Frequently Asked Questions

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What health plan choices do I have?

You can see your health plan choices in the Health Plan Comparison Chart that came in your Welcome Packet. The Comparison Chart also shows benefits and services in each plan. To see the chart, click here.

For questions or help, call our Customer Service Center at 202-639-4030 or 800-620-7802. Or visit one of our offices.

How do I use the Health Plan Comparison Chart?
The Comparison Chart shows the services each plan offers. Here’s how to compare plans and choose your plan:
  • The top row shows the name of each health plan.
  • The left-hand column shows the benefits and services.

Click here to see the Comparison Chart.

What is a health plan?
A health plan offers you medical, dental, and sometimes vision services. A health plan may also be called a managed care organization (MCO). Each plan has doctors, hospitals, clinics, and pharmacies that work with the health plan to provide the services. The District pays the health plan to give services to you and your family.
Do I need to choose a health plan before I choose my doctor?
You can choose a plan first or a doctor first. It’s up to you. If you choose a doctor first, we’ll tell you which health plans work with the doctor. Then you can choose one of those plans. If you choose a plan first, you can then choose a doctor who works with that plan.
How do I choose a health plan and a doctor?
Can I change my health plan?
Yes. You can change your health plan during the first 90 days after you enroll. To change health plans, call our Customer Service Center at 800-620-7802.
If you don’t change plans in 90 days, then you must stay in the health plan for at least one year, unless you can show a good reason to change. DC Healthy Families may then decide you can change plans.
I have health care coverage from another insurance company. Does this affect my Healthy Families membership?

Click here to see a video

If you are a DC Healthy Families member and have other health insurance, you must tell your ESA caseworker. You must also tell your health plan right away. Use the phone number on your plan Member ID card to call your health plan.

If you have other health insurance, you cannot join the DC Alliance program. DC Alliance is for people who don’t have health insurance and can’t get Medicaid or Medicare.

Do I need to choose a health plan and primary doctor or clinic for each member in my household?
Yes. You must choose a health plan and primary care provider (PCP) for each family member in the program. To help you find health plans and doctors that meet your family’s needs, use the “How to Choose a Health Plan” guide in the Welcome Packet.
I have a problem with my health plan or primary care doctor. What should I do?
Call your health plan member services. The number is on your Member ID card.
If you can’t get the help you need from member services, call our Complaint Line at 800-788-0342 (TTY/TDD 866-879-0065).
I don’t have my Member ID and PIN. What should I do?
If you don’t have your Member ID and PIN, go to “My Account” on this website. Click “Forgot Pin.”
If you still cannot log in, call our Customer Service Center at 800-620-7802. The call is free.
What is a Member ID and PIN?

Your Member ID and PIN are special identification numbers. They show you are a member of the DC Healthy Families or DC HealthCare Alliance program. You can find your Member ID and PIN in your letter from DC Healthy Families or DC HealthCare Alliance. To see what the Member ID and PIN looks like, click here.

You need your Member ID number and PIN to log into your online account. You also need your Member ID number when you call us.

I have a complaint about my health care coverage. What can I do?
Where can I get more help?

Click here to see a video

Call our Customer Service Center at 800- 620-7802.

How can I change my address or other contact information?

To change your address or contact information, you must contact Economic Security Administration (ESA). ESA used to be called IMA. Call 202-727-5355. Or you can go to your ESA Service Center. Service centers are in Anacostia, Congress Heights and Fort Davis and on H Street and Taylor Street.

If you do not update your information with ESA, we may not be able to contact you. Your documents and benefit information may be mailed to the wrong address.

How do I apply for DC Healthy Families?

You can apply for Healthy Families online or by mail.

Online:

  1. Go to dchealthlink.com.
  2. Click “Individual and Family Health Insurance.”
  3. Click “Get Started.”
  4. On the next page, click “Apply for Medicaid.”

To download and print an application, go to the home page and click “Forms.”

Mail:

  1. To have an application mailed to you, call 888-557-1116 (TTY/TDD 877-672-7368).
    You can also get a Combined Medical Assistance application at any CVS, Safeway, Rite Aid or Giant store. You can also get one at the District’s public libraries, the Department of Motor Vehicles, and the Department of Employment Services.
  2. Complete and sign the application
  3. Include:
    • Proof that you live in DC
    • Copies of Social Security cards for children and parents who are applying
    • Proof of one month's income
  4. Mail your application and proof in the envelope that came with the application. You do not need a stamp. Mail to:
    • DC Healthy Families
    • ATTN: DC Healthy Families Unit
    • 645 H Street NE
    • Washington, DC 20002

You can also go to any of the ESA Service Centers listed here to apply:

ESA Service CenterAddressPhone
Anacostia2100 Martin Luther King Avenue, SE(202) 645-4614
Congress Heights4001 South Capitol Street, SW(202) 645-4546
Fort Davis3851 Alabama Avenue, SE(202) 645-4500
H Street645 H Street, NE(202) 698-4350
Taylor Street1207 Taylor Street, NW(202) 576-8000
What services does DC HealthCare Alliance cover?
DC HealthCare Alliance covers:
  • Doctor visits
  • Preventive care, such as checkups, diet and nutrition
  • Doctor visits and checkups, including physicals and mammograms, etc.
  • Hospital services
  • Emergency services
  • Prescription drugs
  • Rehabilitative services
What are the DC Healthy Families Program?

