Long-Term Care Medicaid in the District of Columbia: 2026 Guide

In the District of Columbia, Medicaid is run by the Department of Health Care Finance (DHCF). Applications are processed by the Economic Security Administration (ESA). Long-Term Care Medicaid can pay for nursing facility care and for care at home or in assisted living through the Elderly and Persons with Physical Disabilities (EPD) Waiver. This guide explains the 2026 rules in plain language.

At a glance: the District of Columbia 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with the DC Department of Health Care Finance before relying on them.

What Long-Term Care Medicaid covers in the District of Columbia

Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Medicaid pays the rest.

EPD Waiver. For DC residents 65 and older, or 18 to 64 with a physical disability, who are eligible for DC Medicaid and need a nursing facility level of care. Services include case management, personal care aides, adult day health, respite, home changes, therapies, personal emergency response, participant-directed services and assisted living.

Other programs.

How Medicare fits in. Medicare Part A covers skilled nursing facility care only for a limited time. You generally need a medically necessary inpatient hospital stay of at least 3 days in a row first (time under observation or in the emergency room does not count), and you must need daily skilled nursing or therapy. In 2026, Medicare charges nothing for days 1 to 20 after the Part A deductible ($1,736) is met, $217 a day for days 21 to 100, and nothing after day 100, when you pay all costs. Medicare limits this coverage to 100 days in each benefit period. Medicaid can be a way to pay for long-term nursing home care after Medicare coverage ends.

Who qualifies

A person generally must:

• be 65 or older, or blind or disabled;
• live in the District and be a U.S. citizen or qualified non-citizen;
• meet a nursing facility level of care, based on a prescription order form from a DC Medicaid provider and a face-to-face assessment;
• meet the income and asset rules below, as decided by DHCF and ESA.

Income rules

In 2026, the special income standard is $2,982 a month.

Once you are on Medicaid in a nursing facility, most of your income goes to the facility. You keep a personal needs allowance of $109 a month, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant can have up to $4,000 in countable resources, and a couple $6,000.

Countable resources include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within DHCF rules

Spousal protections

• Assets: The spouse at home can keep a share of the couple’s assets within federal limits, plus the home, one car and belongings.
• Income: The spouse at home keeps their own income, and part of the applicant’s income can be set aside if their income is low.

Look-back and penalties

When you apply, the District of Columbia looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($15,238.80 a month).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $15,238.80 is about 3.3 months without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in the District of Columbia

The District’s estate recovery program is run by DHCF.

• What is recovered: Medicaid paid for long-term care and related services received at age 55 or older, and for some people of any age in a nursing facility.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: the state must have a way to waive recovery when it would cause undue hardship. Ask DHCF for the current rules.
• Family members and personal representatives can contact DHCF with questions.

How to apply

• For Long-Term Care Medicaid:
• For the EPD Waiver: the Aging and Disability Resource Center (ADRC) helps coordinate the application and sends it to ESA. You will need a prescription order form from a DC Medicaid provider and a face-to-face assessment. See EPD Waiver.

Applying for a spouse or parent. If you are applying for someone else, you may need legal authority to act for them, or you can be named as an authorized representative on the application. Gather statements for every account, not just the main one, and write down when the person’s care needs began. If the person is already in a nursing home, ask the facility’s business office or social worker which Medicaid forms they need from you and when, and tell the agency if any requested document is hard to get, since agencies can often give extra time when you ask before the deadline.

After you apply. DHCF will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing (appeal). The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in the District of Columbia

• DHCF and ESA: Medicaid applications and eligibility.
• DC Department of Aging and Community Living (DACL) and its ADRC: help with the EPD Waiver and other services.
• SHIP (State Health Insurance Assistance Program): free Medicare counseling.
• Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and other long-term care settings.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including the District of Columbia:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Any state limit above $1,000,000 will have to come down to the cap by January 1, 2028.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• District of Columbia Elderly and Persons with Physical Disabilities (EPD) Waiver
• District of Columbia State Plan Personal Care Aide (PCA) Services
• District of Columbia Adult Day Health Program (ADHP)

Frequently asked questions

What is the EPD Waiver? DC’s Medicaid waiver for care at home or in assisted living for people 65 and older and adults 18 to 64 with a physical disability.

Why is DC’s asset limit $4,000? That is DHCF’s 2026 limit for a single applicant; a couple can have $6,000.

What is the personal needs allowance? $109 a month for a nursing facility resident.

How long is the penalty for a gift? DC divides the gift by its penalty divisor.

Will the state take my home after I die? DHCF can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with the DC Department of Health Care Finance before relying on them.

Sources

• DHCF, Long-Term Care
• DHCF, Transmittal 26-02 (PNA)
• DACL, EPD Waiver
• DHCF, EPD Waiver Services
• DHCF, EPD Waiver quick reference
• Medicare.gov, Skilled nursing facility care
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.