Losing DC Medicaid in 2026 opens a 90-day Special Enrollment Period (SEP) on DC Health Link, the District's state-based Marketplace at dchealthlink.com. The Department of Health Care Finance (DHCF) runs DC Medicaid, and the District Direct portal at districtdirect.dc.gov holds your notices and renewal dates. Coverage can end for several reasons: income rose above the 2026 limit, a renewal form went unreturned, a mailing address was out of date, or a Childless Adult enrollee turned 65 or gained Medicare. The biggest 2026 change landed on January 1, when the FY2026 Budget Support Act of 2025 cut the Medicaid income limit for Childless Adults and Parent/Caretaker Relatives to 138% of the Federal Poverty Level (FPL), down from roughly 215% and 221%. Adults above the new line moved to the Healthy DC Plan or to DC Health Link qualified health plans. Anyone who loses Medicaid for any reason now has the same route: apply on DC Health Link, choose Loss of Medicaid as the qualifying life event, and compare the Healthy DC Plan with subsidized plans. The Marketplace SEP clock starts on your termination date, so check the date on your DHCF notice today and write it down before reading further.
DC Medicaid, delivered through managed care plans that DC residents may know as DC Healthy Families, is year-round and free for eligible residents. For 2026, 138% FPL equals $22,025 for a single person and $45,540 for a family of 4, based on HHS ASPE 2026 Poverty Guidelines; DHCF publishes its own 2026 monthly figures of $1,800 for one person and $3,697 for four after the 5% income disregard. The Healthy DC Plan, approved by CMS on September 30, 2025 as a Basic Health Plan under ACA Section 1331, covers adults age 21 to 64 with income above 138% up to 200% FPL, which is $31,920 for a single person in 2026, with no monthly premium and no out-of-pocket cost for covered care from participating providers. Above 200% FPL, DC Health Link qualified health plans with premium tax credits apply up to 400% FPL ($63,840 for a single person in 2026), because the enhanced credits expired on January 1, 2026 and the subsidy cliff is back. Children and pregnant residents were not affected by the January 2026 change and keep Medicaid (CHIP-level coverage) at much higher incomes. This guide covers every pathway: Medicaid re-application, the Healthy DC Plan, subsidized DC Health Link plans, children's coverage, and appeals. Use the Medicaid income limits and ACA income limits pages linked below to check your household before starting an application.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
Residents who lose DC Medicaid in 2026 most often lose time, not eligibility. Five mistakes show up repeatedly.
- Waiting for an automatic transfer after a later termination. The automatic move into the Healthy DC Plan applied to the January 1, 2026 income-limit change; a termination at any other time in 2026 needs a new DC Health Link application.
- Letting the 90-day SEP lapse because mail went to an old address. DHCF sends notices by mail, so update your contact information in District Direct before your next renewal.
- Reporting last year's income instead of projected 2026 income on DC Health Link. In 2026, prior-year income can wrongly push you above 200% FPL or below 138% FPL and send you to the wrong program.
- Dropping children's coverage along with the parent's. Children's DC Medicaid was not changed in January 2026 and continues at much higher incomes than adult coverage, so confirm each child's status separately.
- Choosing a plan without checking the network. Healthy DC Plan carriers and qualified health plans use different provider networks, and the Healthy DC Plan excludes adult dental and adult vision in 2026.
Medicaid Eligibility in Washington DC After January 2026
Washington DC cut its Medicaid income limit for adults on January 1, 2026, and the cut explains most terminations this year. Before the 2026 change, DC covered Childless Adults up to about 215% FPL and Parent/Caretaker Relatives up to about 221% FPL, far above the 138% FPL line used in most of the 40 expansion states plus DC. For 2026 the limit for both groups is 138% FPL, which is $22,025 for a single person and $45,540 for a family of 4 in 2026. DHCF measures this as 133% FPL plus a 5% disregard and publishes monthly limits of $1,800 for one person and $3,697 for four in 2026. Children and pregnant residents keep DC Medicaid at much higher incomes, and a Parent/Caretaker who earns more through added work hours can receive 12 months of Transitional Medical Assistance instead of an immediate cut-off. Adults age 65 or older, or with Medicare, cannot stay in the Childless Adult category and are evaluated for another group such as Aged, Blind, or Disabled coverage or QMB. The Healthy DC Plan, DC Health Link, and the DC Healthcare Alliance (for residents who are ineligible for Medicaid because of immigration status) fill the gaps. Federal law also adds work requirements (about 80 hours a month of work, training, or volunteering) and six-month renewals for most expansion adults age 19 to 64 without dependent children starting January 1, 2027, according to DHCF, so confirm current rules with DHCF if you re-apply. Check the DHCF Medicaid eligibility programs page at dhcf.dc.gov and the CMS and KFF state data before assuming you are ineligible.