The DC Healthy Families program offers free health insurance coverage through Managed Care Organizations. Coverage is for low-income people living in DC. Healthy Families is part of the DC Medicaid program.

These people can join the DC Healthy Families Program if they qualify:

  • Adults age 21-64 who do not have dependent children
  • Pregnant women
  • Parents and caretaker relatives
  • Children under age 21

What happens to the personal information I provide?

We use your information to update our records. We use your address to send you materials about your health plan choices. We also send letters to tell you about changes and yearly renewals.

We keep your personal information completely private.

Who is eligible for DC HealthCare Alliance?

DC Health Care Alliance provides free coverage for people who:
  • Live in the District of Columbia
    Temporary non-immigrants such as embassy personnel do not meet this rule.
  • Have no other health insurance, including Medicare and Medicaid
  • Have low income, at or below 200% of the Federal Poverty Level
You do not need to be a U.S. citizen or a legal immigrant. You can apply for the program no matter what your immigration status is. The D.C. government covers 100% of the program costs.
When can I go to a doctor?
You can go to a doctor as soon as you enroll in a health plan.
Who is eligible for DC Healthy Families?

You may be able to join the Medicaid Program if you have low income. We compare your income to the federal poverty level (FPL). The federal government sets the FPL each year.

2016 Federal Poverty Level
Household Size100%133%150%200%250%300%400%
1$11,880$15,800$17,820$23,760$29,700$35,640$47,520
216,02021,30724,03032,04040,05048,06064,080
320,16026,81330,24040,32050,40060,48080,640
424,30032,31936,45048,60060,75072,90097,200
5 28,440 37,825 42,660 56,880 71,100 85,320113,760
6 32,580 43,331 48,870 65,160 81,450 97,740130,320
7 36,730 48,851 55,095 73,460 91,825110,190146,920
8 40,890 54,384 61,335 81,780102,225122,670163,560
Do I need to tell Healthy Families when I move, change jobs, or have a child?
Yes. Call the ESA Change Center at 202-727-5355. Also call your health plan to report all household changes.
I already see a doctor I like. Can I stay with this doctor?
Yes, if your doctor works with one of the health plans in DC Healthy Families. Many doctors work with the program. You can ask your doctor if they are in the program. Or you can search for your doctor on this website. Go to “Find a Doctor.”
When will I know whether I am eligible for DC Healthy Families?
After you send in your application, you will get a letter from the ESA within 45 days. The letter will say if you qualify. If you don’t get that letter, call the ESA at 202-727-5355.
Will I get an insurance card?

Yes. Make sure the card shows that you are in the plan you chose, with the right doctor. If any information is wrong, call the health plan.

For DC Healthy Families members: Once you choose your health plan and doctor, or we choose them for you, your health plan will send you a Member ID card.

For DC Health Care Alliance Members: Once you choose a doctor, or we choose one for you, your health plan will send you a Member ID card.

How long does my DC Health Care Alliance eligibility last?
Once you qualify, you are eligible for 6 months. To prove you still qualify for benefits, you will need to fill out a renewal form every 6 months. ESA will send you that form in the mail.
How long does my DC Healthy Families eligibility last?
Once you qualify, you are eligible for 12 months. To prove you still qualify for benefits, you will need to fill out a form every year. ESA will send you that form in the mail.
What is the DC Health Care Alliance?
The DC Health Care Alliance program offers medical assistance to District residents who do not qualify for Medicaid or Medicare, or do not have any other health insurance. If you have low income, you may qualify to become a member of DC Alliance.
Can I change my doctor?
Yes. You can call your health plan member services any time to change your primary care doctor. The phone number is on your Member ID card.
I logged in to My Account, but the page showed someone else, not me.
Try entering your Member ID and PIN again. Make sure you put in the right numbers. If the website still shows the wrong person, call the Customer Service Center at 800-620-7802.
How do I get medical services?

Click here to see a video

To get medical care, call your PCP (doctor). You can find your PCP’s phone number on the front of your Member ID card and in the DCHF Provider Directory or Alliance Provider Directory.

Your PCP will help you get all of the health services you and your family need. Even if you are healthy, you should make an appointment with your doctor. If you have never seen this doctor before, you should contact them as soon as possible.

