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Medicaid Reports

Managed Care Plans Reports

The District contracts with 3 MCPs to provide access to services for the DC Healthy Families Program (DCHFP), the DC Health Care Alliance (Alliance) and the Immigrants Children’s Program (ICP). Those MCPs are Wellpoint DC, AmeriHealth Caritas DC, and MedStar Family Choice DC.  Health Services for Children with Special Needs (HSCSN) is the MCP contracted to provide access to services for the Child and Adolescent Supplemental Security Income Program (CASSIP).

The current Managed Care Contract for DCHFP, ICP, and Alliance as of April 1, 2023.

The current CASSIP contract for HSCSN as of April 1, 2022.

The individual website of each MCP can be found at dhcf.dc.gov/page/medicaid-managed-care-plans-mcps

MCP External Quality Review Annual Technical Reports

Medicaid Managed Care Plans Performance Reports

The Medicaid Managed Care Performance Reports illustrate the financial condition of the District’s MCPs over the duration of a calendar year. Administrative functions of the MCPs – such as timely claims processing, enrollee encounter systems, and appropriate claims denial procedures – are also detailed in the report.

CMS Form 416 

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health and specialty services.

Early: Assessing and identifying problems early

Periodic: Checking children's health at periodic and inter-periodic, age-appropriate intervals

Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems

Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and

Treatment: Control, correct or reduce health problems found.

The CMS-416 is used by CMS to collect basic information on State Medicaid programs to assess the effectiveness of EPSDT services. The District requires its participating Medicaid managed care plans to complete a MCP 416 for their enrollees.

Annually, states must provide CMS with the following information: Enrollment figures, Number of children provided child health screening service and well-child visits; Number of children referred for corrective treatment; and  Number of children receiving dental services  and lead screens;  National 416 data prior to 2019 can be accessed here.

CMS 416 FY24

CMS 416 FY23

CMS 416 FY22

CMS 416 FY21

CMS 416 FY20

CMS 416 FY19

DC Medicaid HealthCheck Periodicity Schedules

The DC Medicaid HealthCheck Periodicity Schedule follows the American Academy of Pediatrics (AAP) health recommendations in consultation with the local medical community. The recommendations are for the care of children who have no manifestation of any important health problems. Additional visits or interperiodic screens may become necessary if circumstances suggest the need for more screens, i.e., medical conditions, referral by parent, Head Start, DC Public Schools, Early Intervention Programs. If a child comes under care for the first time at any point on the schedule, or if any items are not done at the suggested age, the schedule should then be brought up to date as soon as possible.

The DC Medicaid HealthCheck Dental Periodicity Schedule follows the American Academy of Pediatrics Dentistry Periodicity Schedule oral health recommendations in consultation with the local dental community. This schedule is designed for the care of children who have no contributing medical conditions and are developing normally. The DC HealthCheck Dental Periodicity Schedule will be modified for children with special health care needs or if disease or trauma manifests variations from normal.

 

Medicaid and Alliance Enrollment Reports

Medicaid and Alliance Enrollment Reports capture beneficiary enrollment data from a window in time across the District’s Managed Care Plans, fee-for-service program and D-SNP.

Enrollment Reports 2026

Enrollment Reports 2025

Enrollment Reports 2024

Enrollment Reports 2023

Enrollment Reports 2022

Enrollment Reports 2021

Enrollment Reports 2020

Enrollment Reports 2019

For enrollment information prior to 2019, please visit this page

DC Medicaid MCP Report Cards

DHCF annually publishes an MCP report card that compares how the MCPs compare to one another in key areas of performance, like access to care, child services, and care for adults with chronic illnesses. Enrollees are encouraged to use the report cards as tools in selecting an MCP for their care.

  • DC Medicaid MCP 2024 Report Card
  • DC Medicaid MCP 2023 Report Card – Unreported due to Public Health Emergency
  • DC Medicaid MCP 2022 Report Card – Unreported due to Public Health Emergency
  • DC Medicaid MCP 2021 Report Card – Unreported due to Public Health Emergency
  • DC Medicaid MCP 2020 Report Card – Unreported due to Public Health Emergency
  • DC Medicaid MCP 2019 Report Card

 Miscellaneous Data and Reports

These items are published on an as-needed basis, generally in support of specific or time-limited projects at DHCF. They reflect point-in-time data on various health and District Medicaid-related issues. This list also includes a current copy of the District’s Medicaid Managed Care Quality Strategy, 2024-2027.

 

Attachment(s): 
PDF icon 2024 National CMS Form 416

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