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Washington DC Health Care Info for Adults

MEDICAID AND DC HEALTHCARE ALLIANCE

DC Medicaid and DC Healthcare Alliance are local health insurance programs.

To get Medicaid or Alliance:

  • You must live in Washington, DC
  • You must have a low income. For example:

 

Number of people in your family Your income each month must be less than:*
1 $1,915
2 $2,585
3 $3,255
4 or more For each additional person, add $670
to the number just above

Attention: If your income is a little higher than the numbers below, you should still apply. Some of your income may not count.

* These are the numbers for 2013. They will go up a small amount each year.

  • Your income can be higher if:
    • you have high medical bills, have work income, or pay for child care;
    • you are pregnant;
    • you need care at home for an illness;
    • you have breast or cervical cancer; or
    • you are applying for a child.
  • If you have Medicare and a low income, you may also qualify for Medicaid.

With Medicaid or Alliance you will probably get your health care through a managed care plan.

The plans are: Chartered Health and Unison. Medicaid and Alliance pay for:

  • Prescriptions
  • Doctor visits, including specialists
  • Hospital stays
  • Dental care
  • Some other health care services

Only Medicaid pays for:

  • Mental health care
  • Substance abuse care
  • Bills for medical care you got in the three months before you apply

To apply for Medicaid or Alliance:

  • Call the Department of Human Services at 202-727-5355. They will help you figure out which program is right for you.
  • Ask for the address of the office or clinic nearest you where you can apply. Find out what information you will need.

When you are approved for Medicaid, you will get one insurance card from Medicaid and another one from your managed care plan, if you have one. When you get the Alliance, you only get a card from your managed care plan.

To keep getting Medicaid or Alliance:

The Department of Human Services will send you a form. Fill out the form and return it right away so your health insurance does not get cut off.

OTHER PROGRAMS TO HELP YOU PAY FOR CARE

If you are disabled, or if you are 65 or older, or if you need a kidney transplant or dialysis:

  • You get Medicare if you or your spouse gets a Social Security check.
  • Medicare pays most of the bills for doctor and hospital care. Medicare also pays for some nursing home care. You have to pay for part of the care you get.
  • You can apply for Medicare at your local Social Security office. Or call 800-772-1213.
  • If you have a low or moderate income, Medicaid may help you pay some of your Medicare costs. Medicaid can pay the monthly Medicare premium that is taken out of your Social Security check. This program is called QMB. Apply at your local Department of Human Services office. Or call DHS at 202-727-5355.

If you have HIV or AIDS:

  • The DC AIDS Drug Assistance Program can pay your premiums and copayments. The program also pays for medicines. Call 202-671-4900 or visit http://budget.dc.gov/node/137072.

Consider buying private health insurance:

  • This can cost a lot.
  • When you apply, you will have to answer questions about your health. You may need a physical exam. Private insurance may turn you down because of a health problem you had before you applied. This is called a pre-existing condition. Even if you are accepted, the insurance may not cover your preexisting condition. Make sure to ask if the insurance will pay for all the services you need.
  • If you have a pre-existing condition and have had no insurance for 6 months or longer, you may qualify for the Pre-Existing Condition Insurance Plan. Call 866-717-5826 or visit www.pcip.gov.
  • CareFirst Blue Shield offers you the Blue Preferred Open Enrollment plan. Your health status and your immigration status do not matter. Call CareFirst Blue Shield at 800-544-8703.
  • For health insurance companies and plans for DC residents, visit www.healthreform.dc.gov. Click on “Insurance Coverage Options.”

HOW TO GET CARE IF YOU ARE NOT A U.S. CITIZEN

You do not need to be a U.S. citizen to get health care and health insurance in Washington, DC

Applying will not hurt your immigration status.

If you meet the other requirements for getting Medicaid you probably can get benefits if:

  • you are a Legal Permanent Resident for five years, or
  • you are a refugee, or
  • you are an asylee.

Some other legal immigrants can also get Medicaid. Call the Department of Human Services at 202-698-4241.Or call Legal Aid at 202-628-1161.

You can get Alliance if:

  • You cannot get Medicaid.
  • You meet the requirements for Alliance (see the first page of this brochure). For the Alliance, your immigration status does not matter.
  • You can also get Emergency Medicaid:

  • Emergency Medicaid covers the birth of your child and most medical emergencies. Call the Department of Human Services at 202-698-4241.
  • Your immigration status does not matter.
  • You must live in Washington, DC and meet other Medicaid requirements.

HELPFUL PHONE NUMBERS

For problems with Medicaid, Alliance, or Medicare:

  • Call the Legal Aid Society of the District of Columbia at 202-628-1161.
  • If you do not qualify for legal aid help, call the Bar Association of the District of Columbia Lawyer Referral Line at 202-296-7845. The lawyers they refer you to may charge a fee. Tell them that you have a low income or ask for a reduced fee.

For any problems with your health care:

  • Call the Office of Ombudsman & Health Care Bill of Rights at 877-685-6391.

If you need to contact your managed care plan:

  • Call the DC Medicaid/Alliance Managed Care Line at 202-639-4030. They can connect you to your plan.

For questions about a Medicaid bill or renewal:

  • Call Terris, Pravlik & Millian at 202-682-0578.

For help with Medicare and other programs for seniors:

  • Call the George Washington Health Insurance Counseling Project at 202-739-0668.

If you or a family member has HIV or AIDS:

  • Call the Whitman-Walker Health at 202-939-7627.
  • Call the HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) at 202-671-4900. There is one application for several HIV/AIDS programs.

If you have a disability:

  • Call the University Legal Services/Protection and Advocacy Program at 202-547-4747.

If you or your child has a developmental disability and you need referrals for health care or other support:

  • Call DC Quality Trust at 202-448-1450.

 

If you need a test or treatment for breast, cervical or ovarian cancer:

  • Call Project WISH at 202-442-5900.