Medicaid agency: DHCF
The District of Columbia's Medicaid program is run by the Department of Health Care Finance (DHCF) and delivered mostly through risk-based managed care, with more than nine in ten Medicaid beneficiaries under 21 enrolled in a managed care plan. The District covers the ACA expansion population; since January 1, 2026, the income limit for parent and caretaker relatives and for childless adults has been 138 percent of the federal poverty level. CMS's managed care enrollment data for report year 2024 counts 238,159 members across the District's comprehensive managed care programs. The DC Healthy Families Program now runs with two plans: Wellpoint DC (formerly Amerigroup DC) left the program on August 1, 2026, and its members were assigned to AmeriHealth Caritas DC, with the right to move to MedStar Family Choice DC through January 31, 2027. Alongside Medicaid, the locally funded DC Healthcare Alliance covers residents who do not qualify for Medicaid; its adult enrollment rules and benefits changed on October 1, 2026 under the Fiscal Year 2027 Budget Support Act. The District's Section 1115 demonstration, now titled Whole-Person Care Transformation, continues coverage of inpatient and residential treatment in institutions for mental disease for adults with serious mental illness or substance use disorder.
Three managed care programs carry most enrollment. The DC Healthy Families Program, the District's main Medicaid managed care program for children, parents and other adults, contracts with AmeriHealth Caritas DC and MedStar Family Choice DC under a shared model contract. The Child and Adolescent Supplemental Security Income Program (CASSIP) serves children and young adults who receive Supplemental Security Income through a single plan, Health Services for Children with Special Needs (HSCSN). District Dual Choice is an integrated Medicare and Medicaid plan for dual eligibles aged 21 and older, offered by UnitedHealthcare. In report year 2024, AmeriHealth Caritas DC was the largest plan, with 106,839 members. The plan contracts include risk corridors, so DHCF and each plan share gains or losses beyond set bounds rather than the plans bearing unlimited risk.
Long-term services and supports are split by population. For dual eligibles enrolled in District Dual Choice, Medicare, Medicaid and long-term care benefits run through one plan. Home and community-based waiver services otherwise remain fee-for-service under three 1915(c) waivers: the Elderly and Persons with Physical Disabilities (EPD) waiver, administered by DHCF, and the Intellectual and Developmental Disabilities (IDD) and Individual and Family Support (IFS) waivers, operated by the Department on Disability Services. PACE is available through Edenbridge.
Partially integrated into managed care
DC Healthy Families and CASSIP plans cover inpatient and residential stays in institutions for mental disease for enrollees with serious mental illness or substance use disorder, under the District's Section 1115 demonstration. From October 1, 2026, the plans must cover IMD stays for enrollees aged 21 to 64 for up to 60 days, up from the first 15 days.
Carved in
Dental care is a covered Medicaid benefit, and for children it is part of the EPSDT benefit, known in the District as HealthCheck, which includes oral health assessments in primary care and fluoride varnish for children under three. From October 1, 2026, dental coverage was added for adult members of the DC Healthcare Alliance.
Prime Therapeutics administers the fee-for-service pharmacy benefit for DHCF. Fee-for-service Medicaid stopped charging copays for prescription drugs and eyeglasses on October 1, 2026.
Non-emergency medical transportation runs through a broker, Medical Transportation Management (MTM).
Gainwell Technologies is the District's Medicaid fiscal agent and claims payment vendor and operates the DC Medicaid provider portal.
35 agency updates tracked for District of Columbia. Available with Pro.
See them with ProWashington, D.C.'s fiscal year 2027 budget proposal has sparked debate over whether opioid settlement funds should offset existing Medicaid and behavioral health spending or fund new addiction treatment programs. The dispute mirrors a national pattern in which states use settlement dollars to backfill current obligations rather than expand services. How D.C. allocates these funds will determine whether Medicaid beneficiaries gain access to new substance use disorder treatment capacity or whether the settlement primarily provides budget relief. The decision affects Medicaid spending priorities and could set precedent for how jurisdictions treat one-time settlement revenues in Medicaid budgeting.
5 active waivers tracked for District of Columbia. Available with Pro.
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