Medicaid is a government health insurance program that helps certain people get health care services at a lower cost. In D.C., Medicaid is called D.C. Medicaid. There are different Medicaid programs for different groups of people in D.C.

Apply for D.C. Medicaid Online

D.C. Medicaid pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care
• Hearing services
• Podiatry services
• Hospice care

Since the program serves those with limited income and resources, people with Medicaid pay few to no out-of-pocket costs for their benefits. To get coverage once you are enrolled, you must go to health care providers that take part in the Medicaid program.

The Department of Health Care Finance (DHCF) administers the Medicaid program in Washington, D.C. Eligibility is determined by the Department of Human Services (DHS) Economic Security Administration (ESA). Check with your local ESA Service Center to learn more about the coverages provided.

How do I know if I qualify for Medicaid?

In general, to be eligible for Medicaid, you must:

• Be a Washington, D.C. resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income and/or asset limit for your coverage group

What are the different Medicaid programs in D.C.?

D.C. Medicaid ABD Program

D.C. Medicaid for the Aged, Blind, and Disabled (ABD) covers people who are age 65+, blind, or living with a disability who also have limited income and resources. Note: If you are under 65 and have limited income, you may want to consider applying for Expanded Medicaid coverage.

D.C. Medicaid Spend-Down Program

If your income puts you over the limit to qualify for D.C. Medicaid ABD, you may still be able to get coverage if you have very high medical expenses. You would be required to “spend down” your income until it is under a special income limit called the “medically needy” income limit. The income must be spent on medical expenses.

With the D.C. Medicaid Spend-Down Program, you can only use medical expenses that you are responsible for paying. You cannot use expenses covered by other insurance or Medicare.

Examples of health care-related expenses to spend down your income on include:

• Medications
• Paid medical bills
• Unpaid medical bills (if they were outstanding 3 months prior to the date of your Medicaid application)
• Nursing home care
• Health-related home renovations, such as wheelchair ramps or chair lifts
• Transportation to medical appointments

If you need help with your health care coverage and costs, you should apply for Medicaid even if you think you are over the income limit or your assets are too high. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance. For example, if you have Medicare, you may qualify for a Medicare Savings Program (MSP).

If you are over the income limit, but you have very high medical costs, you may be able to qualify for the Spend-Down Program.

EPD Waiver Program

The Elderly and Persons with Physical Disabilities (EPD) Waiver Program helps D.C. residents who need nursing home-level care but want to stay in their own home or an assisted living community. If you need help with daily tasks like eating, getting dressed, using the bathroom, or bathing, this program may provide the support you need.

How do Medicare and Medicaid work together?

Medicaid pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from D.C. Medicaid. Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums.

Depending on the level of Medicaid you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

In addition, if you are dual-eligible for Medicare and Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You may be able to get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048(TTY).

How do I prepare to apply for D.C. Medicaid?

When you apply for D.C. Medicaid, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements

How do I apply for ABD Medicaid in D.C.?

There are a few different ways you can apply for Medicaid in D.C. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for ABD Medicaid in D.C. is online through the District Direct portal. All your personal information is kept 100% confidential and protected by special security technology.

Create Account to Apply Online

You can download and print a paper benefits application (the Integrated Application for Public Assistance Benefits), complete it, and mail it to:

Department of Human Services | Economic Security Administration
Case Record Management Unit
P.O. Box 91560
Washington, D.C. 20090

You can also fax the application to 1-202-671-4400 or drop it off at your local ESA Service Center.

How can I get help with my application?

There are a few ways to get help filling out your Medicaid application:

• Contact your local your local ESA Service Center directly.
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.
• NCOA also has a HelpLine you can call to get free support. To get started today, call 1-800-794-6559.