How the Healthy DC Plan Works for Adults Who Lost Medicaid in 2026
Healthy DC Plan is a Basic Health Plan (BHP) that the DC Health Benefit Exchange Authority (HBX) launched on January 1, 2026 after CMS approval on September 30, 2025, and medicaid.gov describes the BHP option under ACA Section 1331. Adults age 21 to 64 who are US citizens or lawfully present, not eligible for Medicaid, not offered affordable employer coverage, and with income above 138% up to 200% FPL qualify, which is up to $31,920 for a single person in 2026. The plan has no monthly premium and no out-of-pocket cost for covered care from participating providers, and participating hospitals include Children's National, Howard University Hospital, and MedStar Georgetown University Hospital. Carriers for 2026 are AmeriHealth Caritas DC, MedStar Family Choice DC, and CareFirst BlueCross BlueShield. Benefits cover primary care, specialists, urgent care, hospital stays, prescriptions, and mental health, but not adult dental, adult vision, or non-emergency transportation in 2026. People whose Medicaid ended in the January 2026 change were enrolled automatically; anyone losing Medicaid later in 2026 applies through DC Health Link and selects Loss of Medicaid as the SEP reason. Undocumented residents are not eligible for the Healthy DC Plan under federal law and may look at the DC Healthcare Alliance.
Documents Explained: Why Each Proof Matters for Your 2026 SEP
The DHCF termination notice proves the qualifying life event and anchors your 90-day window, so DC Health Link may ask for it before approving the Loss of Medicaid SEP. Income documents drive the eligibility split among DC Medicaid (138% FPL), the Healthy DC Plan (200% FPL), and premium tax credits (400% FPL), which is why projected 2026 income beats last year's tax return. Immigration documents decide whether you land in Medicaid, the Healthy DC Plan, a qualified health plan, or the DC Healthcare Alliance. A Medicare card matters in 2026 because adults with Medicare above 138% FPL move to QMB, and an employer coverage offer matters because affordable employer coverage blocks Healthy DC Plan eligibility. Keep every notice and Form 1095-A, since the IRS uses the 1095-A to reconcile advance premium tax credits when you file your 2026 return in 2027. Upload documents through District Direct or DC Health Link within the deadline on any request, because a missed verification deadline is a leading cause of denial.
Frequently Asked Questions
What is the SEP window after losing DC Medicaid in 2026?
The SEP window is 90 days after the date your DC Medicaid ends, and you can also apply up to 60 days before it. If coverage ends October 31, 2026, the window runs November 1, 2026 through January 29, 2027. DC Health Link also operates a Loss of Medicaid exceptional circumstance SEP, which covers the Healthy DC Plan, for anyone whose Medicaid ends on or before December 31, 2026. Apply at dchealthlink.com or call 1-855-532-5465, and select Loss of Medicaid coverage as your reason. The healthcare.gov Special Enrollment Period rules give 90 days after losing Medicaid or CHIP coverage, and DC Health Link, a state-based exchange, confirms its own window when you apply, so the clock starts on your termination date, not the date you opened the DHCF letter.
How do I document losing DC Medicaid for a special enrollment application?
Use your DHCF termination notice as the primary proof, since it shows the end date and the reason. You can view and download it in your District Direct account at districtdirect.dc.gov if the mailed copy is lost. DC Health Link may also verify the Medicaid status electronically, but upload the notice if the application asks for it. Add proof of DC residency, Social Security numbers or immigration documents, and income proof for projecting 2026 income, such as pay stubs or a 2025 tax return. Keep copies of everything, because the same records support an appeal, a Medicaid re-application, or the premium tax credit reconciliation on your 2026 tax return.
