Health Services for Children with Special Needs.

What Health Services for Children with Special Needs. does

Health Services for Children with Special Needs, Inc. (HSCSN) is a nonprofit Medicaid managed care organization founded in 1994 and headquartered in Washington, DC. It operates as the sole contracted health care plan provider for the District of Columbia's Child and Adolescent Supplemental Security Income Program (CASSIP), serving children and young adults from birth to age 26 with special health care needs who receive SSI or have SSI-related disabilities. HSCSN coordinates comprehensive medical, dental, behavioral health, pharmacy, and transportation services for 5,000+ enrollees through a network of more than 4,000 contracted providers, including major partners such as Children's National Hospital, MedStar Georgetown University Hospital, Kennedy Krieger Institute, George Washington University Hospital, and Mary's Center.

The organization's revenue model is government capitation-based: HSCSN receives monthly per-member payments from the DC Department of Health Care Finance (DHCF) and provides covered services to enrollees at no direct cost. Its product portfolio includes the core HSCSN Health Plan plus modular services — the EASY Connect mobile care coordination app (secure chat, daily checklists, medication/appointment reminders), a Care Coordination Plan with assigned Care Managers (face-to-face assessments up to three times annually), 24/7 Nurse Advice Line and Virtual Urgent Care powered by Imagine Pediatrics, CVS/Caremark Pharmacy Benefit Management, Verida transportation, Delta Dental, prior authorization via Availity Essentials, Covermymeds, and SureScripts, and an HSCSN Wellness Center providing community health services. The technology stack also includes CMS-mandated interoperability APIs delivered through CareMesh for provider directory and patient access.

HSCSN is a component of The HSC Health Care System and operates without venture capital or private equity backing. It holds NCQA Health Plan Accreditation, NCQA Case Management 3-Year Accreditation, and NCQA HEDIS Compliance Audit MY2023 Medicaid certification. Leadership includes President Anna Dunn (former Booz Allen Hamilton Principal with healthcare/Medicaid background) and Chief Medical Officer Eric B. Levey, MD. Operations are geographically restricted to Washington, DC, with headquarters at 1101 Vermont Avenue NW and a Wellness Center at 3400 Martin Luther King Jr Ave SE. The organization reports almost 200 employees and volunteers and is part of The HSC Health Care System nonprofit.

Name

Health Services for Children with Special Needs.

Legal name

Health Services for Children with Special Needs, Inc.

Website

https://hscsnhealthplan.org

Company type

Private

Founded year

1994

Operating status

Operating

Headcount range

51–100 employees

Short description

Health Services for Children with Special Needs (HSCSN) is a DC-based nonprofit Medicaid managed care plan serving 5,000+ SSI-eligible children and young adults up to age 26 with special health care needs, operating as the sole contractor for the District's CASSIP program through a 4,000+ provider network.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Child and Youth Services (62411), Services for the Elderly and Persons with Disabilities (62412)

SIC

Services-Health Services (8000)

akta.pro primary industry

Children’s & Family Medicaid Managed Care Plans (HLAEAEAF)

akta.pro secondary industry

Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH)

Keywords

• Medicaid managed care
• Pediatric care coordination
• Special needs health plan
• Behavioral health services
• Pharmacy benefit management

Headquarters

HQ city

Washington

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales, Others

Revenue model

1. Medicaid Capitation Payments: HSCSN is a Medicaid managed care organization that receives capitation payments from the District of Columbia Department of Health Care Finance (DHCF) for providing comprehensive health care services to CASSIP enrollees. The organization coordinates medical care, dental care, behavioral health services, and drug and alcohol abuse services for enrolled children and young adults with special health care needs.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels6 records

Core offering

HSCSN is the contracted managed care plan for Washington, D.C.'s Child and Adolescent Supplemental Security Income Program (CASSIP), providing fully coordinated medical, dental, behavioral health, pharmacy, transportation, and family support services to children and young adults (birth through age 26) with special health care needs who receive SSI. Services are delivered through a network of more than 4,000 contracted providers and supported by dedicated Care Managers, 24-hour care coordination, the EASY Connect mobile app, telehealth, and the HSCSN Wellness Center, with no direct cost to eligible enrollees.

