DHCF-DCAS

What DHCF-DCAS does

The District of Columbia Department of Health Care Finance (DHCF) is the single state Medicaid agency for the District of Columbia, established on February 27, 2008 under D.C. Law 17-109 and headquartered at 441 4th Street NW, Washington, DC. The agency administers a portfolio of healthcare coverage programs for District residents — DC Medicaid (joint federal/state insurance for low-income, disabled, and family populations), DC Health Care Alliance (locally funded coverage for residents ineligible for Medicaid/Medicare), DC Healthy Families (administered by Wellpoint DC), CASSIP for children with special needs receiving SSI, and PACE plus D-SNPs for elderly and dual-eligible populations — through a panel of five contracted Managed Care Plans (AmeriHealth DC, Wellpoint DC, HSCSN, MedStar Family Choice, Trusted Health Plan).

DHCF operates a layered technology stack centered on the DC Health Information Exchange (DC HIE), with CRISP DC serving as the competitively designated HIE entity under a six-year agreement running April 13, 2025 to April 14, 2031 and CPC-HIE registered as a second District Registered HIE Entity from February 24, 2026. Supporting infrastructure includes the District Direct self-service application portal, the Medicaid Provider Portal (medicaid.dc.gov) for claims and eligibility verification, the Right Rx Initiative for clinical decision support, DC Care Connect for long-term care services, Electronic Visit Verification (EVV) systems mandated by the 21st Century CURES Act, telemedicine billing guidance, and the Section 1115 Whole-Person Care Transformation demonstration. Long-Term Care Administration oversees the EPD Waiver and HCBS programs, including the self-directed Services My Way program which has scaled to over 1,100 participants (more than 5x its original forecast since March 2016).

The agency employs 65 staff and is funded through federal Medicaid matching funds plus local District appropriations — it does not sell commercial products or services and does not have traditional venture or equity funding. DHCF is led by Director Wayne Turnage, MPA (who concurrently serves as Deputy Mayor for Health and Human Services) and Senior Deputy Director / State Medicaid Director Melisa Byrd. Recent strategic activity centers on the Section 1115 demonstration renewal submitted June 2024, the EPD Waiver amendment, the Managed Care Plan transition to AmeriHealth Caritas DC effective August 1, 2026, and the implementation of federal Medicaid changes under the One Big Beautiful Bill Act effective January 1, 2026.

Name

DHCF-DCAS

Legal name

District of Columbia Department of Health Care Finance

Website

https://dhcf.dc.gov

Company type

Private

Founded year

2008

Operating status

Operating

Short description

The District of Columbia Department of Health Care Finance (DHCF) is the single state Medicaid agency for Washington, D.C., administering Medicaid, Alliance, Healthy Families, CASSIP, EPD Waiver, and the DC HIE for low-income, disabled, elderly, and special-needs District residents through five contracted Managed Care Plans and CRISP DC.

Ownership category

akta.pro rank

Product category

State Medicaid Administration

NAICS

Administration of Public Health Programs (923120), Services for the Elderly and Persons with Disabilities (624120)

SIC

Services-Health Services (8000)

akta.pro industry

PRIMARYBPAIACAK

Local Public Health & Human Services Administration

Business & Public Services/Public Sector & Government Administration/Local/Municipal Government Administration

SECONDARYHLAEAEAJ

Managed Care Entity Administration for Medicaid (MCO/PHP/PIHP/PAHP)

Healthcare & Life Sciences/Health Insurance & Managed Care/Medicaid Managed Care (MMC) Plans

Keywords

• Medicaid administration
• Health information exchange
• Long-term care services
• Managed care plans
• Home and community-based services

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, Infrastructure, Others, Marketing or Sales

Distribution channels4 records

Marketing channels6 records

Core offering

DHCF is the District of Columbia's state Medicaid agency that administers the DC Medicaid program, DC Health Care Alliance, DC Healthy Families, CASSIP, and long-term care programs for low-income, disabled, and elderly residents. The agency operates the DC Health Information Exchange (DC HIE), Electronic Visit Verification (EVV), provider portals, and digital health infrastructure to coordinate care across the District's health system.

