosed confidential,
proprietary and protected information that was contained in offerors’
proposals and evaluation documents." *
*The Mayor, in her statement on Tuesday, stated that she will come up with
a plan in the coming days, but not before seeming to place blame of this
situation on the DC Councils' vote **refusing to step in to change the law
retroactively--to clean up the mess. This is not the way to go. As a
Council member, I also would have voted no on cleaning up the procurement
and contracts mess. Instead, it is my hope that she will use her authority
to bring stakeholders together and work it out--to everyone's benefit,
especially for residents FIRST, while also holding the actions of Medstar
Health to account.*
*As for the DC Council and the Council Committee on Health, they can submit
and pass emergency legislation that makes mandatory from this day forward,
that in order to do business in the District of Columbia, that all
hospitals negotiate, in good faith, contracts with medicaid Managed Care
Organizations, and that if those negotiations come to an impasse, that
parties agree to binding arbitration, to include rates and fees and all
other components of the contract.*
*The DC Council should also consider creating in the future, a "Cost
Council," similar to the Maryland Health Quality and Cost Council, giving
it authority over determining health care costs and drug prices, fees and
rates and, of course, contracts.*
*I am NOT going to call for the resignation of DM and Dir. Wayne Turnage
because I don't believe that this fiasco is all his fault. He is however,
the leader that HAS to fix this and fix it for good for the residents I
advocate for. And he deserves one more chance to do that. Mistakes were
made and past mistakes he has tried to fix. I will however, not remain
silent while the health and lives of residents I work with and advocate for
lies in the balance. No one should take my criticism as condemnation, but
this shit better start working--soon.*
*And yes, we are still considering filing a complaint with the US
Department of Health and Human Services Office of Civil Rights*
*Ambrose Lane, Jr., Chair*
*Health Alliance Networ*k
(202) 374-6226
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