DC Medicaid Income Limits 2026 (Washington DC)

Washington DC Medicaid, administered by the Department of Health Care Finance (DHCF), covers roughly 270,000 District residents and is one of the most comprehensive public-health insurance programs in the country. DC adopted the Affordable Care Act Medicaid expansion effective January 1, 2014, and historically extended Medicaid to adults with income up to 210-215% of the Federal Poverty Level, well above the federal 138% floor. Effective January 1, 2026, DHCF reduced adult income limits to the standard federal threshold of 138% FPL under Medicaid Director Letter MDL 25-02, freeing about 25,000 adults who had been enrolled between 138% and 215% FPL. Those adults transitioned to the new Healthy DC Plan, a Basic Health Plan (BHP) under ACA Section 1331 that provides equivalent coverage with no premiums. For children and pregnant individuals, DC's Medicaid limits remain among the highest in the nation at 319% FPL.

DC Medicaid eligibility breaks down into four main populations: (1) adults (childless adults and parents or caretaker relatives) covered at 138% FPL under the ACA expansion; (2) children ages 0-20 covered through DC Healthy Families at 319% FPL, funded through the federal M-CHIP (Medicaid-funded CHIP) structure with no separate stand-alone CHIP program; (3) pregnant individuals covered at 319% FPL with full Medicaid benefits plus 12 months of postpartum coverage; and (4) aged, blind, and disabled adults covered under SSI-related rules with an income limit of approximately $1,330 per month for an individual. DC also offers an expanded Qualified Medicare Beneficiary (QMB) program that covers Medicare cost-sharing for low-income seniors up to 300% FPL, well above the federal standard. All MAGI categories have no asset test.

The 2026 Federal Poverty Level for the 48 contiguous states is $15,960 for a household of one and increases by $5,680 per additional household member, reaching $33,000 for a family of four. DC uses the standard 48-state FPL figures rather than Alaska or Hawaii rates. At 138% FPL, a single adult qualifies for DC Medicaid with income up to $22,025 per year ($1,835 per month). At 319% FPL, a family of four qualifies for children's DC Healthy Families coverage with income up to $105,270 per year ($8,773 per month). If your income is above the adult Medicaid limit but below 200% FPL, the Healthy DC Plan covers you at no premium cost through DC Health Link. Income above 200% FPL may still qualify for subsidized marketplace coverage, and DC Health Link can screen for all three programs simultaneously.

DC Medicaid (District of Columbia Medicaid) income limits by household size (2026)

The 2026 DC Medicaid income guidelines below are based on the 2026 Federal Poverty Level for the 48 contiguous states. Adult column = expansion-group DC Medicaid (138% FPL, covers adults with or without dependent children as of 2026). Children column = DC Healthy Families / M-CHIP (319% FPL; DC has no separate stand-alone CHIP). Pregnancy column = DC Medicaid for Pregnant Individuals (319% FPL, with 12 months of postpartum coverage). Add roughly $5,680 of annual income per additional household member.

DC Medicaid (District of Columbia Medicaid) eligibility requirements (non-income)

DC Medicaid eligibility covers both income-based criteria (covered by the household-size table above) and non-income criteria below. All MAGI categories (adults, children, pregnant individuals) have no asset test. Asset tests apply only to the aged, blind, and disabled (ABD) category and long-term care Medicaid.