When you call your PCP, have your insurance Member ID card ready. Tell them the name of your health plan . Tell them you want to make an appointment. When you go to your doctor appointment, be sure to bring your insurance Member ID card.

Is there information available in another language?

Click here to see a video

All health plan choice materials for the DC Healthy Families and DC HealthCare Alliance programs are available these languages: Amharic, Chinese, French, Korean, Spanish, and Vietnamese.

You can also get all materials in other formats such as large print and Braille.

If you need help in another language, call the Customer Service Center at 800-620-7802. We can help you in the language you speak. This service is free.

What health care services does DC Healthy Families cover?

DC Healthy Families health care services include:

  • Doctor visits and checkups
  • After-hours care 24 hours a day, 7 days a week
  • In-patient care
  • Emergency care
  • Well-child services (EPSDT/HealthCHECK)
  • Dental services including full routine care for children and emergency care for adults
  • Lab and x-ray services
  • Prescription drugs
  • Home health care including durable medical equipment
  • Vision care
  • Transportation for emergencies or when medically needed
My doctor is not listed with any of the health plans. Can I still see them?
Maybe. First, check the spelling of your doctor’s name. Make sure you typed the correct name on the “Find a Doctor” page on this website. If the name isn’t listed, call your doctor to ask if they work with DC Healthy Families. If they say yes, call Customer Service Center at 800-620-7802 to choose this doctor.
Do I have to pay for health care services?
You should always ask your health plan if it covers the services your doctor says you need. To learn more about covered services, look in your member handbook. The handbook is in the welcome packet your health plan sent to you.
Do I get dental care?

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Yes. Dental care coverage is part of your DC Healthy Families and DC HealthCare Alliance benefits. For questions or to make a dentist appointment, call the Dental Line at 866-758-6807. Or call your health plan member services to make a dentist appointment. The number is on your Member ID card.

How do I apply for DC Health Care Alliance?
You must apply for DC Health Care Alliance in person. You cannot apply online or by mail.
  • To get an application online, go to http://dhs.dc.gov/publication/combined-application-benefits
  • Print out and complete the Combined Application for Benefits form. The form lists proof you need to bring with you when you apply.
  • Take the completed form and proof to an ESA Service Center.
  • You will get a letter from the ESA within 45 days. The letter will say whether you can join the program. If you don’t get that letter, call the ESA at 202-727-5355.
  • If you can join, you will get a letter that gives the date your health insurance starts.
I used to have DC health care coverage, but my coverage ended. What should I do?
If you or your family members were in the DC Healthy Families or DC Healthcare Alliance programs but coverage ended, visit or call the ESA at 202-727-5355. You will need to re-apply to see if you qualify.
How do I choose a primary care provider?

Look at the provider directory in your welcome packet. It lists all the primary care physicians (PCPs) participating in the DC Healthy Families or DC HealthCare Alliance programs. It also shows the languages each doctor speaks. Check the list to make sure the PCP (doctor) you want works with your health plan.

If you need help choosing a doctor or clinic, call your health plan. Or call the Customer Service Center at 800-620-7802.

What is a primary care provider?
A PCP (doctor or clinic) is who you see most often for health concerns. Your PCP gives you health care and teaches you about healthy lifestyle choices. Your PCP will refer you to a specialist when you need one.
Some of the people listed in My Account are not members of my household. What should I do?
Please call the ESA Change Center at 202-727-5355.
What if I have a complaint about my health care coverage?
What if I have health care coverage under a different insurance provider?
What health plan choices do I have?

You can see your health plan choices in the Health Plan Comparison Chart that came in your Welcome Packet. The Comparison Chart also shows benefits and services in each plan. To see the chart, click here.

For questions or help, call our Customer Service Center at 202-639-4030 or 800-620-7802. Or visit one of our offices.

I don’t have my Member ID and PIN. What should I do?
If you don’t have your Member ID and PIN, go to “My Account” on this website. Click “Forgot Pin.”
If you still cannot log in, call our Customer Service Center at 800-620-7802. The call is free.
What is a health plan?
A health plan offers you medical, dental, and sometimes vision services. A health plan may also be called a managed care organization (MCO). Each plan has doctors, hospitals, clinics, and pharmacies that work with the health plan to provide the services. The District pays the health plan to give services to you and your family.
What is a Member ID and PIN?

Your Member ID and PIN are special identification numbers. They show you are a member of the DC Healthy Families or DC HealthCare Alliance program. You can find your Member ID and PIN in your letter from DC Healthy Families or DC HealthCare Alliance. To see what the Member ID and PIN looks like, click here.

You need your Member ID number and PIN to log into your online account. You also need your Member ID number when you call us.

Where can I get more help?

Click here to see a video

Call our Customer Service Center at 800- 620-7802.