How to Apply for Medicaid in the District of Columbia

You can apply for Medicaid online by clicking here.  You can also submit a paper application, which you can find on the state website (here), or get assistance applying via an attorney.

Medicaid Eligibility Program Overview

Medicaid pays for the cost of Nursing Home care in the District of Columbia that meets certain financial and health criteria.  The average cost of Skilled Nursing Care in the District of Columbia is$147,096 per year, so securing Medicaid coverage is essential.  There are 17 nursing homes in the District of Columbia, most of which accept Medicaid insurance as a form of payment.  Nursing homes in the District of Columbia are currently 80.9% occupied, with an average of 2,025 patients using 2,505 available beds.

District of Columbia Medicaid Asset Limitations for 2023

Individuals in the District of Columbia can keep $4,000 when they apply to Medicaid for long-term care.  If they are over this amount, they must spend down on care.  It’s important to note that individuals are not allowed to give gifts of any amount for a period of 5 years (60 months) before applying for Medicaid.  If an individual’s assets are more than $4,000, they should learn about Medicaid Planning strategies.  This asset limit only applies to assets that are considered countable.  Countable assets include; savings accounts, checking accounts, retirement accounts and a second home.  If you have multiple assets and are looking to access Medicaid, it may make sense to speak with a Medicaid Planner or Elder Law attorney in the District of Columbia.

Couples requiring Medicaid for long-term care in the District of Columbia can keep $6,000 in assets.  If one spouse requires care and one does not, the spouse that does not receive care is known as the Community Spouse.  The Community Spouse is allowed to keep 50% of their assets up to $123,600 in countable assets, which is known as the Community Spouse Resource Allowance.  The Community Spouse is allowed to keep 100% of their marital assets up to $24,720.

The maximum amount of home equity allowed when applying to Medicaid is $858,000.  Despite the fact that the home is not a countable asset, Medicaid can look for repayment in probate court from the sale proceeds after it stops paying for care.  It is important to understand if your home may be subject to the Medicaid repayment process.

Income Limits in the District of Columbia For Medicaid

In the District of Columbia, the individual receiving Medicaid cannot earn over $4,000.  If their income exceeds that amount, they will need to do some Medicaid planning to create eligibility.  One strategy that works well is a Miller Trust, also known as a Qualified Income Trust.  If an individual is married, the spouse’s income does not typically count towards the income cap, but it is important to maximize income protection via the Monthly Needs Allowance rules.  The maximum amount of income the Medicaid office allows a community spouse to keep in the District of Columbia is $3,022.  All of an individual’s monthly income must go towards their cost of care, which can include medical bills, prescriptions and other health care costs.  $70 can be set aside for the personal needs allowance.  The income limits are based on a percentage of the Supplemental Security Income defined by the Social Security Administration’s Federal Poverty Levels (FPL) and change annually.

Penalty Information in the District of Columbia For Medicaid

If a gift of any amount is given in the District of Columbia during a period of 5 years before applying to Medicaid, a penalty period will be initiated. This penalty period in the District of Columbia is called a look-back period, which can make an individual not eligible for Medicaid.   Medicaid will not pay for care until the penalty period is over.  The penalty is calculated by dividing the total amount of gifts given by $9,456, which creates a number of months before Medicaid coverage begins.

The average cost of Nursing home care (private room) in the District of Columbia is $13,049, so penalties can become very costly for a family that has not planned appropriately for Medicaid.