If you have both Medicare and Medicaid in DC, District Dual Choice puts them into one UnitedHealthcare plan, and joining is optional. In DC, anyone eligible for Medicare Advantage who is also eligible for partial or full Medicaid can choose District Dual Choice, and the Dual Choice plan covers and pays for Medicaid services such as long-term services and supports, behavioral health care and dental care. Leaving District Dual Choice changes both coverages at once: you can't keep it for Medicare and leave it for Medicaid, and after you leave, your Medicaid becomes fee-for-service.

In This Guide

What District Dual Choice Covers

District Dual Choice is the District of Columbia's dual eligible special needs plan (D-SNP) program for people enrolled in both Medicare and Medicaid. Since February 1, 2022, District Dual Choice has integrated Medicare and Medicaid benefits into a single program with one set of comprehensive benefits and one accountable entity.

In practice, the DC Department of Health Care Finance (DHCF) describes what changes for a member:

  • One plan pays for Medicaid services too: Long-term services and supports, behavioral health care and dental care are among the Medicaid services covered and paid for by the Dual Choice plan.
  • One card: A Dual Choice member gets a UnitedHealthcare card that carries both the member's Medicare and Medicaid IDs.
  • One case manager on the waiver: Elderly and Persons with Physical Disabilities (EPD) Waiver participants in Dual Choice now have a single case manager who coordinates their care, whether it's a Medicare or a Medicaid service.

The sources this guide relies on don't list Dual Choice copays or extra benefits. Ask UnitedHealthcare for the plan's benefit summary and provider directory before you enroll, and check that your doctors, pharmacy and home care agency are in the network.

Who Can Join District Dual Choice?

DHCF says that, at this time, anyone eligible to enroll in Medicare Advantage who is also eligible for partial or full Medicaid coverage may choose to enroll in District Dual Choice. On its Dual Choice enrollment page, DHCF adds an age condition: it describes the dual eligible individuals it means as people 21 or older who receive both Medicare Parts A, B and D and Medicaid coverage.

In DC, DHCF administers the Medicare Savings Program as the Qualified Medicare Beneficiary (QMB) program, which the DC Department of Aging and Community Living (DACL) describes as partial Medicaid that only helps pay for Medicare-covered services. DHCF says QMB helps pay for services covered under Medicare but not for Medicaid services. Full dual eligibles, who have full DC Medicaid benefits and Medicaid coverage of their Medicare premiums, coinsurance and deductibles, are also known as QMB Plus. If your Medicaid is QMB only, ask UnitedHealthcare what the Dual Choice plan would cover for you before you join. Our guide to DC Medicare Savings Programs explains QMB in full, and our guide to dual eligibility covers how Medicare and Medicaid work together.

How to Enroll in District Dual Choice

  1. Get free advice first if you're unsure. DHCF says you can get free counseling, education and help with enrollment through the DC State Health Insurance Assistance Program (SHIP) at (202) 727-8370.
  2. Call UnitedHealthcare. DHCF tells people interested in District Dual Choice to enroll directly with UnitedHealthcare by calling 1-855-801-7175 (TTY 711) or through UnitedHealthcare's website.
  3. Check your providers. Ask whether your doctors, specialists, pharmacy and any home care or long-term care providers work with the plan, and get the answer before your coverage starts.

Can You Keep the EPD Waiver?

Yes. DHCF says individuals may be enrolled in either of DC's 1915(c) waiver programs for home and community-based services and also in the Dual Choice health plan. For a member of the EPD Waiver, the difference is coordination: DHCF says EPD Waiver participants in Dual Choice now have a single case manager covering both Medicare and Medicaid services.

The EPD Waiver lets DC residents who would otherwise need nursing-home care get services at home or in an assisted-living community. The EPD Waiver has its own eligibility conditions, and our guide to the DC EPD Waiver covers them.

How to Leave, and What Leaving Changes

Yes, you can leave District Dual Choice and keep your Medicaid, but the move is all or nothing across the two programs. DHCF says a member who changes enrollment in Dual Choice changes both Medicare and Medicaid coverage, and can't leave Dual Choice for Medicaid while keeping it for Medicare.

After leaving District Dual Choice, DHCF says, a person is enrolled in Medicaid on a fee-for-service basis and in Medicare either on a fee-for-service basis or under a different health plan. So before you leave, decide where your Medicare will go (Original Medicare with a drug plan, or another plan) and line up providers who take fee-for-service DC Medicaid.

To leave District Dual Choice, DHCF lists three phone routes:

How Often Can You Change Plans?

Two sources describe the timing, and they use different words, so here is each one as it's written.

What DHCF says. DHCF's District Dual Choice page says a member may leave once per quarter or during special election periods.

