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District of Columbia - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The District of Columbia Department of Health (DC Health) Health Regulation and Licensing Administration (HRLA) licenses congregate residential care as Assisted Living Residences (ALRs) under DC ST § 44-101.01. Medicaid reimbursement for these services is administered by the Department of Health Care Finance (DHCF) through the Elderly and Persons with Physical Disabilities (EPD) Waiver.

Prospective Medicaid providers cannot access the DC Provider Data Management System (DCPDMS) until they secure a formal pre-approval notice from the DHCF Long Term Care Administration, which is initiated by submitting a formal Letter of Intent. Only after passing a mandatory information session and a pre-enrollment site visit by Maximus will DHCF authorize the facility to submit an EPD-Waiver application in the enrollment portal.

1. Service Definition and Scope

The District of Columbia defines two primary levels of congregate residential care: Assisted Living Residences (ALRs) and Community Residence Facilities (CRFs). ALRs provide a higher level of care, combining housing, health, and personalized assistance.

Licensure is required regardless of facility size, as the District does not utilize a separate adult foster care license for small homes.

2. Regulatory and Oversight Agencies

Facility licensure is managed by DC Health, while Medicaid enrollment and waiver operations are overseen by DHCF.

DHCF utilizes third-party vendors for site visits and claims processing.

3. Gatekeeping Prerequisites: Who Can Even Apply

DHCF strictly controls access to the EPD Waiver provider enrollment process. Facilities cannot simply submit an application in DCPDMS; they must clear a multi-step pre-approval sequence managed by the Long Term Care Administration.

This sequence begins with a Letter of Intent and includes mandatory training and site visits before portal access is granted.

4. Licensure and Certification Requirements

ALRs operate under the statutory authority of the Assisted Living Residence Regulatory Act. Facilities must maintain continuous compliance with staffing, resident rights, and physical plant standards.

Licenses are issued for specific capacities and must be updated if facility details change.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the DC Provider Data Management System (DCPDMS). Selecting the correct application type is critical, as errors result in immediate rejection.

The District transitioned its fiscal agent to Gainwell in March 2026, updating the enrollment and claims infrastructure.

6. Staffing, Training and Background Checks

ALRs must employ specific administrative and clinical personnel to oversee daily operations and medication management.

Nursing oversight is required on a strict schedule to supervise unlicensed staff administering medications.

7. Documentation, Policies and Records

The initial LOI and subsequent application require specific documentation proving the agency's readiness and financial stability.

DHCF implemented a revised financial viability assessment for EPD providers in March 2026.

8. Billing, Rates and Claims

Claims are submitted through the medicaid.dc.gov portal managed by Gainwell. Providers serving managed care populations face additional credentialing steps.

A pending DC Council bill aims to streamline managed care credentialing by 2027.

9. Approval Sequence and Timeline

Becoming an ALR Medicaid provider in DC is a linear process that requires clearing DC Health licensure before initiating the DHCF waiver enrollment sequence.

Timelines depend heavily on the scheduling of mandatory information sessions and Maximus site visits.

10. Common Denials and Survey Findings

DHCF frequently returns applications that bypass the required pre-approval steps or select the wrong application type in the portal.

Site visit compliance is a major hurdle for both new and existing providers.

11. Key Contacts and Resources

Providers must utilize specific DHCF and DC Health portals for licensure, LOI submission, and Medicaid enrollment.

Ensure all inquiries are directed to the correct division to avoid delays.

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