The District Dual Choice program is exclusively for dually eligible beneficiaries and aims to better coordinate their Medicare and Medicaid benefits. On February 1, 2022, the District expanded its existing Dual Choice program into a more comprehensive program that integrates Medicare and Medicaid benefits into a single program. That means that there is ONE set of comprehensive benefits and ONE accountable entity to coordinate the delivery of services to help coordinate the unique needs of individuals. This further simplifies health care for participants and promotes greater care coordination.

This page reflects the most frequently asked questions DHCF receives and will be updated with more information as it becomes available. For more information, you may contact DHCF staff via email ([email protected]).

Who are Dual Eligible Beneficiaries? 

Dual eligible individuals are 21 years of age or older, receive both Medicare (Parts A, B, and D), and Medicaid coverage. There are approximately 37,000 dual beneficiaries in the District.

If you are a dual eligible, you may have received a letter from DHCF about your eligibility for Dual Choice and PACE. These programs are designed specifically for people enrolled in both Medicare and Medicaid, and you can read more about Dual Choice below (and more about PACE here).

How do I know if I am already enrolled? 

If you are enrolled in the Medicare program, you may have a “red, white and blue card” that is your Medicare enrollment card; if you are enrolled in a Medicare Advantage plan, you will have a health plan card that reflects the plan with which you’re enrolled (e.g., Kaiser Permanente, Aetna, etc.). UnitedHealthcare is the private health plan that currently offers Dual Choice enrollment for District Medicaid enrollees. If you are enrolled in Dual Choice, you will receive a card from UnitedHealthcare that has both your Medicare and Medicaid IDs.

You can find more information about UnitedHealthcare’s Dual Choice plan here.

Does the health plan cover Medicaid services under the expanded Dual Choice program? Yes. The purpose of a more-integrated approach is to better coordinate the delivery and management of a person’s entire array of services. Previously, Medicaid beneficiaries enrolled in Dual Choice had their services covered and paid by two different programs, and sometimes that could make accessing and using care confusing for beneficiaries and families, and it could also lead to needless duplication of care. The expanded program helps to address that. Medicaid services – like long-term services and supports, behavioral health care, dental care, and so forth – are a part of the services covered by and paid for by UnitedHealthcare. As a result, care managers will be able to better ensure care is coordinated and delivered by the right provider at the right time and place for each participant.

For more information on how Medicare and Medicaid work together, or for health care options for people with both programs, check out these resources:

• Dual Choice
• Medicare and Medicaid (English) (Spanish) (Amharic)
• Duals and LTC Program Comparison (English) (Spanish) (Amharic)

Can just anyone enroll in a Dual Choice plan?  At this time, anyone eligible to enroll in Medicare Advantage who also is eligible for partial or full Medicaid coverage may choose to enroll in the participating health plan. In the future, there may be different plans for partial and full-benefit duals, since those two groups have different types of Medicaid coverage. DHCF expects that some form of Dual Choice coverage will remain available to all groups currently eligible.

How do I enroll in the Dual Choice plan?If you are interested in enrolling, you may do so directly with UnitedHealthcare by calling 1-855-801-7175 / TTY: 711 or visiting their website.

You may also receive free counseling, education, and assistance with enrollment through our DC State Health Insurance Assistance Program (SHIP). Connect with a SHIP counselor at (202) 727-8370 to get your questions answered and better understand your coverage and options.

Does anyone have to enroll in the Dual Choice program? Currently, enrollment in the Dual Choice program is optional. At this time, it’s a choice individuals can make about integrating their Medicare and Medicaid coverage. As the District moves toward a comprehensive Medicaid managed care delivery system in the coming years, the District will preserve choices among coverage options, but the fee-for-service Medicaid program will not remain an option for all current fee-for-service enrollees.

Can an individual be enrolled in both the EPD waiver and a Dual Choice Plan? Yes. Individuals may be enrolled in either of DC’s 1915(c) Medicaid HCBS waivers and also enrolled in the Dual Choice health plan. Previously, EPD Waiver participants may have had a care coordinator in the Medicare Advantage plan and a case manager from the waiver. Now, EPD Waiver participants have a single case manager who coordinates their care regardless of whether it is a Medicare or Medicaid service.

How can I disenroll from the Dual Choice program? Enrollment in the expanded Dual Choice program is optional, you have the right to leave and may make the decisions to do so once per quarter or during special election periods. However, if you change your enrollment in the Dual Choice program, both your Medicare and Medicaid coverage options will have to change. That means you may not leave Dual Choice for Medicaid and keep it for Medicare. If you disenroll from Dual Choice, you will be enrolled in Medicaid on a fee-for-service basis and enrolled in Medicare on either a fee-for service basis or under a different health plan.

You can disenroll by calling UnitedHealthcare’s Enrollee Services at 1-866-242-7726, TTY 711, by calling the State Health Insurance Assistance Program (SHIP) at (202) 727-8370, or by calling 1-800-Medicare.

I work for a Medicaid provider. Can my provider organization contract with the Dual Choice? Yes. HCBS providers can contact [email protected]; all other providers can contact [email protected]. All providers can call 888-350-5608 for assistance. Additional provider resources can be found here, including LTSS-specific information.

If you work for a health plan interested in partnering with DHCF in the Dual Choice program, you must contact us via email ([email protected]) no later than May 10 for participation in the subsequent program year.

What is network adequacy? Network adequacy refers to a health plan’s ability to provide access to a sufficient number of in-network providers and deliver all services included under the terms of the health plan’s contract. Additional information on network adequacy requirements and standards under District Dual Choice can be found here.

Where can I find more information on Dual Eligible Special Needs Plans?
D-SNPs are offered in many jurisdictions, not just DC. You can learn more about D-SNPs as a program by visiting the following websites:

• Centers for Medicare and Medicaid Services
• The Medicaid and CHIP Payment and Access Commission
• The Integrated Care Resource Center