Medicaid programs in the District of Columbia and Virginia are looking at ways to save money and adapt to changes mandated in the federal health reform law. The District is planning to shift the costs of 35,000 members of its city-funded Health Alliance program to the federal government by expanding its Medicaid program early. Virginia is limiting provider rates and practicing more aggressive control of utilization of services. In addition, it is tightening its pharmacy program for fee-for-service plans. In Maryland and the District, top insurer CareFirst BlueCross BlueShield is launching a new health plan, HealthyBlue, this summer and will introduce a primary care medical home to work in conjunction with it beginning next year. The company will provide phased-in incentives to physicians if they decide to work as a medical home. The drawback is that physicians will have to wait years for the payback to build. Maryland's hospital rate-setting commission is nearly ready to unveil reimbursement rates for next year and is keeping a close eye on federal Medicare reimbursement, which sets the standard the state must meet to keep its rate-setting capability.