Dc pof 2026

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  1. Click ‘Get Form’ to open the dc pof in the editor.
  2. Begin by filling out SECTION I: PATIENT INFORMATION. Enter the Patient DC Medicaid Number, or note 'N/A' if unavailable. Provide the patient's full name, date of birth, and telephone number.
  3. Continue with the current and permanent address fields, along with emergency contact details.
  4. Move to SECTION II: DETERMINING NEED FOR SERVICES. Indicate any chronic medical conditions and specify the reason for referral. Select the appropriate request type from the options provided.
  5. If applicable, complete the retroactive coverage request effective date and describe any significant changes in patient condition since the last assessment.
  6. In SECTION III: PHYSICIAN/APRN INFORMATION, enter your name, telephone number, provider address, and National Provider Identifier Number. Finally, sign and date to certify that services are necessary.

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Income Asset Limits for Eligibility 2023 Washington DC Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleMarried (both spouses applying)Income LimitAsset LimitInstitutional / Nursing Home Medicaid$2,742 / month*$6,000Medicaid Waivers / Home and Community Based Services$2,742 / month$6,0001 more row Feb 21, 2023
If you have questions, contact Provider Inquiry at (202) 906-8319 (inside DC metro area) or (866) 752-9233 (outside DC metro area) or via email at providerinquiry@conduent.com.
Department of Health Care Finance - DC Medicaid / Alliance and Me.

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Department of Health Care Finance - Provider Enrollment Required Documentation. For assistance, contact the Maximus Provider Screening and Enrollment Customer Service Center at 844-218-9700 Monday through Friday (8:00 am 5:00 pm).
By Phone: Call the Department of Human Services Economic Security Administration Public Benefits Call Center at (202) 727-5355.

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