District of Columbia and ACA Medicaid expansion

DC's Medicaid eligibility guidelines are among the most generous in the U.S.

Medicaid expansion in the District of Columbia

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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.

Generous Medicaid program contribute to low uninsured rate

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. That said, 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.

The emergence of the coronavirus and the Covid-19 pandemic have driven job losses and sharp increases in the uninsured rate across the U.S. as a whole. The District of the Columbia’s uninsured rate was 6 percent as of May 2020; this is the lowest rate in the nation.

Who is eligible for Medicaid in the District of Columbia?

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. Medicaid eligibility levels in DC are among the most generous in the nation, and about one in three DC residents is covered by Medicaid.

The following are the District of Columbia’s Modified Adjusted Gross Income (MAGI) limits for some of the main groups covered by Medicaid:

  • 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 Medicaid-covered groups.

How can I enroll in Medicaid in the District of Columbia?

You can apply for Medicaid in the District of Columbia online, over the phone, or in person. You can also fill out and submit a paper application.

  • Online: Use the health insurance marketplace, DC Health Link.
  • By phone: Call the DC Health Link Customer Service at 1-855-532-5465
  • In Person: Apply in person at an Income Maintenance Administration (IMA) Service Center. Locate a center online or call 202-727-5355 for help.
  • Paper Application: Download an application form, complete it, and and then submit it by mail, in person, or by fax. Visit DCHealthLink.com or call 1-855-532-5465 for help

District of Columbia Medicaid enrollment numbers

From the end of 2013 to June 2020, total Medicaid/CHIP enrollment in DC increased by 5 percent, from 235,786 to 248,591.

District of Columbia Medicaid history

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.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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How to apply in DC

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.

Eligibility: 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

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