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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

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 2010. Five states and the District of Columbia took advantage of an option in the ACA to expand Medicaid ahead of schedule (the scheduled start date was January 2014) and obtained federal matching funds to provide coverage for applicants with income up to 138% of the poverty level (this includes an additional 5% income disregard that is built into the ACA’s formula for calculating Medicaid eligibility based on modified adjusted gross income).

Soon thereafter, DC further expanded Medicaid, to cover adults with income up to 205% of the poverty level (200% plus the 5% income disregard). And this was subsequently increased again: DC currently provides Medicaid coverage to parents/caretakers of minor children if their household income doesn’t exceed 221% of the poverty level, and to other non-disabled adults under age 65 if their household income doesn’t exceed 215% of the poverty level.

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So although Medicaid eligibility for most adults ends at 138% of the poverty level in most other states, it extends well above that in DC. This is 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 private plans in the exchange is instead eligible for Medicaid in DC.

Other coverage programs available in DC

Under its early adopted approach to 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% 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. The enrollment and recertification processes for DC Healthcare Alliance were relaxed during the COVID pandemic, reducing the barriers to entry for this program. Consumer advocates in DC are hoping that these changes become permanent.

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

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% of them were eligible for Medicaid. That said, the District’s uninsured rate is among the lowest in the nation, at 3.5% in 2019. Only Massachusetts had a lower uninsured rate at that point. DC’s uninsured rate is down from 6.7% in 2013, and from more than 18% 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 COVID pandemic resulted in job losses and sharp increases in the uninsured rate across the U.S. as a whole. The District of Columbia’s uninsured rate was 6% as of May 2020. This was the lowest rate in the nation at that point, and a testament to the District’s commitment to providing health coverage for people with limited income. This included the fact that the normal enrollment and recertification process for DC Healthcare Alliance were relaxed during the COVID pandemic.

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 (including the 5% income disregard):

  • 324% of the federal poverty level (FPL) for children 0-18
  • 324% of FPL for pregnant women
  • 221% of FPL for parents with dependent children
  • 215% 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 does Medicaid provide financial assistance to Medicare beneficiaries in D.C.?

Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – including long-term care.

Our guide to financial assistance for Medicare enrollees in Washington, D.C. includes overviews of these programs, including Medicaid long-term care benefits, Extra Help, and eligibility guidelines for assistance.

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 February 2021, total Medicaid/CHIP enrollment in DC increased by 12%, from 235,786 to 264,528.

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 2018, about 71% 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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Apply for Medicaid in District of Columbia

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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