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Transition to Managed Care

The Department of Health Care Finance (DHCF) is moving towards a fully managed Medicaid program designed to transform the managed care program into a more organized, accountable, and person-centered system that best supports the District’s Medicaid beneficiaries in managing and improving their health.  

Starting October 2020, DHCF will transition over 19,000 individuals currently in the Medicaid fee-for-service program to the Medicaid managed care program, also known as the DC Healthy Families Program (DCHFP). Today, fee-for-services beneficiaries must manage their health care needs without assistance or care coordination. By joining the DCHFP, individuals will receive access to care coordination, and as a result, improved health outcomes.  

DC Medicaid and You Virtual Town Hall Meetings 

DC Medicaid & You FAQs

September 2020- DC Medicaid Reform and You – What’s Next?

Learn about your DC Healthy Families Health Plan assignment, how to get help selecting or changing your health plan, and an opportunity to hear from all three Medicaid health plans in DC.

DC Medicaid Reform and You Slide Presentation [PDF]

DC Medicaid & You: A Virtual Town Hall on Medicaid Reform & DC 
Healthy Families-20200829 1454-1
Saturday, September 19, 2020

Play recording (52 min)
Recording password: (This recording does not require a password.)

 

August 2020- DC Medicaid and You- A Virtual Town Hall Meetings

Learn about upcoming changes to DC's Medicaid, Alliance, and Immigrant Children's Program.

DC Medicaid Reform and You Slide Presentation [PDF]

DC Medicaid & You: A Virtual Town Hall on Medicaid Reform & DC 
Healthy Families-20200829 1454-1
Saturday, August 29, 2020

Play recording (1 hr)
Recording password: (This recording does not require a password.)

 

How does the transition affect current and future enrollees?  

MUST ENROLL (Mandatory) 
  • Adults and Children who are not enrolled in an excluded category 
  • Pregnant Women 
  • Childless Adults 
  • Non-Medicare Aged, Blind, Disabled Adults (includes SSI recipients over age 20*) 
  • Individuals participating in the DC Healthcare Alliance Program 
  • Individuals participating in the Immigrant Children’s Program 
CANNOT ENROLL (Excluded) 
  • Individuals Receiving Home and Community-Based Waiver Services 
  • Elderly and Persons with Physical Disabilities (EPD)  
  • Intellectual and Developmental Disabilities (IDD) 
  • Program of all-inclusive care for the elderly (PACE) 
  • Incarcerated individuals 
  • Medically Needy Spend Down 
  • Partial dually-eligible Medicaid/Medicare 
  • Dually-eligible Medicaid/Medicare 
  • Long Term Care Facility patients 
  • TEFRA/Katie Beckett 
  • Children under age 21 receiving SSI  
  • Enrolled in the Child and Adolescent Supplemental Security Program (CASSIP) 
MAY ENROLL (Exempt) 
  • Federally recognized tribal members 
  • Foster Care/Adoption Medicaid 

*Individuals between the ages of 21 – 26 enrolled in the Child and Adolescent SSI Program (CASSIP) with Health Services for Children with Special Needs (HSCSN) Health Plan on October 1, 2020 may remain in the program until age 26 or September 30, 2021. Click here for more information on changes to the CASSIP program.  

Beneficiaries affected by this change will get a letter in the mail. See an example of the letter. If you have questions about this process, you can call the Office of the Health Care Ombudsman at 1-877-685-6391. Children under age 21 with Medicaid SSI, beneficiaries dually enrolled in Medicare, and beneficiaries enrolled in a Medicaid waiver are not affected. 

When is the transition happening? 

This change will be effective October 1, 2020. If this change applies to you, you will get a letter in September 2020 from DCHFP. The letter will tell you the managed care organization (MCO) assigned to you. You will also get a welcome packet and an MCO program guide (Sample packets attached here). 

What do I need to do? 

When you get your letter, review your MCO assignment. If you are happy with your assignment, you do not need to do anything. If you are unhappy with your assignment, you may change your health plan by contacting the DCHFP Enrollment Broker at 1-800-620-7802 or online at https://www.dchealthyfamilies.com/Home/Login.aspx beginning October 1, 2020.  

If you are unsure, you can call the DCHFP Enrollment Broker at 1-800-620-7802 or visit https://www.dchealthyfamilies.com/ to learn more. The Enrollment Broker can help you choose a health plan and provider. 

Who are the MCOs in DC? 

The Department of Health Care Finance (DHCF) intends to award three new contracts to the following health plans effective October 1, 2020: 

  • AmeriHealth Caritas District of Columbia, Inc., 
  • MedStar Family Choice, and 
  • CareFirst BlueCross BlueShield Community Health Plan District of Columbia (formerly known as Trusted Health Plan). 

 

Where can I get more information?  

 

Benefits of Enrolling in an MCO: 

Your MCO will provide you with the care you need when you need it.  

Your MCO:  

  • Has many doctors, specialists, clinics, and hospitals for you to choose from. 
  • Will make sure that you are able to see a primary care doctor within 30 days of when you call. 
  • Provide you with a care manager who will: 
    • Support you. 
    • Work with you to develop a care plan to make sure you receive the care you need. 
    • Help you schedule appointments with providers. 
    • Review doctor instructions with you. 
    • Help you with your medications. 
    • Follow up with you after a hospitalization or an emergency room visit. 

Your care manager will also help you with other issues that impact your well-being, like housing, employment, legal help, food security, transportation, and child care. Fee-for-service members do not have a care manager to help them.