Washington DC
What is Washington DC Medicaid Long-Term Care?
Who is eligible for long-term care Medicaid in DC?
Medicaid offers health coverage to low-income individuals, including seniors aged 65 and older. In Washington DC, long-term care services are available not only in nursing homes but also in assisted living, adult foster care, and in-home settings.
What types of long-term care Medicaid programs are available in DC?
Washington DC provides three types of Medicaid long-term care programs for seniors:
- Institutional / Nursing Home Medicaid – This is an entitlement program. If you qualify, you will receive coverage for care in a nursing facility.
- Home and Community-Based Services (HCBS) / Medicaid Waivers – These are limited enrollment programs intended to help individuals avoid nursing home placement. Services may be provided at home, in adult foster care, or in assisted living settings.
- Aged, Blind, and Disabled (ABD) / Regular Medicaid – Also an entitlement program, this option may offer in-home support services like personal care or adult day care for eligible individuals.
What Are the Financial Eligibility Requirements for DC Medicaid Long-Term Care?
How much income and assets can a single applicant have in 2025?
To qualify for Nursing Home Medicaid in 2025, a single applicant must:
- Earn less than $2,901 per month
- Have assets under $4,000
- Require a Nursing Home Level of Care (NHLOC)
Is there a quick way to check eligibility?
Yes. Seniors can reference the table below or use an online Medicaid Eligibility Test. Note: Not meeting all criteria does not automatically mean ineligibility.
What are the 2025 eligibility limits for seniors in DC?
| Program Type | Income (Single) | Assets (Single) | Level of Care | Income (Married – Both) | Assets (Married – Both) | Income (Married – One Applies) | Assets (Applicant / Spouse) |
|---|---|---|---|---|---|---|---|
| Institutional / Nursing Home Medicaid | $2,901/mo* | $4,000 | Nursing Home | $5,802/mo | $6,000 | $2,901/mo* | $4,000 / $157,920 |
| HCBS / Medicaid Waivers | $2,901/mo† | $4,000 | Nursing Home | $5,802/mo | $6,000 | $2,901/mo† | $4,000 / $157,920 |
| Regular Medicaid / ABD | $1,305/mo‡ | $4,000 | Help w/ ADLs | $1,763/mo‡ | $6,000 | $1,763/mo‡ | $6,000 |
* Most income must go toward nursing home costs, with small deductions allowed.
† Living arrangements may affect how much income can be kept.
‡ Individuals approved for SSI are automatically eligible for Medicaid, including long-term services if they meet functional criteria.
How Is Income Counted for DC Medicaid?
What counts as income?
Generally, most income sources count toward the limit—wages, pensions, Social Security, IRA withdrawals, and investment earnings. Exceptions include Holocaust restitution and certain VA benefits.
What if only one spouse applies?
When one spouse applies for Nursing Home Medicaid or a Waiver, only their income is considered. The non-applicant may receive income from the applicant through the Minimum Monthly Maintenance Needs Allowance (MMMNA), which is $3,948 in 2025.
How is income handled for Regular Medicaid applicants?
For Regular ABD Medicaid, income from both spouses is counted. The MMMNA does not apply in this case.
How Are Assets Counted for DC Medicaid?
Which assets are considered countable?
Countable assets include savings, stocks, real estate (other than the primary home), and investment accounts. Exempt assets include one home (in most cases), one vehicle, personal belongings, and certain insurance policies.
How are assets treated for couples?
Assets are considered jointly owned. However, the non-applicant spouse is allowed to retain a portion of the couple’s assets under the Community Spouse Resource Allowance (CSRA), up to $157,920 in 2025.
What Is the Medicaid Look-Back Period?
What is the purpose of the look-back period?
DC enforces a 5-year (60-month) look-back for Nursing Home Medicaid and HCBS Waivers. If assets were gifted or sold below fair market value during this time, a penalty period of ineligibility could apply.
Does the federal gift tax limit apply?
No. The federal gift tax exemption ($19,000 per recipient in 2025) does not protect against Medicaid penalties for asset transfers.
Can My Home Be Exempt from Medicaid’s Asset Limit?
When is the home exempt?
The applicant or their spouse must live in the home, or the applicant must have “intent to return.” In 2025, home equity interest must be below $1,097,000. This rule does not apply to Regular Medicaid applicants.
Is the home protected after death?
Not necessarily. DC Medicaid can seek reimbursement from a deceased beneficiary’s estate, including the home, unless planning strategies are in place.
What Are the Medical or Functional Requirements?
What level of care is required?
Institutional Medicaid and Waivers require a Nursing Home Level of Care. For Regular Medicaid, help with Activities of Daily Living (ADLs) may be sufficient.
What if I’m Over the Financial Limits?
What is the Medically Needy Pathway?
Applicants with high medical costs may qualify by spending excess income on medical expenses. In 2025, income thresholds are $837.43 (individual) and $881.50 (couple).
How can I spend down excess assets?
Asset spend-down strategies include paying off debt, home modifications, or prepaying burial costs. All spending must comply with Medicaid’s Look-Back Period rules.
What is Medicaid Planning?
For those over income or asset limits, working with a Medicaid planner may help protect assets and gain eligibility. Professionals can assist in structuring finances appropriately.
What Long-Term Care Programs Are Available Through DC Medicaid?
What are some non-nursing home options?
- Adult Day Health Program (ADHP) – Daytime care for seniors, including supervision, meals, and personal assistance.
- EPD Waiver – Services for aged and disabled individuals to remain at home or in community settings. Includes an option to hire family caregivers.
- Personal Care Aide (PCA) Services – In-home help with daily tasks like bathing and meal prep.
- PACE Program – Combines Medicare and Medicaid benefits with extra services like dental and vision care.
- Money Follows the Person – Helps nursing home residents transition back to home or community living.
How Can I Apply for Medicaid in Washington DC?
Where and how do I apply?
Applications can be submitted:
- Online: District Direct
- Phone: 202-727-5355
- Mail: DHS, ESA, Case Record Management Unit, P.O. Box 91560, Washington, DC 20090
- Fax: 202-671-4400
- In-person: Local ESA Service Centers
What should I do before applying?
Ensure all eligibility criteria are met to avoid denial. If unsure, or if you’re over income or asset limits, consider consulting a Medicaid planner.