Product overview

DHCF operates a multi-program portfolio serving District of Columbia residents' healthcare needs. The core programs include DC Medicaid (joint federal/state insurance for low-income/disabled individuals), DC Health Care Alliance (locally funded program for those ineligible for Medicaid/Medicare), DC Healthy Families (administered by Wellpoint DC), and CASSIP (for children with special needs receiving SSI). Long-Term Care Services provide oversight for elders and persons with disabilities through home and community-based services including the EPD Waiver. Care coordination is delivered through Health Homes (My Health GPS and My Health Home). The agency supports clinical decision-making via the Right Rx Initiative and delivers care through Telemedicine services. Digital health infrastructure includes the DC Health Information Exchange (DC HIE) facilitating secure health data exchange with CRISP DC as the designated entity, DC Care Connect portal, and Electronic Visit Verification (EVV) for home care services. Additional programs include Services My Way (self-directed care), Section 1115 Demonstration for behavioral health transformation, ARPA HCBS enhanced funding, PACE, and D-SNPs. The Medicaid Provider Portal provides web-based access for providers.

Differentiator

Problem solved

Functional benefit

Brands

• Right Rx Initiative: A program providing decision and administrative support to clinicians to facilitate ease of prescribing and appropriate use of medications by Medicaid beneficiaries.
• DC Healthy Families
• DC Health Care Alliance
• Long Term Care Administration (LTCA)
• Health Care Reform and Innovation Administration (HCRIA)
• DC HIE (Health Information Exchange)
• Section 1115 Demonstration (Whole-Person Care Transformation)

Products and services

• DC Medicaid Joint federal/state healthcare insurance program paying for medical services for low-income, disabled, and family individuals in the District of Columbia. Covers doctor visits, hospital stays, prescriptions, and other health services.
• DC Health Care Alliance (Adults) Locally funded healthcare program for DC residents who are not eligible for Medicaid and/or Medicare, serving low-income adults with no other health insurance. Covers primary care, doctor visits, and prescription drugs.
• DC Health Care Alliance (Children) Health coverage program for individuals under age 21 who are not eligible for Medicaid. Services covered are similar to Medicaid for children under 21.
• DC Healthy Families Free health insurance program administered by Wellpoint DC for DC residents meeting income and citizenship/immigration status requirements for DC Medicaid. Covers doctor visits, vision/dental care, prescriptions, hospital stays, and transportation.
• CASSIP (Child and Adolescent Supplemental Security Income Program) Program providing children and young people ages 0-21 with special healthcare needs who receive SSI benefits with Medicaid benefits and additional services through a managed care program (MCP).
• Long-Term Care Services Oversight and monitoring of programs targeted to elders, persons with physical disabilities, and persons with intellectual and developmental disabilities, ensuring access to home, community-based, or institutional long-term care.
• EPD Waiver (Elderly and Persons with Physical Disabilities) Home and Community-Based Services waiver for elderly and persons with physical disabilities. Provides service expansions for waiver participants and reimbursement for HCBS providers.
• Health Homes Under ACA Section 2703, provides comprehensive care coordination and disease management for Medicaid beneficiaries with chronic conditions. Includes My Health GPS (multiple chronic conditions) and My Health Home (severe mental illness).
• Right Rx Initiative Decision and administrative support to clinicians facilitating appropriate prescribing and use of medications by Medicaid beneficiaries. Provides electronic access to preferred medication lists without prior authorization.
• DC Health Information Exchange (DC HIE) Health information exchange network facilitating secure, electronic exchange of health information among registered organizations in the District. CRISP DC serves as the designated DC HIE entity.
• Electronic Visit Verification (EVV) System that electronically captures details of home visits and services provided by caregivers ensuring beneficiaries receive required support and accurate billing. Required under the 21st Century CURES Act.
• Medicaid Provider Portal Web portal for DC Medicaid providers to access claims, eligibility verification, and administrative functions.
• Services My Way Medicaid Participant-directed Services (PDS) program allowing participants to direct their own care. The program has grown to over 1,100 participants.
• Telemedicine Telehealth services and billing guidance for Medicaid providers, including audio-only visits, beneficiary home settings, and documentation standards.
• ARPA HCBS Enhanced Funding American Rescue Plan Act Section 9817 program providing temporary 10 percentage point FMAP increase for Medicaid Home and Community-Based Services used to enhance HCBS programs.
• Section 1115 Demonstration (Whole-Person Care Transformation) Five-year renewal demonstration submitted to CMS for Behavioral Health Transformation renamed to Whole-Person Care Transformation, focused on behavioral health and social determinants of health.
• PACE in DC (Program of All-inclusive Care for the Elderly) Program providing comprehensive care for elderly individuals allowing them to remain in community settings rather than institutional care.
• District Dual Choice (D-SNPs) Dual Special Needs Plans offering coordinated care for beneficiaries eligible for both Medicare and Medicaid.
• DC Care Connect Online resource and portal for long-term care services information and access.