What federal Medicare rules say. The contract year 2025 Medicare Advantage and Part D final rule (CMS-4205-F) replaced the old quarterly Dual/LIS special enrollment period with a once-per-month special enrollment period that lets dual eligibles and people with Extra Help choose a standalone Part D prescription drug plan in any month. The monthly Dual/LIS special enrollment period for standalone Part D plans is not available to someone identified as a potential at-risk or at-risk beneficiary under a Part D drug management program, while that identification stands. CMS-4205-F, the contract year 2025 final rule, also created a separate once-per-month integrated care special enrollment period for full-benefit dual eligibles to enroll in a fully integrated, highly integrated or applicable integrated D-SNP. Medicare.gov says a change made under these special enrollment periods takes effect on the first day of the next month.

The integrated care special enrollment period has a condition: CMS says it must be used to align enrollment with an integrated D-SNP and a Medicaid managed care organization, and people who remain in Medicaid fee-for-service or an unaligned Medicaid plan can't use it. Neither monthly special enrollment period allows enrollment into, or switching between, Medicare Advantage plans that aren't D-SNPs.

The sources this guide relies on don't say how DHCF's "once per quarter" wording and the federal monthly special enrollment periods fit together for District Dual Choice members, or whether a given DC dual eligible meets the integrated care period's alignment condition for Dual Choice. Before you plan a move for a particular month, ask DC SHIP or 1-800-MEDICARE which enrollment period applies to you. Our guide to Medicare special enrollment periods lists the other times you can change Medicare coverage.

Where DC Fits in Federal Medicare Rules

The Centers for Medicare & Medicaid Services (CMS) contract year 2026 integration-status file lists DC among the states with highly integrated (HIDE) SNPs and with coordination-only D-SNPs, and not among the states with fully integrated (FIDE) SNPs. CMS's file shows three DC plan packages: two HIDE packages, both marked as applicable integrated plans, and one coordination-only package.

The HIDE classification is CMS's. CMS names the sponsors of the two HIDE packages by legal-entity name (Care Improvement Plus South Central Insurance Co. and UnitedHealthcare of the Mid-Atlantic, Inc.). This guide doesn't match those names to UnitedHealthcare's plan names, so if a company offers you a "dual" plan in DC, ask whether it's the District Dual Choice plan.

For contract year 2027, CMS addressed its integrated model materials (member handbook, ID card, and provider and pharmacy directory) to applicable integrated plan D-SNPs in 23 states and territories, the District of Columbia among them. For how DC compares with other states, see our state-by-state guide to integrated Medicare-Medicaid plans, and for the federal categories, our guide to fully integrated dual eligible SNPs.

What Could Change After 2026?

DC's direction. DHCF's page says that as the District moves toward a comprehensive Medicaid managed care delivery system in the coming years, it will preserve choices among coverage options, but fee-for-service Medicaid will not remain an option for all current fee-for-service enrollees. DHCF gives no date or details for that change in the sources this guide relies on, so treat it as a direction, not a deadline.

The federal 2027 and 2030 rules. CMS's April 2026 questions and answers on 42 CFR 422.514(h) explain the aligned-enrollment limits on D-SNPs:

  • 2027: A D-SNP whose company (or a company under the same parent) also contracts with the state as a Medicaid managed care organization enrolling full dual eligibles in the same service area may only take new enrollees who are in, or enrolling in, that affiliated Medicaid plan.
  • 2030: From 2030, a D-SNP whose company (or a company under the same parent) also contracts with the state as a Medicaid managed care organization for full dual eligibles in the same service area may only enroll or keep members who are also in that affiliated Medicaid plan; existing unaligned members may stay until then.
  • Not covered: A D-SNP whose company doesn't run a Medicaid managed care organization serving full dual eligibles in the state is outside these limits.
  • Fee-for-service exception: Where a state doesn't require Medicaid managed care for all full dual eligibles and the state Medicaid agency's contract allows it, a covered company may still enroll full dual eligibles in Medicaid fee-for-service in a coordination-only D-SNP or HIDE SNP, and this exception continues in 2030 and beyond unless the state changes to require aligned enrollment through mandatory Medicaid managed care.

The sources this guide relies on don't say how the 42 CFR 422.514(h) limits apply to any DC plan, so this guide doesn't predict the outcome for District Dual Choice. If you're in a DC D-SNP and in fee-for-service Medicaid, ask DC SHIP before 2027 whether your plan is affected.

What Happens If Your Medicaid Lapses?

District Dual Choice is only open to people eligible for partial or full Medicaid, so letting DC Medicaid lapse at renewal time can put membership at risk. Under 42 CFR 422.52(d), when a special needs plan finds that an enrollee no longer qualifies but can reasonably be expected to qualify again within six months, the enrollee is deemed to stay eligible for at least 30 days and no more than six months. CMS's contract year 2027 guidance says each special needs plan chooses the length of that period, from one to six months, as long as it applies the policy consistently and tells members what it is.

