CareFirst, D.C. Council negotiating ways to expand access to health care


Rather than create a new open enrollment program, health insurer CareFirst and Washington, D.C., lawmakers are working on alternatives to meet the requirements of a law passed last year to expand health coverage in the District.

symbol-goldAs part of the Medical Insurance Empowerment Act of 2008, which became law in the District in March, CareFirst is required to expand coverage to a minimum of 2,500 residents, through its Group Hospitalization and Medical Services Inc. subsidiary, who otherwise might be unable to secure commercial health care coverage.

GHMSI covers about 150,000 policyholders in the District, 700,000 in Maryland and 300,000 in Northern Virginia.

That component of the law, however, has been on hold through emergency legislation passed by the D.C. Council to allow more time to negotiate how the program will work.

At their meeting July 14, councilmembers decided to once again delay enacting the open enrollment portion of the law. The stipulation will take effect 90 days after Thomas E. Hampton, the District’s commissioner for its Department of Insurance, Securities and Banking (DISB), completes his review of the Owings Mills, Md.-based insurer’s surplus, another part of the legislation.

Spencer Maguire, legislative director for Councilmember Muriel Bowser, who proposed the extension, told the open enrollment requirement will take effect later this year, unless the District and CareFirst finalize an agreement a public-private partnership.

“The definition for public-private partnership in the bill has all been agreed to in principle,” he said. “We just all have to work out the details this summer.”

According to a proposed amendment to the law, CareFirst would be forced to meet three requirements under a public-private partnership. One would be a $5 million annual contribution to Healthy D.C. program for low-income residents. Another would be the creation of a citywide initiative aimed at improving nutrition and physical fitness among seniors, which could see an annual contribution of $500,000 per year, according to Maguire.

The third component would be the offering of a new HMO product, starting at $300 per member per month premium, while maintaining the insurer’s current open enrollment program.

In a statement to, CareFirst said the further postponement of the open enrollment provision “reflects the fact that CareFirst and the council remain engaged on this front.”

“We will continue to work in the coming weeks and months on methods to expand health care access in the District,” a representative of the insurer said in the statement.

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