District of Columbia Medicaid Office

DC Medicaid office (DHCF)

The Department of Health Care Finance (DHCF) runs four distinct DC health coverage programs from a single Public Benefits intake structure. DC Medicaid is the main Medicaid program. DC Healthy Families is the Medicaid brand for families with kids. DC Health Care Alliance is a locally funded safety net for residents who don't qualify for Medicaid or Medicare. CASSIP is a specialized managed-care contract for children with disabilities. Each routes applications through the same Public Benefits Call Center but ends up at a different program track.

Key DC Medicaid phone numbers

Four DC health coverage programs run by DHCF

• DC Medicaid — joint federal/local program for low-income, disabled, and family residents who meet financial and non-financial eligibility.
• DC Healthy Families — the Medicaid brand for residents with kids — covers doctor visits, vision and dental care, prescription drugs, hospital stays, and transportation. Also offers special programs for newborns, children with disabilities or special health care needs, and people with HIV and AIDS.
• DC Health Care Alliance ("the Alliance") — locally funded program for adults and children who are DC residents, have no other health insurance, and don't qualify for Medicaid or Medicare. Services for children under 21 are very similar to those covered under Medicaid for children under 21.
• CASSIP (Child and Adolescent SSI Program) — managed-care plan covering Medicaid healthcare benefits plus additional services for children ages 0–21 who receive Supplemental Security Income (SSI) or are SSI-eligible. The current CASSIP MCP is Health Services for Children with Special Needs (HSCSN) at hscsnhealthplan.org.

The District has also formed a BH Integration Stakeholder Advisory Group to advise on integrating behavioral health services into managed care contracts.

Who qualifies for DC Medicaid?

One in three DC residents receives Medicaid — the highest per-capita rate in the country. The District applies MAGI methodology (Modified Adjusted Gross Income) to most applicants for income calculation; it implemented MAGI on October 1, 2013 under the ACA. Two District-specific quirks: the MAGI definition of "children" runs through age 21 (not the federal-default 19), and the Non-MAGI resource limit is $4,000 for a single person (higher than the typical $2,000 state limit).

MAGI Medicaid groups (no asset test, just income)

• Adults age 21–64 without dependent children
• Pregnant women
• Parents and caretaker relatives
• Children under 21 (DC extends this category beyond the federal under-19 default)

MAGI is based on federal tax rules for adjusted gross income, with a 5% across-the-board "disregard" deduction. You do not have to file taxes to be eligible for MAGI Medicaid. There is no asset test; assets — bank accounts, cars, homes — do not count.

Non-MAGI Medicaid categories (income plus resource test)

• Age 65 or older, blind, or disabled — single-person resource limit $4,000 (higher than the typical $2,000 state ceiling)
• SSI recipients (automatic Medicaid eligibility)
• Home and community-based waiver participants
• Long-Term Care beneficiaries
• Medicare Savings Program recipients (QMB and QMB Plus)
• Foster Care and Adoption Assistance children
• Medically Needy Spend-Down members
• Former Foster Care Children
• Children under 19 qualifying for TEFRA/Katie Beckett
• Women screened and needing treatment for Breast or Cervical Cancer (Project WISH)

Choose your application based on category

• MAGI applicants — apply at districtdirect.dc.gov or through the District Direct Mobile App.
• Non-MAGI applicants — submit the Integrated Application for Medical Assistance through the Department of Human Services.

The full list of 17 distinct DC Medicaid eligibility categories — including Adults without Dependent Children, ABD, Project WISH (BCC), Children in Foster Care, TEFRA/Katie Beckett, Deemed Newborns, Emergency Medicaid, Former Foster Youth, Infants & Children (0-20), LTC, Medically Needy Spend-Down, Optional State Supplement Payment Program, Parents and Caretaker Relatives, Pregnant Women, Presumptive Eligibility, QMB, and SSI — appears on the Medicaid Eligibility Programs page at dhcf.dc.gov.

DC Medicaid income limits by category

DHCF organizes income limits by category rather than publishing a single combined chart. Each of the 17 Medicaid Eligibility Programs has its own sub-page with the current income test for that category. The percentage anchors below are stable from year to year; the dollar amounts shift each January when the federal poverty level (FPL) updates.

