Medicaid Long-Term Care Guide in Washington D.C.

Long-term care eligibility, benefits, and how to apply through the Department of Health Care Finance (DHCF).

Washington D.C. Medicaid Long-Term Care — Key Takeaways

Updated May 2026

Single applicant in Washington D.C.: monthly income at or below $2,982/mo* and countable assets under $4,000 (2026 nursing home Medicaid).
Spousal protections: the non-applicant spouse keeps up to 50% of couple's assets, up to $162,660 (min $32,532) in assets (CSRA) and at least $4,066.50/mo/month in income (MMMNA).
Look-back period: 5 years (60 months) before the application date — gifts and below-market transfers can trigger a penalty period of ineligibility.
Home equity cap: primary residence is exempt up to $1,097,000 in equity if the applicant intends to return or a spouse/dependent lives there.
Apply through District Direct or call 202-727-5355. Department of Health Care Finance (DHCF) administers benefits and processes applications.

What makes Washington D.C. Medicaid different

Washington D.C. Medicaid provides long-term care through nursing homes, assisted living, and adult foster care homes. DC stands out with HIGHER asset limits ($4,000 single / $6,000 couple) than most states, the HIGHEST home equity interest limit ($1,097,000), IRAs/401Ks are EXEMPT, and the MMMNA is set at the maximum ($4,066.50) rather than a lower state-specific amount. The Personal Needs Allowance ($109/month) is also among the highest nationally. DC expanded Medicaid under the Affordable Care Act.

Administered by the Department of Health Care Finance (DHCF).

Program Types

Entitlement

Institutional / Nursing Home Medicaid

An entitlement program providing care in Medicaid-certified nursing home facilities

Level of care: Nursing Home Level of Care (NHLOC)

Limited Slots

Medicaid Waivers / HCBS

Home and Community Based Services with limited enrollment and potential waiting lists, provided at home, adult day care, adult foster care, or assisted living

Level of care: Nursing Home Level of Care (NHLOC)

Entitlement

Regular Medicaid / Aged, Blind and Disabled (ABD)

Entitlement program with some long-term care benefits like personal care assistance or adult day care

Level of care: Help with ADLs (not NHLOC)

2026 Washington D.C. Medicaid Long-Term Care Eligibility for Seniors

Institutional / Nursing Home Medicaid

Single

Income$2,982/mo*Assets$4,000Care LevelNursing Home

Married (Both)

Income$5,964/mo*Assets$6,000Care LevelNursing Home

Married (One)

Income$2,982/mo (applicant)*Assets$4,000 (applicant) & $162,660 (non-applicant)Care LevelNursing Home

Medicaid Waivers / HCBS

Single

Income$2,982/mo†Assets$4,000Care LevelNursing Home

Married (Both)

Income$5,964/mo†Assets$6,000Care LevelNursing Home

Married (One)

Income$2,982/mo (applicant)†Assets$4,000 (applicant) & $162,660 (non-applicant)Care LevelNursing Home

Regular Medicaid / Aged, Blind and Disabled

Single

Income$1,330/mo‡Assets$4,000Care LevelHelp with ADLs

Married (Both)

Income$1,803.33/mo‡Assets$6,000Care LevelHelp with ADLs

Married (One)

Income$1,803.33/mo‡Assets$6,000Care LevelHelp with ADLs

^*All of a beneficiary's monthly income, with the exception of a Personal Needs Allowance of $109/month, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability).

^†Based on one's living setting, a program beneficiary may not be able to keep monthly income up to this level.

^‡Another pathway to Medicaid eligibility is through SSI. In the District of Columbia, persons eligible for SSI are automatically approved for Regular Medicaid, including long-term services and supports given functional criteria are met.

Explore Washington D.C. Medicaid Programs

Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to Washington D.C..

Long-term care Medicaid guide

Eligibility · Caregiver pay · How to apply · 2026 data

Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.

