Washington D.C. Medicaid Eligibility and Enrollment
- Washington D.C. Medicaid provides health coverage for low-income residents of the District of Columbia. Read this guide to learn more about the program.
What Is Washington D.C. Medicaid?
Washington D.C. Medicaid is a joint program between the Washington D.C. government and the Centers for Medicare & Medicaid Services, the federal agency responsible for administering the Medicare program for older adults and adults with certain disabilities.
The aim of the program is to ensure that low-income residents of Washington D.C. have coverage for the professional services they need to stay healthy, from preventive screenings to treatment for chronic health conditions.
Medicaid Plans
Managed Care
Most enrollees belong to the managed-care plan. In managed care, each participant must choose one health plan from these options: AmeriHealth DC, MedStar Family Choice DC and Trusted Health Plan, Inc. Participants in the managed-care program must also choose a primary care physician, or one will be assigned to them.
Fee-for-Service
Fee-for-service participants can go to any health care provider who accepts Medicaid. They don't need referrals from a primary care provider to see medical specialists. The following people may be enrolled in the fee-for-service program rather than the managed-care program:
- Inmates at jails and prisons
- People who need emergency Medicaid coverage
- SSI recipients
- Medicare recipients who qualify for the Qualified Medicaid Beneficiary plan
- Children in foster care
- Individuals receiving long-term care services
- People with disabilities
- Participants receiving an optional state supplement payment
Covered Services
Medicaid in Washington D.C. covers a variety of medical services. These are some of the most common:
- Doctor visits
- Laboratory tests
- X-rays
- Outpatient procedures
- Inpatient hospital care
- Kidney dialysis
- Bone-marrow and organ transplants
- Mental health services
Out-of-Pocket Costs
Participants in the managed-care plan have no out-of-pocket costs for services covered by Medicaid. Fee-for-service participants may have to pay a copay of $1.00 per prescription and $2.00 for eyeglasses.
Who Is Eligible for Medicaid in Washington D.C.?
Basic Eligibility Requirements
To qualify for Medicaid, applicants must provide proof of Washington D.C. residence. Medicaid recipients must also be U.S. citizens or qualifying immigrants.
MAGI Medicaid
MAGI Medicaid is available to adults between the ages of 21 and 64 who don't have any dependent children, children under the age of 21, parents or caretakers with children and pregnant women. For MAGI Medicaid, the government uses a household's modified adjusted gross income to determine eligibility. Modified adjusted gross income (MAGI) is calculated based on federal guidelines for determining how family size is determined and how household income is counted.
The income limits for MAGI Medicaid are as follows:
- Adults 21-64: 200% of the federal poverty level
- Young adults (19-20): 200% of the federal poverty level
- Pregnant women: 300% of the federal poverty level
- Children 0-18: 300% of the federal poverty level
Non-MAGI Medicaid
For some applicants, the MAGI rules don't apply. This is known as non-MAGI Medicaid. The following groups are exempt from the MAGI guidelines:
- Recipients of the Home and Community-Based Services waiver
- Medicare Savings Program recipients
- Former foster children
- Individuals who've been screened and are in need of treatment for cervical or breast cancers
- SSI recipients
- Older adults (65+), blind adults or disabled adults who have no more than $4,000 in financial resources for a single person
- Individuals receiving long-term care services
To receive non-MAGI Medicaid, an applicant's household income must not exceed 100% of the federal poverty level. For some non-MAGI Medicaid recipients, there is also a limit of $4,000 in countable assets for a single person and $6,000 in countable assets for a married couple.
How Do I Enroll in Medicaid in Washington D.C.?
MAGI Medicaid
Participants who believe they qualify for MAGI Medicaid should fill out the Combined Application for DC, which is used to determine eligibility for Medicaid, food stamps and cash assistance. If an applicant doesn't qualify for Medicaid, this combined application can also be used to determine eligibility for health coverage provided by the DC Healthcare Alliance.
An application can also be filled out in person at one of the following IMA Service Centers:
- Anacostia: 2100 Martin Luther King Avenue SE
- Congress Heights: 4049 South Capitol Street SW
- Fort Davis: 3851 Alabama Avenue SE
- H Street: 645 H Street NE
- Taylor Street: 1207 Taylor Street NW
Non-MAGI Medicaid
Individuals who believe they qualify for non-MAGI Medicaid should fill out a DC Health Link application. To fill out an application, visit the DC Health Link website, look for the "Individual & Family" heading and click the Get Started button. On the next screen, click the Apply for Medicaid button.
The website will then display some information about the Washington D.C. Medicaid program. Click the Apply for Medicaid button a second time to create an account and start the application process.
Contact Information for Washington D.C. Medicaid
Telephone: (202) 727-4631
Service Centers:
Anacostia
2100 Martin Luther King Avenue SE
(202) 645-4614
(202) 727-3527 (Fax)
Congress Heights
4001 South Capitol Street SW
(202) 645-4546
(202) 654-4524 (Fax)
Eckington
51 N Street NE
(202) 724-8720
(202) 724-8602 (Fax)
Fort Davis
3821 Alabama Avenue SE
(202) 645-4500
(202) 645-3348 (Fax)
H Street
645 H Street NE
(202) 698 4350
(202) 724-8964 (Fax)
Taylor Street
1207 Taylor Street NW
(202) 576-8000
(202) 576-8740 (Fax)
Northeast
3917 Minnesota Avenue NE
(202) 724-7900
(202) 724-8549 (Fax)
