Medicaid

DC Medicaid is a healthcare program that pays for medical services for qualified people. It helps pay for medical services for low-income and disabled people. For those eligible for full Medicaid services, Medicaid pays healthcare providers. Providers are doctors, hospitals and pharmacies who are enrolled with DC Medicaid.

Who is eligible for Medicaid?

Anyone who meets the Medicaid eligibility requirements can receive Medicaid. A Medicaid recipient can be any age, race or sex.

What services does Medicaid cover/include?

• Doctor visits
• Hospitalization
• Eye care
• Ambulatory surgical center
• Medically necessary transportation
• Dental services and related treatment
• Dialysis services
• Durable medical equipment
• Emergency ambulance services
• Hospice services
• Laboratory services
• Radiology
• Medical supplies
• Mental health services
• Physician services
• Nurse practitioner services
• Home and Community Based Services (HCBS)
• Transplants

Where do I apply for Medicaid?

You may apply for Medicaid for low-income families and children under 19 and pregnant women at your Income Maintenance Administration (IMA) Service Center. You may call (202) 727-5355 to locate your nearest IMA Service Center. You may apply for benefits at the IMA Service Centers listed below.

What are some Medicaid programs?

• The Services for People with Intellectual or Developmental Disabilities (IDD) Waiver
• The Individual and Family Supports (IFS) Waiver
• Elderly and Physical Disabilities (EPD) Waiver

What else do I need to know?

• Freedom of Choice: Most Medicaid recipients may choose the doctor or clinic they wish to use. The doctor or clinic must be willing to accept Medicaid's Payment.
• Other Health Insurance (Third Party Liability / TPL): You must report to the Department of Health Care Finance (DHCF) any health insurance you may have. If you have health insurance and Medicaid, you must give your insurance information to your doctor when you get services. Medical payments from any source (insurance, liability coverage, Worker's Comp, employer liability, CHAMPUS, lawsuits, accidents or other) that you get for services covered by Medicaid must be reported to Medicaid. In order to be eligible for Medicaid, you must assign your rights to medical payments from any source to DHCF.
• Things You Must Do to Get Health Care Services: Always remember to take your Medicaid ID card every time you go to get health services. Remember that not all doctors, dentists and other providers accept Medicaid. You should always ask the provider if he accepts DC Medicaid before you get services.
• Civil Rights: Participating providers of services in the Medicaid program must comply with the requirements of Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973. Under the terms of those laws, a participating provider or vendor of services under any program using federal funds is prohibited from making a distinction in the provision of services to recipients on the grounds of race, age, gender, color, national origin or disability. This includes distinction made on the basis of race or disability with respect to (a) waiting room, (b) hours for appointments or (c) order of seeing patients.
• Fair Hearings: The Social Security Administration (SSA) holds fair hearings for Medicaid eligibility decisions that are part of a Supplemental Security Income (SSI) decision for low income, aged and blind and disabled individuals. You may call the SSA at 1-800-772-1213.
• Fraud: Please contact the Department of Health Care Finance at 1-877- 632-2873 if your health care provider is:
  • performing a service that you think you may not need, or
  • billing for services you did not get, or
  • asking you to pay for a service you think Medicaid covers