Changes to the DC Health Care Alliance and Immigrant Children's Programs
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Announces merger of DC Health Care Alliance and Immigrant Children's Program into the DC Health Care Alliance Program for Adults and Children effective 10/1/2025 and describes provider enrollment, covered and non-covered services, and administrative points for providers affected.
The Health Care Alliance and the Immigrant Children's (ICP) Programs will merge into one program named DC Health Care Alliance Program for Adults and Children effective October 1, 2025.
Providers must be enrolled with DC Medicaid via DHCF’s enrollment system (dcpdms.com) and convert managed-care-only accounts to standard Medicaid applications if billing Alliance beneficiaries.
Dental services will no longer be covered for Alliance adults effective 10/1/25; children’s dental remains covered.
Covered and Excluded Services
Covered Services (summary)
Covered services for DC Health Care Alliance for Adults and Children enrollees include:
ALL of the following
- Inpatient Hospital Care
- Outpatient medical care (including preventive care)
- Laboratory services
- Radiology services
- Emergency services
- Prescription drugs
- Durable Medical Equipment
- Dental (children only) — dental services will not be a covered benefit for Alliance adults effective 10/1/25; existing prior authorizations for dental services extending beyond 9/30/25 must be reissued by Comagine for continuation
- Emergency Transportation
- Behavioral health services administered by the Department of Behavioral Health (DBH)
Excluded Services (summary)
Services not covered for DC Health Care Alliance for Adults and Children enrollees include:
ALL of the following
- Home Health
- Skilled Nursing Facility care
- Cell and Gene Therapy
- Hospice
- Cosmetic procedures/medications
- Non-emergent transportation
- Podiatry (adults only)
- Organ transplantation
- Vision and hearing (adults only)
- Dental (adults only)
Changes do not apply to children enrolled in the Children and Adolescent Supplemental Security Income Program (CASSIP).
Codes and Billing Notes
| No specific procedure or diagnosis codes provided in this alert. |
Provider Enrollment and Operational Requirements
Enroll with DHCF and convert managed‑care‑only accounts; complete EFT application
Providers must be enrolled with DC Medicaid and complete the enrollment process with the Department of Health Care Finance at https://www.dcpdms.com. If enrolled as a Managed Care–only provider and you plan to bill Alliance beneficiaries, convert your managed-care-only account to a standard Medicaid application at www.dcpdms.com; as part of that conversion you are required to complete an EFT application.
- Enroll via DHCF provider enrollment system: https://www.dcpdms.com
- Convert managed-care-only accounts to a standard Medicaid application if billing Alliance beneficiaries
- Complete an EFT application during the conversion/enrollment process
Reissue dental prior authorizations extending beyond 9/30/25
Dental services will not be a covered benefit for Alliance adults effective 10/1/25; any existing prior authorizations for dental services that extend beyond 9/30/25 must be reissued by Comagine for continuation under the new program.
- Dental remains covered for children; adult dental coverage ends effective 10/1/25
- Prior authorizations extending beyond 9/30/25 must be reissued by Comagine
Key Definitions and Exceptions
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