Quantifiable outcome

• Medicaid health home services include comprehensive care management, care coordination, health promotion, comprehensive transitional care/follow-up, patient and family support, and referral to community and social support services

Segments6 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

13 partnerships are on record, tiered core and minor.

• District of Columbia Primary Care Association (CPC-HIE)coreTechnology or Integration · 24 February 2026Registered as a District Registered HIE Entity from February 24, 2026 to February 24, 2029. Serves as a participant in the DC HIE network facilitating health information exchange.
• Chesapeake Regional Information System for our Patients, Inc. DC (CRISP DC)coreTechnology or Integration · 13 April 2025CRISP DC serves as the District Designated DC HIE Entity and strategic partner of DHCF since April 2020. They support ongoing maintenance and operation of HIE infrastructure and services that facilitate secure, electronic exchange of health information among District Registered HIE entities and participating organizations. Designated term runs from April 13, 2025 to April 14, 2031. Also registered as a District Registered HIE Entity from November 23, 2025 to November 23, 2028.
• text4babyminorStrategic or Co-development PartnerDHCF has partnered with text4baby which helps pregnant women and new moms increase their knowledge about caring for their health and giving their babies the best possible start in life. Free text messages provide health information to District residents.
• DC Health LinkminorOthersDC Health Link is the District's health insurance marketplace. DHCF maintains informational links to DC Health Link on the DHCF website as part of coordinated healthcare coverage resources.
• AmeriHealth District of ColumbiacoreChannel Partner/ Reseller/ DistributorManaged Care Plan providing Medicaid coverage. Starting August 1, 2026, Wellpoint DC (formerly Amerigroup DC) enrollees will be automatically assigned to AmeriHealth Caritas DC (AmeriHealth).
• Wellpoint DCcoreChannel Partner/ Reseller/ DistributorManaged Care Plan offering DC Healthy Families program covering doctor visits, vision/dental care, prescriptions and more. Formerly Amerigroup DC, transitioning to AmeriHealth Caritas DC effective August 1, 2026.
• Health Services for Children with Special Needs (HSCSN)coreChannel Partner/ Reseller/ DistributorCurrent CASSIP Managed Care Organization providing Medicaid healthcare benefits and additional services for children ages 0-21 with special health care needs who receive SSI benefits.
• MedStar Family ChoicecoreChannel Partner/ Reseller/ DistributorMedicaid Managed Care Plan offered in DC, one of the options available to District Medicaid beneficiaries for healthcare coverage.
• Trusted Health PlancoreChannel Partner/ Reseller/ DistributorMedicaid Managed Care Plan offered in DC, one of the options available to District Medicaid beneficiaries for healthcare coverage.
• DC HIE Policy BoardcoreOthersEstablished in 2012 by the Mayor to provide strategic guidance on secure exchange of health information. Comprises 22 members including public and ex-officio representatives from provider associations, hospitals, health systems, payers, providers, Medicaid beneficiaries, information technologists, and District agencies. Advises Mayor and agency Directors on HIE policies, goals, and strategies.
• Department of Behavioral Health (DBH)coreStrategic or Co-development PartnerDistrict partner agency working with DHCF on ARPA HCBS planning initiatives. Collaborates on efforts to enhance Medicaid Home and Community-Based Services under Section 9817 of the American Rescue Plan Act.
• Department on Disability Services (DDS)coreStrategic or Co-development PartnerDistrict partner agency working with DHCF on ARPA HCBS planning initiatives. Collaborates on efforts to enhance Medicaid Home and Community-Based Services under Section 9817 of the American Rescue Plan Act.
• Centers for Medicare & Medicaid Services (CMS)coreStrategic or Co-development PartnerFederal agency that provides approval and oversight for District Medicaid programs including ARPA Section 9817 HCBS enhanced funding, Section 1115 Demonstrations, and Health Home State Plan options.

