Council roundtable flags denials, prior‑auth delays and credentialing gaps in DC Medicaid managed care

Councilmember Christina Henderson, chair of the Committee on Health, convened a roundtable Sept. 30 to examine performance and provider experiences with the District’s Medicaid managed‑care organizations (MCOs). The hearing gathered testimony from the three MCOs that contract with the Department of Health Care Finance (DHCF), provider groups, legal advocates and families.

The committee opened with context about scale and spending: “As of June 2025, there were over 240,000 people — approximately 88 percent of all Medicaid enrollees — enrolled in these managed care plans,” Henderson said. The council noted that the District spent nearly $2,000,000,000 in 2022 on services administered by MCOs and that two‑thirds of provider payments were delivered through managed care by FY2024.

Witnesses described recurring operational problems. Community providers and doulas told the panel that credentialing and contracting times vary widely across plans, that paperwork is sometimes lost, and that claims denials and inconsistent coding practices have led to delayed or missing payments. “After a lengthy process, I did establish a contract with two other MCOs, which took about six months,” Crystal Jackson, owner of Aqui Grama Doula Services, testified. Gina Vallow, owner of…