What if I miss the SEP window after losing DC Medicaid?
Missing the 90-day window usually means waiting for DC Health Link open enrollment, which has run November 1 through January 31, with coverage starting after you select a plan. You then have no Marketplace coverage in the gap, and you pay full price for care. Two exits remain open year-round: re-apply for DC Medicaid at districtdirect.dc.gov if income is at or below 138% FPL ($22,025 for one person in 2026), and enroll children in Medicaid at any time. A new qualifying life event, such as a move, marriage, or birth, can also open a fresh SEP. Call the DC Health Care Ombudsman at (202) 724-7491 if a verification problem, not your own delay, caused the miss.
Can I get retroactive coverage after losing DC Medicaid?
DC Medicaid eligibility, when approved, starts on the first day of the month in which you applied, according to DHCF, so applying early in the month protects the most days in 2026. For DC Health Link, a standard Loss of Medicaid SEP plan normally starts the first of the month after you select a plan. HBX advisory council materials describe Loss of Medicaid enrollments that can start on the first of the month, so ask DC Health Link at 1-855-532-5465 which start date your application receives. Do not assume past months are covered: apply as soon as you see the termination notice, and if you have an urgent medical need, call before the end date.
What is the difference between COBRA, the Healthy DC Plan, and a Marketplace plan?
COBRA continues a former employer plan at 102% of the full premium, about $400 to $900/mo for one person in 2026, and applies only if employer coverage ended recently. The Healthy DC Plan charges no monthly premium and no out-of-pocket cost for covered care from participating providers, for adults age 21 to 64 with income above 138% up to 200% FPL ($31,920 for one person in 2026). A DC Health Link qualified health plan uses premium tax credits to cut cost for income up to 400% FPL ($63,840 for one person in 2026). Most people who lost Medicaid choose the Healthy DC Plan or a subsidized plan, since both usually cost far less than COBRA.
What Washington DC rules apply when I lose Medicaid in 2026?
Three DC-specific rules matter in 2026. First, the FY2026 Budget Support Act of 2025 cut the Medicaid limit for Childless Adults and Parent/Caretaker Relatives to 138% FPL starting January 1, 2026. Second, HBX created the Healthy DC Plan for adults between 138% and 200% FPL, and extended the Loss of Medicaid SEP through December 31, 2026. Third, in 2026, adults with Medicare above 138% FPL move to QMB only. DC uses the brand DC Health Link for its Marketplace, District Direct for benefit applications, and DHCF for Medicaid. Call the Public Benefits Call Center at (202) 727-5355 for Medicaid questions and 1-855-532-5465 for DC Health Link questions.
Do I still qualify for DC Medicaid after losing it?
DC Medicaid qualification for adults in 2026 depends on income at or below 138% FPL, which is $22,025 for one person and $45,540 for a family of 4 in 2026. If your income fell, your hours dropped, or the termination was procedural, re-apply at districtdirect.dc.gov, since DC Medicaid enrollment is year-round. Pregnant residents and children qualify at much higher incomes, and adults needing long-term care follow separate rules. If you applied after January 1, 2026 with income above 138% FPL, DHCF evaluates you for the Healthy DC Plan or DC Health Link instead. Use the Medicaid income limits page linked on this site for a household-size lookup.
What happens to my children's coverage if I lose DC Medicaid?
Children's coverage is separate from the parent's coverage. The January 2026 income-limit cut applied only to Childless Adults and Parent/Caretaker Relatives, so children can keep DC Medicaid (CHIP-level coverage) even when a parent loses it, at income levels around 324% FPL. Pregnant residents also stay eligible at higher incomes, and an adult who becomes pregnant while on the Healthy DC Plan must report the pregnancy to be moved back to Medicaid for prenatal care and 12 months of postpartum coverage. Log in to districtdirect.dc.gov, check each child's status, and apply for any child without coverage, since children's enrollment is year-round and has no SEP deadline.