Compare Medicaid Programs — Washington D.C.

How the main LTC programs available in Washington D.C. compare side by side.

Washington D.C. does not have a general Structured Family Caregiving program. Consumer-directed hourly pay is the primary Medicaid option for family caregivers.

Program	Pay	Pay type	Tax-free?	Spouse OK?	Waitlist?
Consumer-directed HCBS	$18–21/hr	Hourly wage	No	Usually no	Often
Structured Family Caregiving (SFC)	Not in Washington D.C.	Daily stipend	Yes	Usually no	Often
Personal Care Agreement	Market rate (from assets)	Private pay	No	Yes	No
VA Aid & Attendance	Up to $2,874/mo	Monthly pension	Yes	Yes	No

Washington D.C. Medicaid programs

HCBS Waiver

EPD Waiver

2026 policy warning: The One Big Beautiful Bill Act (signed July 4, 2025) cuts federal Medicaid spending by ~$911 billion over 10 years. HCBS waiver waitlists are expected to grow significantly. Apply as early as possible — do not wait for a crisis.

Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.

How to Apply for Medicaid Long-Term Care in Washington D.C.

What to expect when applying for LTC Medicaid and getting family caregiver pay set up in Washington D.C.. The process typically takes 45–90 days from application to first paycheck.

Gather financial documents

You'll need: Social Security or Medicare card, 3 months of bank statements, most recent tax return, pension or benefit award letters, property deed(s), vehicle title(s). Having these ready speeds up the application by weeks.

Consider a Medicaid planning consultation

An elder law attorney or Certified Medicaid Planner (CMP) can review your finances before you apply — especially if income or assets are over the limit. Many families save thousands by planning first. Find one at elderlawanswers.com or medicaidplanners.org.

Get a physician's statement of care needs

LTC Medicaid requires documentation that the person needs a nursing facility level of care (NFLOC). Your doctor fills out a form confirming they need help with 3+ ADLs or have a qualifying condition. Ask for this before or during the application.

Submit the application — Washington D.C.

Where to apply: DHS · dhs.dc.gov. Most states accept applications online, by mail, or in person. You can usually apply by phone too. The application covers both financial information and care needs.

Level of care assessment

After the financial review, a nurse or social worker will assess the person's care needs and confirm NFLOC. This is required for all HCBS programs. Be honest about the worst days, not the best.

Program enrollment and fiscal intermediary

Once approved for a self-directed HCBS or SFC program, you'll be assigned to a fiscal intermediary — a company that handles payroll, taxes, and compliance on your behalf. Examples: Public Partnerships LLC (PPL), FreedomCare, Careforth — depending on which programs are available in Washington D.C..

Caregiver begins getting paid

Once the fiscal intermediary is set up, the caregiver is added to payroll. SFC programs typically pay twice per month. Consumer-directed programs pay weekly or biweekly. You'll receive a W-2.

5-year lookback warning: Medicaid reviews every asset transfer made in the 60 months before application. Gifts, transfers to family, or selling assets below market value can trigger a penalty period. Do not transfer assets without professional guidance first.

Don't wait for a crisis. HCBS waitlists in Washington D.C. can be long — sometimes 1–2 years. Apply now, even if care hasn't started yet.

Apply in Washington D.C.: DHS · dhs.dc.gov

Medicaid Eligibility Screener — Washington D.C.

Answer 7 quick questions — we'll check the financial and care requirements for Washington D.C. and explain what each one means.

What is the marital status of the person who needs care?

Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.

Sources

CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income

Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.