  • If you don't requalify in time: A special needs plan member who doesn't requalify within the plan's period is expected to be disenrolled at the end of it, and the plan should send a disenrollment notice at least 30 days before.
  • Your enrollment window: A person who loses special needs status gets a special enrollment period that starts the month the status changes and ends three calendar months after the involuntary disenrollment takes effect.

Ask UnitedHealthcare how long the Dual Choice plan's deemed continued eligibility period is, and return DC Medicaid's renewal paperwork as soon as it arrives. Our guide to DC Medicaid recertification and renewal explains the renewal process.

Where to Get Free Help

DC SHIP is a service of DACL, which says Medicare beneficiaries, families and caregivers living in the District can get free health insurance information, counseling and help through it. DC SHIP counselors help compare and choose Medicare Advantage, Medigap and Part D plans, and screen for and help with applications for Medicare Savings Programs and Extra Help. Our guide to free Medicare counseling through SHIP explains what a session covers.

What you need Who to call
Join District Dual Choice UnitedHealthcare, 1-855-801-7175 (TTY 711)
Leave District Dual Choice UnitedHealthcare Enrollee Services, 1-866-242-7726 (TTY 711); DC SHIP; or 1-800-MEDICARE
Free, unbiased counseling before you decide DC SHIP, (202) 727-8370 or ship.dacl@dc.gov

The UnitedHealthcare numbers and the disenrollment routes come from DHCF's District Dual Choice page, and the SHIP helpline and email come from DACL.

Frequently Asked Questions

I only have QMB. Can I join District Dual Choice, and what would it pay for?

DHCF opens District Dual Choice to people eligible for partial or full Medicaid, and DACL describes QMB as partial Medicaid that only helps pay for Medicare-covered services; its example is that QMB doesn't pay for dental or routine vision care, because Medicare generally doesn't cover them. So don't assume the Medicaid services DHCF lists for the plan, such as dental care, come with your membership; ask UnitedHealthcare before you join. The monthly integrated care special enrollment period is for full-benefit dual eligibles only, so a QMB-only member can't use it.

Can I switch from District Dual Choice to Original Medicare and a standalone drug plan?

Under federal rules, full-benefit and partial-benefit dual eligibles can use the monthly Dual/LIS special enrollment period to move into Original Medicare plus a standalone Part D drug plan, with the change taking effect on the first day of the next month; that period isn't available to someone flagged as at-risk under a Part D drug management program. DHCF says a person who leaves District Dual Choice is enrolled in Medicaid on a fee-for-service basis. DHCF's own page describes leaving as possible once per quarter or during special election periods, so ask DC SHIP at (202) 727-8370 which timing applies before you pick a month.

Is District Dual Choice a FIDE SNP, and does that matter?

No. CMS's contract year 2026 file lists DC among the states with highly integrated (HIDE) and coordination-only D-SNPs, not fully integrated (FIDE) SNPs. The label matters less than it sounds for switching: the federal integrated care special enrollment period reaches HIDE SNPs and applicable integrated plans as well as FIDE SNPs. Whether you meet that period's alignment condition is a question for DC SHIP.

Learn More

MedicareIntegrated Medicare-Medicaid Plans by State: Which Dual Plan Can You Get?Whether you can get one plan for Medicare and Medicaid depends on your state, sometimes your county. See how each state's integrated dual plans work in 2026. MedicareMedicare in Washington, DC: Costs, Plans, and Free Help ChoosingMedicare in Washington, DC for 2026: the $202.90 Part B premium, enrollment windows, Medicare Advantage vs. Medigap, and free DC SHIP plan counseling. MedicaidDistrict of Columbia Medicaid: A Guide for Seniors and FamiliesDistrict of Columbia Medicaid is run by DHCF: 138% FPL adult coverage, a $4,000 asset limit for long-term care, the EPD Waiver, and QMB up to 300% FPL. MedicaidDistrict of Columbia Medicare Savings Programs: Help Paying Medicare CostsDC Medicare Savings Programs pay Medicare premiums, deductibles, and coinsurance. See the District's 2026 QMB income limits ($4,010 single) and how to apply. MedicaidHow DC Medicaid Pays for Care at Home: The EPD WaiverHow District of Columbia Medicaid HCBS waivers work in 2026: the EPD Waiver, who qualifies, what it covers, income and asset limits, and how to apply. MedicareFully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) ExplainedFIDE-SNPs are the high-integration dual-eligible plans replacing the MMP demonstration on 1/1/2026: definitions, state landscape, and family pitfalls.

Find personalized help deciding whether District Dual Choice fits your family at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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