District of Columbia Medicaid for seniors and long-term care

Last verified: June 2026

Long-term care options in DC Medicaid

DC Medicaid covers nursing facility care and home and community-based services through several waiver programs. Per DHCF, DC explicitly covers Home and Community Based Services (HCBS) as part of its standard Medicaid benefit — making DC one of the few jurisdictions where HCBS is in the standard benefit rather than only available through a capped waiver.

• Nursing facility (nursing home) coverage
• Elderly and Physical Disabilities (EPD) Waiver — HCBS for seniors and adults with physical disabilities
• IDD Waiver — services for people with intellectual and developmental disabilities
• Individual and Family Supports (IFS) Waiver — community-based supports for people with IDD
• Personal care services
• Home health aide services
• Adult day services
• Respite care
• Hospice care
• Medically necessary transportation

Source: DHCF Medicaid page (dhcf.dc.gov/service/medicaid). Contact DHCF at (202) 727-5355 for current waiver availability and eligibility requirements.

DC's HCBS infrastructure relative to its size

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.

Fair hearings for Medicaid decisions in DC

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 DHCF at (202) 727-5355. 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 estate recovery

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. DC enforces the 60-month asset lookback period. Consult a DC or Maryland elder law attorney before making asset transfers if long-term care Medicaid may be needed.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. District of Columbia's share of that population is administered through DC Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

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 — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, District of Columbia may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether District of Columbia uses this approach with DC Medicaid.

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through DC Medicaid differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact DC Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

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 state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

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. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult DC Medicaid or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. District of Columbia's current CSRA is set by DC Medicaid and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments