Are you credentialed?Need help becoming credentialed? Get help
Skip to main content
Skip to main content
cpt code 90834 psychotherapy session 1
Payer Policy Updates

DC Medicaid Wellpoint Exit: What Providers Must Do Before October 31, 2026

DC Medicaid Wellpoint exit: two clinicians reviewing patient authorization dates on a printed calendar

The DC Medicaid Wellpoint exit took effect on August 1, 2026, and the transition period for providers runs through October 31, 2026. Wellpoint DC, formerly Amerigroup DC, left DC Medicaid managed care. Its members moved to AmeriHealth Caritas DC. If you saw Wellpoint members, you have a short window left to check authorizations, contracts and claims. This post on the DC Medicaid Wellpoint exit uses the six-part payer update format. It is DC only. Sources were checked on October 9, 2026.

What changed in the DC Medicaid Wellpoint exit

DHCF’s Transmittal 26-19, Managed Care Plan Transition, is dated July 2, 2026. It says Wellpoint DC is exiting. Enrollees are automatically assigned to AmeriHealth Caritas DC. Anyone unhappy with that assignment can choose MedStar Family Choice DC until January 31, 2027.

For background, the DC Council approved Medicaid managed care contracts for AmeriHealth Caritas, AmeriGroup and MedStar in October 2022, covering the city’s Medicaid patients through 2028, per the Washington Informer. The transmittal names Wellpoint as the former Amerigroup plan.

When it takes effect

  • August 1, 2026: the exit and the automatic reassignment take effect.
  • August 1 to October 31, 2026: the transition period.
  • July 31, 2026, 11:59 p.m.: Wellpoint pays for covered services through this time, including inpatient stays that run past it.
  • October 31, 2026: prior authorizations and referrals issued before August 1 stay valid through this date.
  • January 31, 2027: last day for an enrollee to choose MedStar Family Choice DC.

Who it affects

Any provider who treated Wellpoint DC Medicaid members. That includes therapists, psychiatrists and group practices whose patients were assigned to the plan. It also affects members, who may not know they were moved. Behavioral health services reach members through their managed care plans, so a plan change changes your payer. Our Medicaid HCPCS guide shows how codes differ by state.

Practical impact

What does this mean on Monday morning?

  • Eligibility. A patient you saw in July under Wellpoint is now with AmeriHealth Caritas DC unless they chose MedStar. DHCF tells providers to verify each patient’s active eligibility and current plan before service.
  • Claims. Dates of service through July 31 belong to Wellpoint. Dates on or after August 1 go to the member’s new plan. The transmittal does not describe how Wellpoint handles old claims after the exit, so ask for its post-termination contact.
  • Authorizations. DHCF says to honor active referrals and prior authorizations issued before August 1 through October 31, whether or not you contract with AmeriHealth or MedStar. Do not cancel appointments with current patients.
  • Continuity of care. The transmittal says AmeriHealth must honor ongoing treatment authorized before enrollment for up to 60 days or through the last day of the transition period, whichever applies.
  • Medications. Active prescriptions are honored through October 31 or until transferred to an in-network provider. Psychiatrists who prescribe should check their patients’ pharmacy status.
  • Contracting. If you have no agreement with the other plans and want to join, contact each plan’s provider office. Read our credentialing page and the guide to credentialing and network status first.

What to do next after the DC Medicaid Wellpoint exit

These steps help your practice get through the DC Medicaid Wellpoint exit.

  1. Pull a list of Wellpoint DC patients you saw this year.
  2. Verify each one’s current plan using DC Medicaid eligibility tools. Our insurance verification service page shows the checks.
  3. Contact AmeriHealth Caritas DC credentialing at 877-759-6186 or if you need a contract.
  4. Contact MedStar Family Choice DC provider relations at 800-261-3371 or if you want in-network status there too.
  5. Re-enter authorizations, referrals and expiration dates in your calendar. Anything issued before August 1 expires October 31 under the transmittal.
  6. Submit concerns through the Provider Inquiry Form linked in the transmittal.
  7. Keep a list of unpaid Wellpoint dates of service and follow up.

For the terms, see our authorization glossary and eligibility glossary.

Questions to verify with the plans

Ask AmeriHealth Caritas DC and MedStar Family Choice DC:

  • Will you honor my pre-August 1 authorization after October 31 if the patient is still in treatment?
  • What is my contracting status, and do I need to be credentialed before I bill?
  • What is the correct payer ID and claims address for dates of service on or after August 1?
  • How do I check which plan a member is in today?
  • Who handles unpaid Wellpoint dates of service?

If a claim denies, learn the plan’s appeal path early. Our claim denial terms glossary and denied claims page cover the basics. DC fee-for-service claims, a separate path, are paid through the portal at medicaid.dc.gov after the Gainwell change described in Medicaid Director Letter 26-01. Official plan news also appears on the DHCF website.

DC Medicaid Wellpoint exit FAQ

Short answers on the DC Medicaid Wellpoint exit follow.

Which plan did Wellpoint members move to?

Automatically to AmeriHealth Caritas DC. They can choose MedStar Family Choice DC until January 31, 2027.

Do I have to be in network to keep treating a patient?

DHCF says to honor authorizations and referrals issued before August 1 through October 31, whether or not you contract with the new plan. After that, check your status with each plan.

Does this change fee-for-service Medicaid?

No. The transmittal covers managed care plans.

Does MCM South bill DC Medicaid?

MCM South offers billing services to mental and behavioral health practices in the District of Columbia. To talk through which payers and programs fit your practice, request a free consultation. For more answers, see our mental health billing FAQ and the Maryland and DC insurance contact guide.

Where MCM South Medical Billing Service Works

MCM South Medical Billing Service, LLC works exclusively with mental and behavioral health practices, including psychotherapists and psychiatrists, and bills out-of-network claims. We offer our services to practices in the District of Columbia, and we also work with practices in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. If you want to talk through your own billing, you can request a free consultation.