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District of Columbia and ACA Medicaid expansion

DC Medicaid eligibility guidelines among most generous in U.S.

dc Medicaid guide

The District of Columbia administers a generous Medicaid program for low-income and medically needy residents. DC implemented Medicaid expansion through the Affordable Care Act (ACA), and DC Medicaid covers children, pregnant women, parents, and other adults at higher income levels than the thresholds applied in most states. About one in three DC residents is covered by Medicaid.

As of 2015, the Kaiser Family Foundation estimated that there were still 42,000 uninsured residents in DC, and 48 percent of them were eligible for Medicaid. But the District’s uninsured rate is among the lowest in the nation, at 3.9 percent in 2016—down from 6.7 percent in 2013, and from more than 18 percent in the late 1990s. The drop in the uninsured rate is due in large part to the District’s efforts to implement the DC Healthcare Alliance, expand Medicaid and integrate the two programs.

From the end of 2013 to November 2017, total Medicaid/CHIP enrollment in DC increased by 12 percent, from 235,786 to 264,513.

Eligibility guidelines

To receive federal Medicaid funding, the states and the District of Columbia must provide Medicaid to “mandatory eligibility groups,” including low-income children, pregnant women, parents of minor children, elderly people, and people with certain disabilities. States have the option of covering other eligibility groups, such as individuals receiving hospice care or certain women being treated for breast or cervical cancer.

While the mandatory and optional covered populations are consistent across the country, each state and DC set eligibility guidelines for the groups they cover.

Eligibility levels in DC are among the most generous in the nation:

  • 319 percent of the federal poverty level (FPL) for children 0-18
  • 319 percent of FPL for pregnant women
  • 216 percent of FPL for parents with dependent children
  • 210 percent of FPL for other, non-elderly adults

Visit the District’s Department of Health Care Finance site for eligibility criteria for other covered groups.

How you can sign up for Medicaid

Children, pregnant women, and adults up to age 64 can apply for Medicaid online through the health insurance marketplace, DC Health Link. You may also apply in person at an Income Maintenance Administration (IMA) Service Center. Locate a center online or call 202-727-5355 for help.

Individuals who may qualify for Medicaid should use the Combined Application for Benefits. Submit the application to the nearest IMA Service Center, which you can find online or by calling 202-727-5355.

DC’s unique approach to Medicaid expansion

DC decided early on to participate in Medicaid expansion and sought federal approval just months after the Affordable Care Act was signed into law. Enrollment in DC’s ACA Medicaid expansion began in 2011. Five states and the District of Columbia took advantage of an option in the ACA to expand Medicaid ahead of schedule and obtain federal matching funds to provide coverage for applicants with income up to 138 percent of the poverty level. DC’s early expansion also included a Section 1115 waiver.

Through Medicaid expansion, DC moved about 34,000 people who had been enrolled in DC HealthCare Alliance — a District-funded program that allows low-income residents to obtain medical and dental services at no cost from participating providers — to the Medicaid program. Enrollment in DC Healthcare Alliance had reached 50,000 by 2009; most of those people became eligible for Medicaid instead once Medicaid was expanded.

So by opting to expand Medicaid early, DC was able to take advantage of federal funding to help cover a low-income population that was already being covered in a DC-based program that received no federal funding; expanding Medicaid early was obviously a good financial move for DC. In addition, the benefits through DC HealthCare Alliance are more limited than Medicaid, with no funding for mental health care or medical transportation. So Medicaid provides better coverage for enrollees as well.

DC Healthcare Alliance coverage is still available to people who aren’t eligible for Medicaid, but who have income at or below 200 percent of the poverty level and resources/assets at or below $4,000 for a single person and $6,000 for a family. To be eligible, people must live in the District, but there are no immigration status requirements, so Alliance coverage is available to undocumented immigrants, and provides no-cost health care to enrollees.

For immigrant children under the age of 21, the Immigrant Children’s Program in DC provides coverage for those with income up to 200 percent of the poverty level, regardless of assets.

Cover All DC is an additional program available to undocumented immigrants (or anyone who isn’t eligible for Medicaid or private coverage through DC Health Link), regardless of income, so it’s for those with income above 200 percent of the poverty level, and/or assets above the Healthcare Alliance threshold. It allows enrollees to purchase private health insurance, with no financial assistance. The ACA specifically prevents undocumented immigrants from enrolling through the exchanges, so Cover All DC is separate from the exchange.

Along with Minnesota, DC adopted more generous eligibility standards than the federal guideline of 138 percent of FPL. In DC, non-elderly adults without children with income up for 216 percent of FPL qualify for Medicaid. That’s a big part of the reason DC Health Link (the exchange in DC) has such a low percentage of enrollees eligible for premium subsidies; a large segment of the population that would — in other states — be eligible for subsidized QHPs in the exchange is instead eligible for Medicaid in DC.

History of Medicaid in DC

The District of Columbia implemented a Medicaid program in July 1968. In general, children, pregnant women, parents, and other non-elderly adults enrolled in DC Medicaid are covered by managed care plans. Most other DC Medicaid beneficiaries are covered through fee-for-service Medicaid. As of 2014, about 72 percent of DC Medicaid beneficiaries were enrolled in managed care.

Total enrollment in DC Medicaid/CHIP stood at 264,513 as of November 2017. That’s nearly 39 percent of the District’s population.

District of Columbia Medicaid

How to apply

Online at DC Health Link; submit a Combined Application for Benefits in person at an Income Maintenance Administration (IMA) Service Center; or phone (202) 727-5355 for help.

Who is eligible

Children 0-18 with incomes up to 319% of FPL; pregnant women with incomes up to 319% of FPL; parents with dependent children with incomes up to 216% of FPL; other non-elderly adults with incomes up to 210% of FPL

More District of Columbia coverage

Insurance Guide

A guide to health insurance in your state.

Exchange

News, history, and enrollment info for your state marketplace

Medicare

Insurance for those over 64 (off-site)