View Full Washington D.C. Medicaid Guide →Compare Medicaid Eligibility Across All States →

Key Rules at a Glance

Nearly all income counts: employment wages, alimony, railroad retirement, pensions, Social Security (including SSDI and SSI), IRA withdrawals, and stock dividends
Nationally, Holocaust restitution payments are NOT counted
Washington D.C.: VA Aid & Attendance payments (above Basic VA Pension) do NOT count as income
Married couples (Nursing Home/Waiver): Only applicant's income is counted; non-applicant spouse income is disregarded
Married couples (Regular Medicaid): Both spouses' income is counted toward eligibility
SSI eligibility: Persons eligible for SSI are automatically approved for Medicaid, including long-term services if functional criteria are met

Countable assets: cash, stocks, bonds, investments, cryptocurrency, bank accounts, and non-residential real estate
Exempt assets: personal belongings, clothing, household furnishings, one vehicle, burial plot (for applicant and spouse), primary home (with conditions)
Life insurance: Exempt if face value is not greater than $1,500
IRAs/401Ks: EXEMPT (not counted as assets)
Asset limits are HIGHER than most states: $4,000 for singles, $6,000 for couples
Married couples: All assets considered jointly owned regardless of which spouse applies

Home automatically exempt if applicant's spouse, child under 21, or blind/disabled child (any age) lives in it
Home equity interest limit: $1,097,000 (2026)—one of the HIGHEST limits nationally
If above family members don't live in home, applicant must have 'Intent to Return'
Regular Medicaid: No home equity interest limit applies
Home equity = home value minus outstanding debt; equity interest = portion of equity owned by applicant
Estate Recovery: Home is NOT exempt from Medicaid's Estate Recovery Program—DC may seek reimbursement from deceased's estate

Washington D.C. has a 60-month (5-year) Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers
Medicaid scrutinizes all asset transfers during the 60 months immediately before application date
Includes asset transfers made by a non-applicant spouse
Gifting assets or selling for under fair market value triggers a Penalty Period of ineligibility
U.S. Federal Gift Tax Rule (up to $19,000/recipient in 2026) does NOT protect transfers from Medicaid's Look-Back
Regular Medicaid: No Look-Back Period applies
Keep documentation of all asset transfers and expenditures to prove compliance

MMMNA: $4,066.50/mo · CSRA: 50% of couple's assets, up to $162,660 (min $32,532) · CSRA Min: $32,532
UNIQUE: MMMNA is set at the MAXIMUM of $4,066.50/month—the highest possible under federal rules
If non-applicant's monthly income is under $4,066.50, income can be transferred from applicant spouse up to that amount
Also called a Community Maintenance Needs Allowance (CMNA) in Washington D.C.
CSRA: Non-applicant spouse can retain 50% of couple's assets, up to $162,660. If their share is under $32,532, they can keep up to $32,532
Spousal protections apply to Nursing Home Medicaid and Medicaid Waivers, NOT Regular Medicaid
Regular Medicaid: No Community Maintenance Needs Allowance for non-applicant spouse

Medically Needy / Spend-Down Program: For applicants over income limit—MNIL is $856.90/month for individuals and $902/month for couples (eff. 2/1/26 – 1/31/27)
Spend-down amount is difference between monthly income and MNIL
Eligible medical expenses: private health insurance, prescription medications, unpaid medical bills, and expenses Medicaid doesn't cover
Asset Spend-Down: Reduce countable assets by spending on exempt items—home modifications (wheelchair ramps, stair lifts), prepay funeral/burial, pay off debt
CRITICAL: Never gift assets or sell below fair market value within 60-month Look-Back Period—always keep receipts
Medicaid Planning: Work with a Certified Medicaid Planner to employ legal strategies for eligibility and home protection from Estate Recovery

Washington D.C. Medicaid Programs

Adult Day Health Program (ADHP)

Part of Regular Medicaid plan. Provides personal care assistance, supervision, meals, and therapeutic activities during daytime hours in adult day care centers as a nursing home diversion service.

Elderly and Persons with Physical Disabilities (EPD) Medicaid Waiver

Promotes independent living at home, in adult foster care, and in assisted living. 'Services My Way' option allows hiring one's own caregiver, including adult children. Benefits include adult day health care, personal emergency response systems, home modifications, respite care, and homemaker services.

