District of Columbia FQHC Intelligence

DHCF says that beginning October 1, 2026, full federally funded Medicaid for adult noncitizens will generally be limited to lawful permanent residents, Cuban and Haitian entrants, and COFA migrants, subject to applicable waiting-period rules and exceptions. Lawfully residing children and pregnant people remain protected, including 12 months of postpartum coverage in DC.

Refugees, asylees, parolees, trafficking survivors, and several other humanitarian groups who have not transitioned to an eligible status may lose full Medicaid, although emergency Medicaid remains available for qualifying emergencies. FQHC enrollment teams should verify documents and alternative coverage rather than assuming all noncitizens are affected alike.

Legal Aid DC's July 13 post-final-vote account says the Council restored DC Health Care Alliance services to pre-October 2025 levels, including specialty care; funded dental and vision benefits for Alliance and Healthy DC members; restored affordable coverage for some low-income lawfully present immigrants affected by federal changes; and partially funded a Medicaid buy-in for certain workers with disabilities.

The same source says the Alliance eligibility age limit was delayed—not repealed—and that the lower Alliance and Medicaid income limits remain. Much of the FY2027 restoration uses one-time funding, so it is a time-limited operating bridge rather than a permanent reversal.

DHCF Transmittal 26-19 says DC Medicaid managed-care members enrolled with Wellpoint DC will be automatically assigned to AmeriHealth Caritas DC effective August 1, 2026. Members may choose MedStar Family Choice through January 31, 2027.

Wellpoint remains responsible for covered services through July 31, including inpatient stays that continue past termination. From August 1 through October 31, active prior authorizations, referrals, ongoing treatment, and prescriptions receive transition protections.

Providers should verify each patient's current plan and complete AmeriHealth or MedStar contracting and credentialing where needed.

Unity's patient transition page announced that care was scheduled to begin June 8, 2026 at two locations: Varnum Street, with services in Suites 312 and 317, and Unity at Perry School Health Center. Patient records were scheduled to become accessible at Unity on or after June 8 for continuity of care; the page does not independently confirm that the transition occurred as planned.

The February announcement separately says Ascension provided a $7 million charitable contribution and community-benefit grant for integration and projected that Unity would serve more than 90,000 District residents after the transition. That figure is projected organization-wide reach, not a transferred-patient count, and the sources do not establish a count of two practices.

On May 20, the Council's Committee on Health unanimously approved FY2027 recommendations that included $800,000 in one-time funds for grants to FQHCs caring for uninsured patients. The same package recommended $3.97 million for Alliance adult dental and vision benefits, $5.733 million for Healthy DC dental and vision, $907,323 to restore Alliance adult medical services to FY2025 levels, and continued Alliance eligibility at 138% FPL.

This source records the committee-stage allocations; the later final-vote outcome is reported separately rather than being retroactively attributed to the committee release.

Reporting published March 26 found that about 17,000 DC residents lost Medicaid on January 1 after the adult income-limit reduction. Roughly 15,000 were automatically enrolled in Healthy DC, while about 2,200 did not qualify for that program; only about 300 of the latter group had been reached by late March.

The same report said Alliance enrollment fell from 27,600 to about 19,000 after October 2025 changes, a decline of roughly 8,600. Healthy DC initially omitted dental, vision, and non-emergency transportation, so transfer from Medicaid was not benefit parity even when medical coverage continued.

In January 2026 oversight testimony, DHCF reported about 271,000 total Medicaid enrollees as of November 2025 and estimated that 78,000 childless adults at 0%–138% FPL would be subject to the federal community-engagement requirement. DHCF estimated 28% might meet the standard through earnings of at least 44% FPL, leaving about 56,000 who may need qualifying work, community service, education, combined activities, or an exemption.

The rule requires 80 hours per month or a qualifying alternative and must apply to covered applications and renewals no later than January 1, 2027; the 56,000 figure is not a forecast that all will lose coverage.

DC Health Link's current Healthy DC page says the Basic Health Program began January 1, 2026 and has no monthly premium or out-of-pocket cost for covered services from participating providers, including community health centers. Standard eligibility covers DC residents ages 21–64 who are not eligible for Medicaid, employer coverage, or other coverage and have income from 138% through 200% FPL.

A special 2026 exception also covers lawfully present residents below 138% FPL who are ineligible for Medicaid because of immigration status. The no-cost statement does not erase network, eligibility, or covered-service rules, and the initial benefit set did not include every Medicaid service.

DHCF Medicaid Director Letter 25-02 lowered the effective income limit for parent and caretaker-relative and childless-adult Medicaid categories to 138% FPL on January 1, 2026. The letter's table distinguishes the statutory 133% threshold plus the 5% income disregard from the effective 138% limit: childless adults moved from 210% plus the disregard, and parents or caretaker relatives from 216% plus the disregard.

People above the new Medicaid limit may be assessed for Healthy DC or Marketplace coverage, but eligibility is not automatic for every person losing Medicaid.

DHCF's official program-change page says that effective October 1, 2025 the adult Alliance income limit fell from 215% to 138% FPL, no new enrollment was allowed for adults 26 or older, Alliance and the Immigrant Children's Program were combined administratively, covered benefits changed, and delivery moved from managed care to fee-for-service.

The later measured enrollment decline and FY2027 Council outcome are documented in separate claims using their own sources rather than attributed to this October 2025 policy page.

DCPCA reported that the January 2025 federal grant-payment restriction affected DC health centers serving more than 180,000 residents, including almost 50,000 children, 16,000 older adults, and 1,000 veterans. It quantified more than $90,000 per day in inaccessible revenue while the pause continued.

The administration rescinded the original OMB memorandum after a court blocked it, although DCPCA warned that payment delays or rejections could continue under further reviews. The $90,000 figure therefore measures temporarily inaccessible cash flow during the episode, not a verified permanent daily revenue loss.

HRSA's official 2024 Uniform Data System state report lists eight reporting Health Center Program awardees in the District and 184,662 total patients. Of those patients, 100,710 (54.54%) used Medicaid or CHIP and 29,783 (16.13%) were uninsured.

DCPCA separately describes the local network as nine community health centers: eight FQHCs and one FQHC Look-Alike. The measures are not interchangeable, and the local network should not be described as nine HRSA-funded awardees.

The current DC Code defines advanced practice registered nursing as the independent performance of advanced-level nursing actions. It expressly includes advanced assessment, medical diagnosis, prescribing, selecting and dispensing therapeutic measures, and treatment.

The code also authorizes certified nurse practitioners to provide a full range of primary, acute, and specialty services. Authority remains bounded by education, national certification, population focus, licensure, and applicable rules; the statute does not impose a physician collaboration agreement on these functions.