Medicaid for Senior Care in District of Columbia
What Medicaid Actually Covers for Senior Care
Navigating senior care can be overwhelming, but understanding what District of Columbia Medicaid covers is a crucial first step. DC offers several programs to help your parent, whether they need care at home, in assisted living, or a nursing facility.
The main program for community-based support is the Elderly and Persons with Physical Disabilities (EPD) Medicaid Waiver, sometimes called the Home and Community Based Services (HCBS) Waiver. This waiver is designed to help seniors remain independent in their own homes, a loved one's home, or an assisted living residence by covering services like adult day care, home modifications for safety, personal care assistance, and personal emergency response systems. A unique feature of the EPD Waiver is the "Services My Way" option, which allows your parent to hire and pay caregivers of their choice, including adult children, though not spouses. However, it's important to know that while the EPD Waiver covers care services in assisted living or adult foster care, it does not pay for room and board costs in these settings.
For those needing care in a nursing home, DC Medicaid's Institutional/Nursing Home Medicaid covers a comprehensive range of services, including the cost of the facility's room and board, skilled nursing care, personal care, therapy, and prescription medications. Additionally, the State Plan Personal Care Aide (PCA) Services Program provides personal care assistance at home, and the Program of All-Inclusive Care for the Elderly (PACE) offers a coordinated plan for medical, social, and long-term care for eligible seniors aged 55 and older who live in the community.
Do You Qualify?
The financial eligibility picture for Medicaid in the District of Columbia has specific rules for 2026. For a single senior applying for Nursing Home Medicaid or an HCBS Waiver, their monthly income generally needs to be under $2,982. The asset limit for a single applicant is $4,000. If your parent is married and both apply for Nursing Home Medicaid, their combined income limit is $5,964/month, and combined assets are limited to $6,000.
If only one spouse is applying, the applicant spouse's income limit remains $2,982/month, and their assets are capped at $4,000. However, the non-applicant spouse can keep a significant portion of the couple's assets, up to $162,660, known as the Community Spouse Resource Allowance. They can also receive an income transfer from the applicant spouse, called a Community Maintenance Needs Allowance, to bring their monthly income up to $4,066.50 if needed.
For those whose income exceeds these limits, DC offers a "Medically Needy Pathway" or "spend-down" program. You can reduce your countable income by incurring high medical expenses, such as private health insurance premiums, prescription costs, or other unpaid medical bills not covered by Medicaid, until your income reaches the Medically Needy Income Limit (MNIL) of approximately $856.90/month for an individual. Assets can also be spent down on non-countable items like home modifications or prepaid funeral expenses. Be aware of the 60-month (five-year) "look-back" rule, which scrutinizes any asset transfers made for less than fair market value before applying, potentially leading to a penalty period of ineligibility.
If your parent owns a home, it's typically considered an exempt asset if a spouse, a child under 21, or a blind or disabled child lives there. Otherwise, there's a home equity interest limit of $1,130,000 in 2026. While the home might be exempt for eligibility, it's generally not protected from Medicaid's Estate Recovery Program after your parent's passing. Pension payments are counted as income, but IRAs and 401Ks are usually exempt as assets in DC.
Waitlists & How to Apply
When it comes to accessing services, Nursing Home Medicaid is an entitlement, meaning anyone who meets the eligibility requirements will receive coverage. However, Home and Community Based Services (HCBS) Waivers, like the EPD Waiver, are not entitlements. They have a limited number of enrollment slots, which means waitlists can exist. Generally, placement on these waitlists is on a first-come, first-served basis. The EPD Waiver has an approximate cap of 6,360 beneficiaries per year.
To apply for long-term care programs, including waivers and nursing facilities, you'll need to complete the Long-Term Care Program Medical Assistance Application. You can request this application by calling the Department of Aging and Community Living (DACL) at (202) 724-5626 or by contacting your local Economic Security Administration (ESA) Service Center. For the EPD Waiver specifically, start by contacting the DC Office of Aging, Aging and Disabilities Resource Center (ADRC) at (202) 724-5626.
Beyond the specific long-term care application, you can also apply for Medicaid more broadly online via District Direct, by calling the Department of Human Services Economic Security Administration Public Benefits Call Center at (202) 727-5355, or by mailing a paper application to P.O. Box 91560, Washington, DC 20090. When submitting the application for long-term care, ensure you include a completed and signed application along with an approved Level of Care determination from the Department of Health Care Finance (DHCF). After submitting a complete application, it typically takes up to 45 days for a decision, or 60 days if the applicant has a disability.
Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.