Product overview

HSCSN is a Medicaid Managed Care Plan (CASSIP) providing coordinated healthcare for children and young adults with special needs up to age 26 in Washington, DC. The core product is the HSCSN Health Plan, which delivers medical, dental, behavioral health, and pharmacy benefits through a network of 4,000+ providers. The offering includes integrated support services: the EASY Connect mobile app for care coordination, 24/7 Nurse Advice Line and Virtual Urgent Care powered by Imagine Pediatrics, a Care Coordination Plan with assigned Care Managers, Prior Authorization System, CVS/Caremark Pharmacy Benefit Management, HSCSN Wellness Center, Transportation Services, and Health and Family Support Programs including Summer Programs. The modular architecture allows enrollees to access these services individually while maintaining unified care coordination through the core health plan.

Differentiator

Problem solved

Functional benefit

Products and services

• HSCSN Health Plan (CASSIP Medicaid Managed Care Plan) DC Medicaid managed care plan for children and young adults with special health care needs up to age 26 who are SSI recipients/SSI-related in Washington, DC; provides coordinated medical, dental, behavioral health, and pharmacy benefits through a 4,000+ provider network.
• EASY Connect Mobile Application

Quantifiable outcome

• NCQA Accredited Health Plan, HEDIS Compliance Audit MY2023 Medicaid, and Case Management 3 Years Accredited

Named customers1 record

Segments1 record

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration8 records

Feature3 records

Partnerships

13 partnerships are on record, tiered core and major.

• District of Columbia Department of Health Care Finance (DHCF)coreStrategic or Co-development PartnerHSCSN is the contracted health care plan provider for DC's Child and Adolescent Supplemental Security Income Program (CASSIP), operating under regulatory oversight and funding from DHCF. The partnership involves capitation payments for enrolled members and compliance with District Medicaid regulations.
• National Committee for Quality Assurance (NCQA)coreOthersNCQA provides accreditation for HSCSN's health plan, HEDIS compliance, and case management services. This accreditation demonstrates compliance with quality standards for Medicaid managed care organizations.
• CVS/CaremarkcoreTechnology or IntegrationCVS/Caremark serves as the Pharmacy Benefit Manager (PBM) for HSCSN. They handle formulary management, prior authorization for medications, and pharmacy network operations including mail-order services. Their National Pharmacy and Therapeutics Committee develops the formulary template.
• Imagine PediatricscoreTechnology or IntegrationHSCSN partnered with Imagine Pediatrics to provide 24/7 Nurse Advice Line and Virtual Urgent Care services. The partnership includes a mobile app for messaging and calls, connecting enrollees to licensed nurses and virtual medical providers for urgent care needs.
• VeridacoreChannel Partner/ Reseller/ DistributorVerida provides transportation services for HSCSN enrollees to and from medical appointments. Enrollees schedule transportation by calling Verida at 1-866-991-5433 at least 24 hours before appointments.
• Delta DentalcoreChannel Partner/ Reseller/ DistributorDelta Dental provides dental insurance services to HSCSN enrollees. Customer Services available at 1 (800) 357-8258 for enrollee dental benefit inquiries.
• Children's National HospitalcoreStrategic or Co-development PartnerChildren's National Hospital is a major pediatric hospital partner with significant representation in HSCSN's provider network (1,346+ providers). The partnership provides specialized pediatric care for enrollees.
• MedStar Georgetown University HospitalcoreStrategic or Co-development PartnerMedStar Georgetown University Hospital has 1,845 providers in the HSCSN network, serving as a major hospital and specialty care partner for enrollees.
• Kennedy Krieger InstitutecoreStrategic or Co-development PartnerKennedy Krieger Institute, a specialized provider for developmental disabilities, has 910 providers in the HSCSN network serving children with special needs.
• George Washington University HospitalcoreStrategic or Co-development PartnerGeorge Washington University Hospital (1,473 providers) serves as a major hospital partner in the HSCSN network.
• Mary's Center for Maternal and Child CaremajorChannel Partner/ Reseller/ DistributorMary's Center, an FQHC, provides primary care and maternal/child health services with 165+ providers in the HSCSN network.
• Availity EssentialscoreTechnology or IntegrationAvaility Essentials is the provider portal used by HSCSN for authorization submission, providing electronic administrative connectivity for contracted providers.
• CareMeshmajorTechnology or IntegrationCareMesh provides the Provider and Pharmacy Directory API enabling third-party application developers to access HSCSN provider information through standards-based interoperability.

