AmeriHealth District of Columbia

Name

AmeriHealth District of Columbia

Legal name

AmeriHealth Caritas District of Columbia

Website

https://amerihealthcaritasdc.com

Company type

Private

Founded year

2013

Operating status

Operating

Headcount range

11–50 employees

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB)

Keywords

• Medicaid managed care
• Government health plans
• Health insurance services
• Medicaid benefits
• Managed care organization

Headquarters

HQ city

Washington

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

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

Revenue model

1. Medicaid Capitation: AmeriHealth Caritas DC receives capitated (per-member-per-month) payments from the District of Columbia government in exchange for providing covered health care services to enrolled Medicaid beneficiaries. The organization bears financial risk for managing the health care needs of its enrollee population within the fixed per-capita预算.
2. Healthy DC Plan Premiums: Starting January 1, 2026, the plan will offer the Healthy DC Plan for DC adult residents with moderate incomes who do not meet Medicaid income requirements, funded through premium payments.

Go-to-market motion1 record

Distribution channels4 records

Marketing channels8 records

Core offering

AmeriHealth Caritas District of Columbia is a Medicaid managed care organization contracted with the District of Columbia Department of Health Care Finance to provide government-sponsored health coverage to DC Medicaid beneficiaries. The plan covers primary and specialty care, vision and dental care, prescription drugs, hospital stays, and transportation for medical appointments. Effective January 1, 2026, the company is expanding to offer the Healthy DC Plan for DC adult residents with moderate incomes who do not meet Medicaid income requirements.

Product overview

AmeriHealth Caritas District of Columbia operates as a Medicaid managed care organization offering two distinct health plans: the Medicaid Plan for full DC Medicaid beneficiaries, and the Healthy DC Plan (launching January 1, 2026) for DC adult residents with moderate incomes. The company provides a mobile app for enrollee access. The product portfolio centers on government-sponsored health coverage with comprehensive benefits including primary care, specialty care, prescription drugs, dental, vision, and transportation services.

Differentiator

Problem solved

Functional benefit

Brands

• Healthy DC Plan: A new health care plan providing quality health coverage for DC adult residents who have moderate incomes and do not meet the DC Medicaid income requirements.

Products and services

• DC Medicaid Plan A Medicaid health care plan for enrollees who qualify for full DC Medicaid benefits, covering primary and specialty care, vision and dental care, prescription drugs, hospital stays, and transportation for medical appointments.
• Healthy DC Plan A health care plan providing quality health coverage for DC adult residents with moderate incomes who do not meet DC Medicaid income requirements, covering essential health benefits such as primary and specialty care, hospital stays, and prescription drugs.
• AHC Mobile App Mobile application available on iOS and Android platforms enabling enrollees to access their health information, manage benefits, find providers, and control third-party app data sharing preferences.

Named customers2 records

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

14 partnerships are on record, tiered core and minor.