FPL anchors by major DC Medicaid category

MAGI mechanics matter

For MAGI categories, DC applies a 5% across-the-board disregard — effectively raising every percentage anchor by 5 percentage points. So when the eligibility rule says "138% FPL for the Childless Adults group" (new as of January 1, 2026), the practical cap with the disregard is around 143% FPL. There is no asset test for MAGI categories — bank accounts, cars, and homes do not count.

How to confirm the current dollar figures

• Visit the per-category eligibility page on dhcf.dc.gov (the index page lists 17 categories with links).
• Call the Public Benefits Call Center at (202) 727-5355, TTY 711.
• Use the District Direct screening tool at districtdirect.dc.gov to test your specific household.

How to apply for DC Medicaid

The District does not require in-person interviews for Medicaid, the Alliance, or the Immigrant Children's Program — every applicant can choose the channel that's most convenient. DC publishes one application form for all three programs, and processing is faster for disability cases than in most states: 60 days for a disability-based application versus the federal 90-day default.

Five application channels

• Online — apply at districtdirect.dc.gov. Submit applications, renewals, changes, or verifications. If you apply online, you do not need to complete a paper application.
• Mobile App — "DC Access" on Google Play or the Apple App Store. Mirror of the online flow.
• By Phone — call the Department of Human Services Economic Security Administration Public Benefits Call Center at (202) 727-5355.
• By Mail — download an application from the DHS site and mail to: Department of Human Services, Economic Security Administration, Case Record Management Unit, P.O. Box 91560, Washington, DC 20090.
• By Fax — (202) 671-4400.
• In Person — visit any of the 5 Economic Service Centers (no appointment required).

Five in-person Economic Service Centers (ESA)

Application processing timeframes

After you submit, it can take up to 45 days to hear about Medicaid enrollment — or up to 60 days if your application is based on a disability. DC's 60-day disability processing window is faster than the federal default of 90 days for disability applications. Once approved, you'll receive a Medicaid ID card. You must renew your eligibility each year to keep coverage.

Long-Term Care and Afghan refugees

• Long-Term Care (Waiver or Nursing Facility) — see the LTC services page at dhcf.dc.gov for the specialized application pathway.
• Afghan refugees resettling in DC — use the Special Immigrant Visa Status Medicaid Application Form (linked on the Apply page).

What DC Medicaid covers

DC Medicaid covers an extensive list of medical services and offers members "Freedom of Choice" — most recipients may choose any doctor or clinic willing to accept Medicaid's payment, rather than being assigned to a closed MCO network. That said, CASSIP members (children 0–21 with SSI) are enrolled in a single contracted plan (HSCSN), and DHCF is integrating behavioral health services into MCOs over time. Third Party Liability rules require members to report any other insurance they have.

Covered services in DC Medicaid

• Doctor visits and physician services
• Nurse practitioner services
• Hospitalization
• Ambulatory surgical center
• Emergency ambulance services
• Medically necessary transportation
• Laboratory services and radiology
• Medical supplies and durable medical equipment
• Prescription drugs
• Dental services and related treatment
• Eye care
• Dialysis services
• Hospice services
• Mental health services
• Home and Community Based Services (HCBS) for members who qualify
• Transplants

Three named DC HCBS waivers

• Services for People with Intellectual or Developmental Disabilities (IDD) Waiver
• Individual and Family Supports (IFS) Waiver
• Elderly and Physical Disabilities (EPD) Waiver

Five IMA Service Centers for Medicaid intake

Member rules that matter

• Freedom of Choice — most DC Medicaid members may pick any doctor or clinic willing to accept Medicaid payment, with the exceptions of CASSIP members (HSCSN network) and certain managed care contracts in progress.
• Third Party Liability (TPL) — you must report any other health insurance to DHCF. If you have other insurance and Medicaid, give your insurance information to your doctor at the time of service. Medical payments from any source (insurance, workers' comp, lawsuits, employer liability) for services covered by Medicaid must be reported, and you must assign your rights to medical payments to DHCF.
• Always carry your Medicaid ID card — not all doctors, dentists, and providers accept Medicaid. Ask the provider whether they accept DC Medicaid before you receive services.
• Fair Hearings — SSA holds fair hearings for Medicaid eligibility decisions tied to SSI eligibility for low-income, aged, blind, and disabled members. Call SSA at 1-800-772-1213.
• Report provider fraud — call DHCF at 1-877-632-2873 if your provider is billing for services you didn't get, performing unnecessary services, or asking you to pay for services Medicaid covers.

Other state Medicaid pages