District of Columbia Medicaid for Seniors & Long-Term Care

DC has invested significantly in HCBS capacity given its dense urban geography. Unlike rural states where transportation barriers make home care difficult to coordinate, DC's compact size and public transit network make HCBS delivery more practical. DC's EPD Waiver serves seniors and adults with physical disabilities who need nursing-facility-level care but prefer to remain in the community.

DC also maintains a meaningful nursing facility sector within its borders, though the District has no large rural facilities. Most nursing facility care occurs in DC proper or in adjacent Maryland and Virginia facilities — DC Medicaid generally covers placement in neighboring state facilities when medically appropriate.

If DC Medicaid denies a service authorization or LTC waiver placement, members have appeal rights. Supplemental Security Income (SSI)-related eligibility decisions may be appealed through the Social Security Administration at 1-800-772-1213.

For DHCF service or coverage decisions, contact the DHCF LTC hotline at (202) 442-9533. DC Medicaid members also have civil rights protections under Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973 — participating providers may not discriminate based on race, age, gender, color, national origin, or disability in scheduling, waiting room access, or service delivery.

DC Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — all income minus a personal needs allowance, which DHCF increased to $109 per month effective January 1, 2026. Medicaid covers the gap. If income exceeds the institutional Medicaid limit, DC may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible.

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the program's limit. Exempt assets are not counted: the primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt, along with personal belongings and a prepaid funeral arrangement. DC enforces the 60-month (5-year) asset transfer lookback period.

For 2026, the EPD Waiver income limit is $2,982 per month for a single applicant (300% of the SSI Federal Benefit Rate), and the asset limit is $4,000 for a single applicant or $6,000 when both spouses apply. When one spouse needs nursing home or waiver care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — which in 2026 ranges from $32,532 up to $162,660. The community spouse may also keep a minimum monthly income (called the Community Maintenance Needs Allowance, or CMNA, in DC), which in 2026 can bring the community spouse's income up to $4,066.50 per month.

DC operates an estate recovery program for members who received long-term care Medicaid services at age 55 or older. DHCF may seek reimbursement from the member's estate after death. The family home is generally exempt while a surviving spouse or dependent child resides in it. Consult a DC or Maryland elder law attorney before making asset transfers if long-term care Medicaid may be needed.

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Contact DC Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.