D.C. Mayor Muriel E. Bowser (D) declared a state of emergency this week to extend the city’s lucrative contract with MedStar an additional nine months, a move that city leaders hope will end a simmering conflict that could have disrupted care for hundreds of thousands of the city’s low-income Medicaid patients.

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       The massive MedStar hospital system said last month that it planned to end its agreements with the two other insurers that cover most of the D.C. residents enrolled in Medicaid, according to Deputy Mayor Wayne Turnage, after a judge last year found that the city violated procurement rules, which meant it should not have awarded MedStar the contract in the first place. The move would have meant that Medicaid patients would have lost access to MedStar’s large network of doctors.

       Under Bowser’s emergency order, Turnage said in a Washington Post interview on Thursday, the Office of Contracting and Procurement moved swiftly to offer MedStar — along with CareFirst and AmeriHealth, the other two insurers who provide managed care in the District and whose contracts were already set to be extended — an additional nine months on their current contracts, effectively skirting the ruling of the Contract Appeals Board judge.

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       “The mayor has said all along that she would fight and fight and fight again to ensure that people’s health care, some of our most vulnerable citizens, is not disrupted, especially at this time. This would accomplish that,” Turnage said.

       But even as Turnage declared victory over the crisis that has threatened to destabilize the city’s Medicaid system, members of the D.C. Council questioned the legality of the administration’s and MedStar’s actions.

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       MedStar’s contract to act as an insurer managing the care of 60,000 D.C. Medicaid patients was set to expire at the end of this month. Before Bowser’s emergency action, the city could not renew it because of the judge’s ruling in December.

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       Last month, according to Turnage, the company said that if it couldn’t act as an insurer to Medicaid patients, its hospitals and doctors would stop treating Medicaid patients covered by other plans.

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       On Wednesday, Bowser declared such a situation to constitute an emergency, noting in a five-page order that only 24 percent of patients in the city’s Medicaid managed-care plans are vaccinated against the novel coronavirus and more than 20 percent of all types of medical care for those patients takes place at MedStar facilities.

       Turnage said he had “every confidence” that with the new deal in hand, MedStar would agree to contracts with the other two insurers to continue treating their patients, so no Medicaid patients will lose access to MedStar doctors.

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       MedStar spokeswoman Marianne Worley said in an email that the company was “pleased” by Bowser’s actions but said she would not answer questions about the company’s negotiations with the other insurers. Worley wrote that MedStar “has never wavered in our steadfast desire to provide world-class healthcare to the most vulnerable residents in the District.”

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       Council member Elissa Silverman (I-At Large) questioned the mayor’s authority to declare the matter an emergency and said she would research whether Bowser’s move stayed within city law.

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       “My concern here is the strong-arm tactics of MedStar to coerce the city to ignore procurement law, ignore the Contract Appeals Board ruling, to get its way,” Silverman said. “I don’t think MedStar should be allowed to threaten and coerce District government into us giving them a contract. … MedStar is playing games with the health care, and I don’t think it’s a stretch to say the lives, of our poorest residents.”

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       The council could still disapprove the contract extensions. Although the council is on recess, Chairman Phil Mendelson (D) said that a signed statement of disapproval from three members could give the council additional time to consider the contracts; otherwise, they will automatically be considered approved on Sept. 12.

       CareFirst previously declined to answer questions on the topic, and AmeriHealth has not responded to questions from The Post.

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       The issue has sharply divided the council for months, with some members sharing Bowser and Turnage’s desire to keep MedStar in the program even if it meant rewriting law that MedStar broke, and others insisting that the city should follow its own procurement laws and the judge’s directive.

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       Silverman and Kenyan R. McDuffie (D-Ward 5), who have both been critical of Bowser’s approach, sent Attorney General Karl A. Racine (D) a letter on Wednesday, asking him to investigate whether MedStar violated the city’s antitrust law.

       “We think it is unfair for a health system to use the resources of its tax-exempt charitable entities [hospitals] for the benefit of its taxable business affiliates [the insurance company],” they wrote.

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       Turnage called the accusation of anti-competitive behavior “risible” from his perspective. “MedStar didn’t even have the highest rates in the market,” he said, noting that other hospitals in the city charge insurers more to treat their Medicaid patients.

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       If MedStar’s extended contract stands, it will have the chance to bid for an even longer contract soon. Amid the standoff with MedStar, Turnage announced recently that the city will start over entirely, with a new request for proposals for the Medicaid managed-care contracts — collectively worth more than $1.5 billion, among the city’s largest expenditures — which will be issued this November, years earlier than expected.

       He praised the mayor for both actions, which could together entirely redo the Medicaid contracts without ever reassessing the existing contracts, as a judge and the council have ordered. “This is a very elegant solution to what was a really, really sticky problem,” he said.