• DC residency: You must be a resident of the District of Columbia. Residency is established by living in DC with the intent to remain. There is no minimum length-of-residency requirement for most Medicaid categories.
• Citizenship and immigration status: U.S. citizens and many lawfully present immigrants qualify for full DC Medicaid benefits. Lawful permanent residents face a federal 5-year waiting period from the date of obtaining their green card (with exceptions for refugees, asylees, and certain other humanitarian categories). DC also offers the DC Health Care Alliance and Immigrant Children's Program (ICP) for residents ineligible for federal Medicaid due to immigration status.
• Social Security Number: Adults must provide a Social Security Number (SSN) or apply for one to receive DC Medicaid. Children and pregnant individuals may receive coverage while an SSN is pending, though one must be applied for as a condition of enrollment.
• Household composition: DC Medicaid uses federal MAGI household rules to determine which household members count toward the household size and income calculation. Dependents on a tax return, spouses living together, and tax filers themselves form the MAGI household. Non-filers use different household composition rules.
• Asset test (ABD and long-term care only): MAGI categories (adults under 65, children, pregnant individuals) have NO asset test. The DC Medicaid aged, blind, and disabled (ABD) category applies a $4,000 individual asset limit and a $6,000 couple limit. Nursing home and home-and-community-based-services Medicaid applies a $4,000 individual asset limit with a 60-month lookback period for asset transfers.
• Other health insurance: Having other health insurance does not automatically disqualify you from DC Medicaid. Medicaid serves as payer of last resort. If you have employer-sponsored insurance, DHCF may coordinate benefits rather than deny enrollment.

What income counts for DC Medicaid (District of Columbia Medicaid)

DC Medicaid uses Modified Adjusted Gross Income (MAGI) to determine income for most non-elderly non-disabled applicants. MAGI is based on federal tax concepts and does not look at assets or resources for adults, children, or pregnant individuals. DC applies the standard federal 5% income disregard, which effectively raises the usable MAGI threshold by 5 percentage points above the nominal limit. The income limit published by DHCF already incorporates this disregard for some categories, so always compare your gross annual income to the DHCF-published figure for your household size.

Income sources included

• Wages, salaries, and tips (reported on Form W-2): All wages and compensation for work performed, including overtime and bonuses, count toward MAGI.
• Self-employment net earnings (Form 1099-NEC or Schedule C): Net profit from freelance, gig work, or business ownership counts after deducting ordinary and necessary business expenses.
• Unemployment compensation: All unemployment benefits received from DC DOES or any other state's unemployment program count toward MAGI.
• Social Security retirement and survivor benefits: Taxable Social Security benefits (reported on Form SSA-1099) count toward MAGI. The taxable portion depends on your overall income under the IRS provisional income calculation.
• SSDI (Social Security Disability Insurance): SSDI benefits count toward MAGI, unlike SSI (Supplemental Security Income) which is excluded. Many SSDI recipients also qualify for Medicare, making dual eligibility (both DC Medicaid and Medicare) common.
• Pensions, annuities, and retirement distributions: Taxable distributions from 401(k), IRA, pension plans, and annuities count toward MAGI in the year distributed.
• Interest, dividends, and capital gains: Investment income, including bank account interest, stock dividends, and capital gains from the sale of assets, counts toward MAGI.
• Rental and royalty income: Net rental income from properties you own and royalty payments from intellectual property or natural resources count toward MAGI.

Income sources excluded

• SSI (Supplemental Security Income): SSI payments from the Social Security Administration are NOT counted as MAGI income. SSI is a needs-based program and does not count even though it provides monthly cash benefits.
• Child support received: Child support payments received from a non-custodial parent are not counted as income for DC Medicaid MAGI purposes.
• Veterans' benefits: VA disability compensation, pension payments, and GI Bill education benefits are excluded from MAGI. This is particularly relevant in DC, which has a significant veteran population from nearby military installations.
• Workers' compensation: Benefits received for a workplace injury or illness under federal or DC workers' compensation programs are not counted as MAGI income.
• Gifts, inheritances, and loan proceeds: One-time or periodic gifts, inherited assets, and proceeds from loans are not income under MAGI rules and do not count toward the DC Medicaid income threshold.
• TANF and most cash assistance: Temporary Assistance for Needy Families (TANF) and similar District-administered cash-assistance payments are excluded from MAGI income.
• Foster care payments: Payments made to foster parents for the care of foster children are not counted as MAGI income for DC Medicaid eligibility purposes.