Scale indicators3 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• Maryland Department of Health (Medicaid): Maryland's single-state Medicaid agency administering HealthChoice and HCBS waivers for a neighboring mid-size jurisdiction. Operates an almost identical program mix (MCO contracts, 1115 demonstrations, HIE infrastructure, EVV, HCBS waivers) and faces comparable CMS oversight, making it the closest functional peer to DHCF.
• Virginia Department of Medical Assistance Services (DMAS): Virginia's state Medicaid agency operating Medallion 4.0 and CCC Plus managed care programs with extensive HCBS waiver portfolio and HIE connectivity. Directly comparable in scope (state plan administration, MCO oversight, LTSS), and serves the District's immediate neighboring jurisdiction.
• Delaware Division of Medicaid and Medical Assistance (DMMA): Delaware's Medicaid agency is a strong scale peer: small state population, Diamond State Health Plan, integrated DSHP Plus managed long-term care program. Closely matches DHCF in program structure (MCO + LTSS + HCBS waivers) given similarly small covered populations.
• Massachusetts Executive Office of Health and Human Services (MassHealth): Massachusetts' Medicaid program is a comparable single-state agency administering MassHealth ACO/MCO contracts, a mature 1115 demonstration, and HCBS waivers. Direct peer in operating an integrated state Medicaid + locally-funded coverage model like DC's Alliance program.
• Rhode Island Executive Office of Health and Human Services (Medicaid): Rhode Island's Medicaid agency is one of the closest population-scale peers to DC and operates a comparable integrated managed care + LTSS model with a Unified Health Infrastructure Project (UHIP) for benefits IT. Strong comparability on digital modernization and small-jurisdiction HIE challenges.
• Pennsylvania Department of Human Services (Office of Medical Assistance Programs): Pennsylvania's Medicaid agency administers HealthChoices (physical health MCO) and Community HealthChoices (MLTSS) — overlapping with DHCF's MCP + CASSIP/LTCA structure. Direct functional peer for managed care oversight and MLTSS operations at state scale.

Broad incumbents

• California Department of Health Care Services (DHCS): California's Medi-Cal agency is a far larger state Medicaid operator with similar program pillars (managed care, 1115 CalAIM demonstration, HCBS, HIE). Operates at materially greater scale but is the leading comparable for DHCF's Whole-Person Care 1115 strategy and HIE governance model.
• New York State Department of Health (Medicaid): NYS DOH administers Medicaid across mainstream managed care, MLTC, HARP behavioral health, and a large 1115 demonstration — overlapping extensively with DHCF's program architecture. Included as a broader-incumbent reference for managed care + behavioral health transformation approaches.

Others

• Centers for Medicare & Medicaid Services (CMS): The federal regulator that approves and oversees DC's Medicaid state plan, 1115 demonstrations, HCBS waivers, and EVV compliance. Not a peer in the commercial sense but the upstream authority whose policy decisions directly shape DHCF's operating envelope.
• National Association of Medicaid Directors (NAMD): The membership organization representing state Medicaid directors, including DHCF's leadership. Functions as the cross-state coordinating and policy body that shapes how DHCF interacts with federal Medicaid policy and benchmarks against peer states.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xtwitter.com/DCHealthCareFin
• Facebookfacebook.com/pages/DC-Department-of-Health-Care-Finance-DHCF/142415329158066

Revenue estimate

Valuation estimate

Number of profiles

Profiles5 records

Funding overview

Funding rounds

Investors

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M&A

Investments

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Frequently asked questions about DHCF-DCAS