Wait List

State Plan Personal Care Aide (PCA) Services Program

Personal care assistance for seniors and persons with disabilities at home. Includes help with bathing, grooming, dressing, eating, mobility, grocery shopping, and meal preparation.

Program of All-Inclusive Care for the Elderly (PACE)

Combines Medicaid long-term care services and Medicare benefits into one program. Additional benefits like dental and eye care may be available.

Money Follows the Person

Federal program helping institutionalized Medicaid-eligible individuals transition back home or into the community.

How to Apply

Online at District Direct
Phone: Department of Human Services Economic Security Administration at 202-727-5355
Mail completed 'Combined Application for Food, Medical, & Cash Benefits' to DHS, ESA, Case Record Management Unit, P.O. Box 91560, Washington, DC 20090
Fax application to 202-671-4400
In person at local Economic Security Administration (ESA) Service Center
For long-term care: Contact Department of Aging and Community Living (DACL) at 202-724-5626 for the Long-Term Care Program Medical Assistance Application
Contact the Aging and Disability Resource Center for application assistance

Long-term care applicants must complete a separate Long-Term Care Program Medical Assistance Application. Application process varies by program. Ensure all eligibility requirements are met—consider Medicaid Planning if over income/asset limits.

More Washington D.C. Long-Term Care Resources

Washington D.C. Long-Term Care Costs

Compare assisted living, home care, and nursing home costs.

Washington D.C. Senior Services Directory

Find local aging agencies, support programs, and community resources.

Veterans Long-Term Care Benefits

Aid & Attendance, caregiver programs, and VA nursing home coverage.

Take the Next Step for Washington D.C. Medicaid

Find out if you qualify or see how Medicaid fits into your overall long-term care plan.

Sources & references

Verified May 2026

Centers for Medicare & Medicaid Services — Long-Term Services & Supports
Administration for Community Living — State Medicaid Agencies
Centers for Medicare & Medicaid Services — Medicaid Eligibility
American Council on Aging — About Medicaid Planning Assistance
Department of Health Care Finance (DHCF) — Washington D.C. Medicaid — Official site

Important notes

Asset limits are HIGHER than most states: $4,000 (single) / $6,000 (couple)

MMMNA is set at the MAXIMUM of $4,066.50/month—highest possible under federal rules

Home equity interest limit is $1,097,000—one of the HIGHEST nationally

IRAs/401Ks are EXEMPT (not counted as assets)

Personal Needs Allowance of $109/month is among the HIGHEST nationally

DC expanded Medicaid under the Affordable Care Act

Life insurance exempt if face value ≤ $1,500

Medicaid Long-Term Care Guide in Washington D.C.

What makes Washington D.C. Medicaid different

Program Types

Institutional / Nursing Home Medicaid

Medicaid Waivers / HCBS

Regular Medicaid / Aged, Blind and Disabled (ABD)

2026 Washington D.C. Medicaid Long-Term Care Eligibility for Seniors

Institutional / Nursing Home Medicaid

Medicaid Waivers / HCBS

Regular Medicaid / Aged, Blind and Disabled

Explore Washington D.C. Medicaid Programs

Long-term care Medicaid guide

Compare Medicaid Programs — Washington D.C.

How Family Caregivers Get Paid Through Medicaid in Washington D.C.

How to Apply for Medicaid Long-Term Care in Washington D.C.

Medicaid Eligibility Screener — Washington D.C.

Key Rules at a Glance

Washington D.C. Medicaid Programs

Adult Day Health Program (ADHP)

Elderly and Persons with Physical Disabilities (EPD) Medicaid Waiver

State Plan Personal Care Aide (PCA) Services Program

Program of All-Inclusive Care for the Elderly (PACE)

Money Follows the Person

How to Apply

More Washington D.C. Long-Term Care Resources

Take the Next Step for Washington D.C. Medicaid

Important notes