Waiver Consulting Group — Start any program. In any state.

District of Columbia - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The District of Columbia Department of Health Care Finance (DHCF) does not fund a standalone Adult Companion service under its Elderly and Persons with Physical Disabilities (EPD) Waiver, instead absorbing non-medical supervision and socialization into Personal Care Aide (PCA) services and the participant-directed Services My Way program. For individuals with intellectual disabilities, the Department on Disability Services (DDS) Developmental Disabilities Administration (DDA) covers a distinct Companion Services under the IDD Waiver.

Prospective providers cannot simply submit an application to bill Medicaid for these services. Approval requires attending a mandatory, ad-hoc quarterly information session hosted by the Long Term Care Administration (LTCA), followed by a formal Letter of Intent (LOI) submitted within 10 business days to secure a pre-approval notice before the Provider Data Management System (PDMS) will even accept an enrollment packet.

1. Service Definition and Scope

Because the District of Columbia does not use the term Adult Companion Services in its EPD Waiver, providers deliver these supports through Personal Care Aide (PCA) services or the Services My Way program. These services provide assistance with activities of daily living, socialization, and non-medical supervision to prevent institutionalization.

Under the DDA IDD Waiver, Companion Services are explicitly defined as non-medical care, supervision, and socialization provided to an adult. Providers must clearly identify which waiver they are targeting, as the scope and allowable tasks differ significantly between DHCF's aging population and DDS's IDD population.

2. Regulatory and Oversight Agencies

Multiple District of Columbia agencies oversee the provision of HCBS waivers, depending on the target population. The Department of Health Care Finance (DHCF) is the single state Medicaid agency responsible for overall waiver administration and provider enrollment.

For the EPD Waiver, DHCF's Long Term Care Administration (LTCA) manages provider approvals, while the Department of Aging and Community Living (DACL) assists with case management. For the IDD Waiver, the Department on Disability Services (DDS) Developmental Disabilities Administration (DDA) manages provider certification.

3. Gatekeeping Prerequisites: Who Can Even Apply

The District of Columbia employs a strict, multi-step gatekeeping process for new EPD and IDD Waiver providers. A provider cannot simply create an account in the Medicaid portal and submit an application; the system requires a pre-approval notice uploaded with the packet.

For the EPD Waiver, DHCF/LTCA requires attendance at a mandatory information session, which is only held quarterly on an ad hoc basis. Providers must request to attend by demonstrating an exigent need, making open enrollment effectively closed unless DHCF identifies a network shortage.

4. Licensure and Certification Requirements

To provide PCA services under the EPD Waiver, agencies must be licensed as a Home Care Agency (HCA) by DC Health. This licensure process involves submitting policies, procedures, and passing an initial site survey conducted by the Health Regulation and Licensing Administration.

Providers targeting the IDD Waiver for Companion Services must undergo a separate certification process through the Department on Disability Services (DDS) Provider Resource Management Unit (PRMU) before they can apply for Medicaid enrollment.

5. Medicaid Provider Enrollment

All Medicaid provider enrollment in the District of Columbia is processed through the Provider Data Management System (PDMS) web portal, managed by Maximus. Providers have exactly 90 days to submit their application in PDMS after receiving their LOI pre-approval from LTCA.

Providers must select the correct application type in PDMS. EPD Waiver agencies select the 'EPD-Waiver' application, while IDD providers select 'IDD/IFS Waiver'. Individual aides working through an agency or the participant-directed program must also enroll using specific application types.

6. Staffing, Training and Background Checks

Direct care workers providing socialization and supervision must meet strict District of Columbia training and background requirements. For EPD Waiver PCA services, staff must hold a valid Home Health Aide (HHA) or PCA certification recognized by DC Health.

Participant-directed workers under Services My Way have slightly more flexible training requirements but must still pass comprehensive background screenings. All waiver staff must maintain current CPR and First Aid certifications.

7. Documentation, Policies and Records

District of Columbia HCBS providers must maintain comprehensive records that align with the beneficiary's Person-Centered Service Plan (PCSP). DHCF requires strict adherence to Electronic Visit Verification (EVV) mandates for all personal care and companion-type services.

Agencies must also maintain detailed incident management policies. Any critical incidents, such as falls, suspected abuse, or unauthorized wandering, must be reported to DHCF or DDS within mandated timeframes.

8. Billing, Rates and Claims

Reimbursement for EPD and IDD Waiver services is processed through the DC Medicaid MMIS, with claims submitted via the PDMS portal or a clearinghouse. Services are not entitlements; they are capped by the waiver's approved slots and the individual's authorized budget.

Before any billing can occur, the participant must have a completed Prescription Order Form (POF) from a DC Medicaid-enrolled physician or APRN, followed by a functional needs assessment conducted by Liberty Healthcare to confirm Nursing Facility Level of Care (NFLOC).

9. Approval Sequence and Timeline

Becoming a provider in the District of Columbia is a lengthy process due to the ad hoc nature of the mandatory information sessions. Providers cannot control the timeline for Step 1, as they must wait for LTCA to announce a session and approve their attendance request.

Once the session is attended, the timeline becomes strictly regulated: 10 days to submit the LOI, 10 days for LTCA to respond, and 90 days to submit the PDMS application. The entire process, including DC Health licensure and Maximus site visits, typically takes 6 to 12 months.

10. Common Denials and Survey Findings

The most frequent cause for application rejection in the District of Columbia is attempting to bypass the gatekeeping steps. Applications submitted in PDMS without the official LTCA or DDA pre-approval notice are immediately denied by the enrollment vendor.

During post-enrollment site visits and audits, DHCF frequently cites providers for failing to properly implement Electronic Visit Verification (EVV) or for deploying staff whose background checks or CPR certifications have lapsed.

11. Key Contacts and Resources

Prospective providers must rely on official District of Columbia portals and help desks to navigate the enrollment process. Informal inquiries via email or phone regarding application status are not accepted by DHCF once the formal review process begins.

The Maximus Customer Service Center is the primary contact for technical issues within the PDMS portal, while DHCF LTCA handles programmatic questions prior to application submission.

See all District of Columbia services · District of Columbia Medicaid consulting · book a consultation.