Medicaid for nursing home and home care in Washington, DC

Who qualifies

You must live in DC, be a U.S. citizen or have an eligible immigration status, and meet DC's medical need rules for long-term care. For the EPD Waiver you must also be 65 or older, or 18 to 64 with a physical disability.

If your income is over the limit

DC lets you spend down. DC subtracts your medical expenses, including the cost of care, from your gross countable income. If what is left is at or below the medically needy level ($856.90 a month for one person in 2026), you get full Medicaid. Spend-down works in six-month periods. Once you meet your spend-down, you are covered from the first day of that month to the end of the period. At the end of each period you must file a new application.

What counts and what does not

Assets that count

Cash, bank accounts, stocks, bonds, trusts, annuities, property other than your home, and life insurance.

Assets that do not count

Your home, one vehicle, and ordinary household and personal goods.

Income

DC counts your monthly income from all sources, such as Social Security, pensions and annuities.

What Medicaid pays for

Nursing home care

Medicaid pays for care in a nursing facility once you are approved and meet the medical need rules.

EPD Waiver (care at home)

The EPD Waiver helps you stay at home instead of moving to a nursing home. It can pay for:

• a case manager who plans your care,
• a personal care aide to help with bathing, dressing, eating and toileting,
• a personal emergency response system so you can call for help,
• services in a licensed assisted living home.

Services My Way lets you choose and direct your own workers.

Personal care aide services without the waiver

If you do not meet the EPD Waiver rules, regular DC Medicaid may still pay for a personal care aide. Your doctor must order it, and it needs approval first.

PACE

PACE (Program of All-Inclusive Care for the Elderly) covers all Medicare and Medicaid services for people 55 and over who need nursing-home-level care and can live safely at home. In DC it serves ZIP codes 20019, 20020 and 20032 (parts of Wards 7 and 8). Call the DHCF PACE coordinator at (202) 535-1960.

How to apply

1. Call DACL at (202) 724-5626 (Monday to Friday, 9:30 am to 4:30 pm). DACL's Medicaid Services Enrollment Unit helps you put together and send your EPD Waiver application and connects you to a case manager.
2. Get a doctor's order. A DC Medicaid provider fills out a Prescription Order Form for the care you need.
3. Have an assessment. Liberty Healthcare does a face-to-face assessment to decide your level of need.
4. Apply for Medicaid if you do not have it yet. Apply online through District Direct at https://dhs.dc.gov/districtdirect, or on the DC Integrated Application at a DHS Service Center. Questions: Public Benefits Call Center, (202) 727-5355.
5. Send proof of income, assets and identity when asked.

After you apply

• Renewals: if you qualify under the Special Income Standard, your eligibility lasts one year, then you must renew. Spend-down cases must reapply every six months. Watch for letters from DHS and return forms on time.
• Report changes in income, assets or address.
• If you are denied or services are cut, your notice explains how to ask for a fair hearing and the deadline. The Office of the Health Care Ombudsman and Bill of Rights can help: 1-877-685-6391.

Estate recovery

If you got nursing home care, EPD Waiver services, or related hospital care and drugs at age 55 or older, DC may seek repayment from your estate after you die. It waits while a surviving spouse, a child under 21, or a blind or disabled child lives in the home. Your family can ask for a hardship waiver. QMB benefits are not subject to estate recovery.

Things people miss

• Income over the limit is not the end. Ask about spend-down.
• The home does not count as an asset, and neither does one vehicle.
• You can get help at home first. If you do not need a full waiver, ask about Medicaid personal care aide services.
• PACE is only in some ZIP codes. Check before you plan on it.
• Older income figures are still online. DACL's EPD page shows a 2023 income limit. The 2026 limit on DHCF's page is $2,982 a month.

Free help

• DACL (DC's aging agency and Aging and Disability Resource Center): (202) 724-5626 (TTY 711), fax (202) 724-2008, [email protected], 500 K Street NE, Washington, DC 20002.
• DC SHIP for Medicare questions: (202) 727-8370.
• Office of the Health Care Ombudsman and Bill of Rights: 1-877-685-6391.
• Adult Protective Services: (202) 541-3950.

Read more about paying for a nursing home, Medicare, and all benefits in Washington, DC.

Phone numbers: Free help lines for District of Columbia agencies

Check what you may qualify for