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Information on becoming a provider of Medicaid Funded Waiver Services
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| Providers certified to deliver Medicaid Services are assigned a Medicaid number necessary to obtain federal reimbursement. |
| Initial Certification for Medicaid Funded Services |
| If you are interested in being a certified Medicaid waiver provider, you must
complete all of the following standard Medicaid enrollment forms, and the waiver service application
for the service you wish to be certified to provide. Located and listed on the bottom of each application are
requirements that must be submitted with your application as documentation of meeting certification standards. |
| If you are a provider or organization applying to become a Medicaid provider
with the District of Columbia, complete the Medical Assistance Medicaid Enrollment Form, titled DCMED- 4000 |
| If you are a provider or organization applying for certification under the
Home and Community Based Waiver Program, complete form, DCWAV-5000 |
| If you are a provider or organization applying for additional funding for
occupancy costs (occupancy costs are not a covered Medicaid Waiver Service) for residential settings as
provided through the Human Care Agreement, complete form, DCHCA-6000 |
| W-9 Taxpayer Identification Form |
| Required Forms for Reimbursement |
| Other Links: |
| Becoming a New Provider |
| Listing of Certified service providers |
| Basis Assurance: Provider Status Report |
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