Scale indicators5 records

Recent moves5 records

Expansion highlights4 records

Direct peers

• AmeriHealth Caritas District of Columbia: A Medicaid managed care organization serving District of Columbia Medicaid beneficiaries, including families and individuals with disabilities. As another DC MCO contractor, it competes with HSCSN for DC Medicaid contracts and serves overlapping eligibility groups with comparable care coordination, member services, and network management infrastructure.
• MedStar Family Choice: A Medicaid managed care plan offered by MedStar Health in the District of Columbia, providing health coverage to DC Medicaid beneficiaries. It is a direct competitor to HSCSN in the DC Medicaid market with a similar care coordination model anchored to a major hospital system (MedStar Georgetown, which is also an HSCSN network partner).
• CareFirst BlueCross BlueShield Community Health Plan District of Columbia: Operates a Medicaid managed care plan in the District of Columbia serving low-income residents. It is a direct competitor to HSCSN in the DC Medicaid market and serves a comparable beneficiary population with similar care coordination and provider network infrastructure anchored to the CareFirst regional health plan system.

Broad incumbents

• UnitedHealthcare Community & State: The Medicaid managed care arm of UnitedHealth Group, serving beneficiaries across dozens of states including specialized programs for children with disabilities and complex needs. It is comparable to HSCSN in operating Medicaid managed care for complex pediatric populations, but at vastly greater national scale and across many state contracts.
• Aetna Better Health: A CVS Health company operating Medicaid managed care plans in multiple states, including services for children and individuals with disabilities. It is comparable to HSCSN in operating Medicaid managed care for vulnerable populations, but at significantly larger scale and across many state contracts.
• Centene Corporation: The largest Medicaid managed care organization in the United States, with extensive operations serving children, low-income families, and individuals with disabilities across all 50 states. It is comparable to HSCSN as a Medicaid-focused managed care operator serving complex populations, but at vastly greater scale and geographic breadth.
• Molina Healthcare: A major managed care company focused on government-sponsored healthcare programs including Medicaid and CHIP across multiple states. It is comparable to HSCSN in operating Medicaid health plans for low-income and complex populations, with similar care coordination imperatives, but at a much broader geographic footprint.
• Anthem Blue Cross Blue Shield Medicaid: Operates Medicaid managed care plans in multiple states through its state-licensed Blue Cross Blue Shield plans, serving low-income populations and individuals with disabilities. It is comparable to HSCSN in serving Medicaid beneficiaries with complex needs, but at much larger scale and across diverse state markets.

Regional players

• Priority Partners: A Maryland-based Medicaid managed care organization operated by Johns Hopkins HealthCare, serving Medicaid beneficiaries in Maryland including children and individuals with disabilities. It is comparable to HSCSN as a regional Medicaid MCO affiliated with a major academic health system, though it serves a different geographic market and broader Medicaid population.
• Jai Medical Systems: A Baltimore-based Medicaid managed care organization serving Maryland Medicaid beneficiaries, including children and individuals with disabilities. It is comparable to HSCSN in operating a regional Medicaid MCO focused on vulnerable populations, though operating in a different state and with a different ownership structure.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks5 records

Key highlights7 records

Customer concentration

• Xx.com/hscsn_inc

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Health Services for Children with Special Needs.