District of Columbia Medicaid Income Limits
Updated August 2026
DC's Medicaid income structure changed substantially for adults at the start of 2026. Parent/Caretaker Relatives and Childless Adults — previously two separate categories with different, much higher thresholds — were consolidated into a single 138% FPL standard matching the standard ACA expansion ceiling used by most other states. Children and pregnant individuals were not part of this change and remain covered at DC's historically high 319% FPL threshold.
DC lowered its adult income limit to 138% FPL effective January 1, 2026 — down from over 210%
Through 2025, DC covered Parent/Caretaker Relatives and Childless Adults at 216% and 210% FPL respectively — among the highest adult thresholds in the country. Effective January 1, 2026, DHCF lowered both groups to a single 138% FPL standard, and beneficiaries whose income exceeded the new limit lost Medicaid on 12/31/2025. Children and pregnant individuals are not affected and remain covered up to 319% FPL. Verify current figures at dhcf.dc.gov or by calling (202) 727-5355.
DC Medicaid income limits by coverage group (2026)
| Coverage group | FPL threshold | Monthly limit (household of 1) | Monthly limit (household of 4) |
|---|---|---|---|
| Adults 19–64 (Parent/Caretaker Relatives and Childless Adults) | 133% FPL + 5% disregard (138% effective) | $1,800/mo | $3,697/mo |
| Children ages 0–18 (Medicaid/DC Healthy Families) | 319% FPL | $4,310/mo | $8,910/mo |
| Young adults ages 19–20 | 216% FPL | $2,940/mo | $6,078/mo |
| Pregnant individuals | 319% FPL | n/a (2-person min.) | $8,910/mo |
| Seniors and people with disabilities | Separate rules apply | Contact DHCF | Contact DHCF |
Adults 19–64 (Parent/Caretaker Relatives and Childless Adults)
- FPL threshold
- 133% FPL + 5% disregard (138% effective)
- Monthly limit (household of 1)
- $1,800/mo
- Monthly limit (household of 4)
- $3,697/mo
Children ages 0–18 (Medicaid/DC Healthy Families)
- FPL threshold
- 319% FPL
- Monthly limit (household of 1)
- $4,310/mo
- Monthly limit (household of 4)
- $8,910/mo
Young adults ages 19–20
- FPL threshold
- 216% FPL
- Monthly limit (household of 1)
- $2,940/mo
- Monthly limit (household of 4)
- $6,078/mo
Pregnant individuals
- FPL threshold
- 319% FPL
- Monthly limit (household of 1)
- n/a (2-person min.)
- Monthly limit (household of 4)
- $8,910/mo
Seniors and people with disabilities
- FPL threshold
- Separate rules apply
- Monthly limit (household of 1)
- Contact DHCF
- Monthly limit (household of 4)
- Contact DHCF
The 2026 adult income limit change — what it means
Before 2026, DC set its own Medicaid income ceilings for adults well above the ACA expansion standard: 216% FPL (plus a 5% disregard) for Parent/Caretaker Relatives and 210% FPL (plus the disregard) for Childless Adults. Per DHCF's Medicaid Director Letter (MDL 25-02), both categories were lowered to a single 133% FPL standard (138% effective with the 5% disregard), effective January 1, 2026. Beneficiaries whose income exceeded the new 138% limit lost Medicaid coverage on December 31, 2025.
This brings DC's adult Medicaid threshold roughly in line with most ACA expansion states rather than the unusually generous limit it maintained for years. Adults who lost Medicaid due to the reduced limit may still qualify for subsidized coverage through DC Health Link, the district's ACA marketplace.
Children and pregnant individuals: still covered up to 319% FPL
Unlike the adult categories, DC's income limits for children (ages 0–18) and pregnant individuals were not reduced and remain at 319% FPL — among the highest child and pregnancy thresholds in the country. Young adults ages 19–20 are covered under a separate, lower threshold of 216% FPL. Newborns of Medicaid-enrolled mothers are automatically covered ("deemed newborns") up to the same 319% FPL standard.
No asset test for DC Medicaid MAGI groups
MAGI-based DC Medicaid — covering adults, children, and pregnant individuals — does not use an asset test. Long-term care Medicaid (Elderly and Physical Disabilities waiver, IDD waiver) applies separate financial eligibility rules. Contact DHCF at (202) 727-5355 for LTC eligibility details.
Medicare Savings Programs (QMB) in District of Columbia
The District of Columbia runs the most generous QMB program in the country. While the federal baseline caps Qualified Medicare Beneficiary eligibility at around $1,350/month for an individual, DC has expanded QMB eligibility up to 300% of the Federal Poverty Level — a threshold no other state or the District's neighbors come close to matching. That means a much wider band of Medicare enrollees in DC qualify for QMB's full cost-sharing protection than would qualify under the standard federal rule elsewhere.
| Program | Situation | Monthly income limit |
|---|---|---|
| QMB | Individual or married couple | Up to 300% FPL — DC's expanded threshold |
| SLMB | Individual | $1,616/mo (federal baseline) |
| SLMB | Married couple | $2,184/mo (federal baseline) |
| QI | Individual | $1,816/mo (federal baseline) |
| QI | Married couple | $2,455/mo (federal baseline) |
QMB
- Situation
- Individual or married couple
- Monthly income limit
- Up to 300% FPL — DC's expanded threshold
SLMB
- Situation
- Individual
- Monthly income limit
- $1,616/mo (federal baseline)
SLMB
- Situation
- Married couple
- Monthly income limit
- $2,184/mo (federal baseline)
QI
- Situation
- Individual
- Monthly income limit
- $1,816/mo (federal baseline)
QI
- Situation
- Married couple
- Monthly income limit
- $2,455/mo (federal baseline)
QMB in DC still works the way QMB works everywhere: it pays the Part B premium ($202.90/month in 2026), the Part A premium if one is owed, and every Medicare deductible, coinsurance charge, and copayment. Providers are barred by federal law from billing a QMB enrollee for any of that cost-sharing, regardless of how generous the eligibility threshold that got them there.
DC also offers Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) coverage for residents above the QMB line, using the standard federal thresholds other states apply: SLMB at roughly $1,616/month for an individual and $2,184/month for a couple, and QI at roughly $1,816/month for an individual and $2,455/month for a couple. Both pay the Part B premium only, and QI's funding is capped annually and awarded first-come, first-served.
All three tiers bring automatic enrollment in Extra Help, which limits what an enrollee pays per covered prescription to $12.65 in 2026. Apply through DC Medicaid at the Department of Health Care Finance — dhcf.dc.gov — not through Medicare or Social Security.
Income Limits in Nearby States
Related guides
Income Limits
Current income cutoffs by state and household size, tied to the Federal Poverty Level.
Read more →Spend-Down
How to qualify by deducting medical bills from income that's above the limit.
Read more →QMB Program
What the QMB program covers, what a QMB card proves, and how to apply.
Read more →