• District of Columbia Department of Health Care Finance (DHCF)coreStrategic or Co-development PartnerDHCF is the District government agency that administers the Medicaid program and contracts with AmeriHealth Caritas DC to provide managed care services to eligible beneficiaries. The agency oversees the program's regulatory compliance and provides program sponsorship.
• District of Columbia GovernmentcoreStrategic or Co-development PartnerThe government of the District of Columbia, led by Mayor Muriel Bowser, partners with AmeriHealth Caritas DC to provide health coverage to District residents through Medicaid and the Healthy DC Plan.
• NaviNet (Provider Portal)coreTechnology or IntegrationNaviNet is the provider-facing portal used by health care providers in the AmeriHealth Caritas DC network for claims, billing, prior authorizations, and care coordination activities.
• DarwinRx (Pharmacy Benefit Management)coreTechnology or IntegrationDarwinRx provides pharmacy benefit management services including the pharmacy directory and prescription drug coverage for AmeriHealth Caritas DC enrollees.
• K&K SolutionsminorStrategic or Co-development PartnerK&K Solutions, founded by Kim Coplen and Kelli Johnson, provides strategic planning and team-building services. They participated in AmeriHealth Caritas DC's 2021 Small Business Program and partner with organizations nationwide on DEI initiatives and engagement plans.
• The Aquiline GroupminorStrategic or Co-development PartnerFounded by Evelyn Rodriguez in 2002, The Aquiline Group provides communications services including marketing communications, partnership development, and recruitment. They assist AmeriHealth Caritas DC with provider recruitment efforts, particularly recruiting doulas for maternal health initiatives.
• Grapevine HealthminorStrategic or Co-development PartnerFounded by Dr. Lisa Fitzpatrick, Grapevine Health delivers trusted health information to underserved communities. They began working with AmeriHealth Caritas DC in 2021 to assist health systems and insurers in addressing health literacy.
• ADC Management SolutionsminorStrategic or Co-development PartnerFounded by Brandy R. Butler in 2003, ADC Management Solutions provides human resources and administrative management solutions. Recognized as a Top Women-Owned Business by Washington Business Journal.
• Tiber Hudson LLCminorStrategic or Co-development PartnerA full-service law firm established in 1996, majority minority owned and Certified Business Enterprise in the District. Malik Edwards joined as partner in 2019 and advises on CBE compliance and District government contracting.
• MMI Consulting Group LLCminorStrategic or Co-development PartnerFounded by Alexandra J. Herndon in 2016, MMI is a woman- and minority-owned Certified Business Enterprise providing training, financial management, health care communications, and professional development services. Partners with AmeriHealth Caritas DC on Small Business Development Program mentorship.
• ROIG Communications LLCminorStrategic or Co-development PartnerFounded in 2014 by Geraldine Barrientos and Mariana Barrientos Roig, ROIG Communications is a cross-cultural advertising and marketing agency providing strategic communications and counsel to build stakeholder relationships.
• Soul Tree LLCminorStrategic or Co-development PartnerFounded by Marni Barron in 2011, Soul Tree LLC is a D.C.-based education, training, and consulting company focused on strategic advising, workforce development, and social services. Works with AmeriHealth Caritas DC on cultural and linguistic diversity training.
• Vanguard CommunicationsminorStrategic or Co-development PartnerFounded in 1987 by Maria Rodriguez, Vanguard Communications is an award-winning D.C.-based communications and PR firm supporting nonprofits, foundations, and government agencies. Since 2017, provides communications and health promotion support for AmeriHealth Caritas DC.
• ACSI TranslationsminorStrategic or Co-development PartnerFounded by Andres Echeverri in 2011, ACSI Translations provides foreign language translation, interpretation, and multicultural marketing services in over 60 languages. Has worked with AmeriHealth Caritas DC since 2015 to support the D.C. immigrant community.

Scale indicators2 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• CareFirst BlueCross BlueShield Community Health Plan District of Columbia: Direct competitor as a contracted DC Medicaid managed care plan, leveraging CareFirst's regional presence and serving an overlapping DC Medicaid population with comparable government-funded managed care products.
• AmeriHealth Caritas Pennsylvania: Sibling Medicaid managed care organization under the same AmeriHealth Caritas parent, operating a comparable state-contracted Medicaid plan in Pennsylvania with similar benefits, provider-network model, and shared back-office infrastructure (NaviNet, DarwinRx).
• MedStar Family Choice: Direct competitor as one of the contracted DC Medicaid managed care organizations serving DC Medicaid beneficiaries, with comparable benefits, provider-network model, and enrollee portal offerings in the same geography.

Broad incumbents

• Centene Corporation: Largest pure-play Medicaid managed care operator in the U.S., with state contracts across most Medicaid expansion states; directly comparable business model, scale, and risk-based capitation framework.
• Kaiser Permanente (Mid-Atlantic): Integrated health system serving the DC metro area with government-sponsored plan products; provides a comparable in-market competitor for government-contracted coverage in the District of Columbia region.
• AmeriHealth Caritas: Parent organization operating Medicaid managed care plans and related health services across multiple states; defines the shared platform, branding, and operational capabilities that AmeriHealth Caritas DC delivers at the state-contract level.
• Molina Healthcare: Pure-play government-sponsored managed care company operating Medicaid and related health plan products across multiple states under capitated contracts; a directly comparable business model serving low-income populations.
• Anthem Blue Cross Blue Shield (Medicaid plans): Operates state-contracted Medicaid managed care plans across many markets under full capitation, with comparable government relationships, member benefit design, and digital tool suites.
• Aetna Better Health: CVS Health-owned Medicaid managed care organization operating in multiple states under full-risk capitated contracts; directly comparable business model targeting Medicaid beneficiaries.
• UnitedHealthcare Community Plan: National Medicaid managed care operator with presence across many states including the mid-Atlantic; competes for state contracts and applies similar capitated, full-risk model serving government-sponsored populations.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/AmeriHealthDC
• LinkedInlinkedin.com/company/amerihealth-caritas-dc

Revenue estimate

Valuation estimate

Number of profiles

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 AmeriHealth District of Columbia