How to apply for DC Medicaid (District of Columbia Medicaid) in Washington DC

DC Medicaid applications are handled by the Department of Human Services (DHS) Economic Security Administration (ESA) in coordination with DHCF. The primary online application portal is District Direct at districtdirect.dc.gov, which also screens for SNAP, TANF, and the Healthy DC Plan in one combined application. DC residents can also apply through DC Health Link at dchealthlink.com, by phone, by mail, by fax, or in person at any of DC's five Economic Service Centers.

1. 1. Gather your documents before you start: photo ID, Social Security Number (or proof of application for one), proof of DC residency such as a utility bill or lease, proof of immigration status if applicable, and income documentation including the most recent pay stubs or award letters.
2. 2. Apply online at districtdirect.dc.gov: Create an account, complete the application for all household members, and upload your supporting documents. The same application covers Medicaid, SNAP, TANF, and the Healthy DC Plan. Alternatively, call the DC Public Benefits Call Center at (202) 727-5355 to apply by phone.
3. 3. Complete and sign the application, listing all household members, reporting all household income, and attesting to your DC residency. Electronic signatures are accepted online.
4. 4. Respond promptly to any DHS/ESA requests for additional information or verification documents. The agency typically issues requests within the first two weeks of receiving your application. Failure to respond within the specified timeframe is one of the most common reasons applications are denied.
5. 5. Wait for the eligibility determination notice. Standard applications are decided within 45 days; disability-based applications take up to 60 days because a medical determination is required. Pregnancy applications are processed on an expedited timeline under federal rules.
6. 6. Once approved, you will receive a Medicaid card or enrollment notice. DC Medicaid uses managed care organizations (MCOs); you may be asked to choose a health plan. Renew your eligibility each year during the annual redetermination process.

Official portal: districtdirect.dc.gov

Documents needed

• Photo ID for the adult applying (DC driver's license, DC non-driver ID, U.S. passport, or other government-issued photo ID)
• Social Security Number for each household member applying for coverage, or proof that an SSN application is pending
• Proof of DC residency such as a recent utility bill, lease or rental agreement, bank statement, or official mail addressed to your DC address
• Proof of U.S. citizenship or qualifying immigration status (birth certificate, U.S. passport, or permanent-resident card; USCIS documentation for other immigration categories)
• Last 30 days of pay stubs for all employed household members, or 12 months of records for self-employment or irregular income
• Award letters or benefit statements for any Social Security, SSDI, SSI, unemployment, pension, or other income sources

Processing timeline: Standard DC Medicaid applications are decided within 45 days of the date your complete application is received. Applications for disability-related Medicaid categories take up to 60 days because they require a medical determination by DHCF. Pregnant individuals are processed on an expedited timeline: federal rules require a decision as quickly as practicable, typically within 15 business days. If you submit your application online at districtdirect.dc.gov and provide all required documents at the time of submission, processing is often faster than the statutory maximum.

Common reasons applications get denied

• Income above the income limit for the applicant's category: adults over 138% FPL, children over 319% FPL, or ABD adults over the SSI-related income limit. Adults between 138% and 200% FPL should check eligibility for the Healthy DC Plan instead.
• Failure to respond to a request for additional documentation within the specified timeframe. Applications are closed if the agency does not receive requested verification within the stated deadline.
• Not a DC resident: Medicaid is state-specific. Applicants must reside in the District and demonstrate DC residency with documentation.
• Federal 5-year bar for certain newly arrived lawful permanent residents. Lawful permanent residents who entered the U.S. after August 22, 1996, generally must wait 5 years before qualifying for federally funded Medicaid (certain exceptions apply for refugees and asylees).
• Duplicate enrollment in another state's Medicaid: A person can only be enrolled in Medicaid in one state at a time. If an applicant is currently enrolled in Medicaid in another state, they must terminate that coverage before being enrolled in DC Medicaid.

If your child's family income is above the DC Medicaid limit for children

Washington DC covers children ages 0-20 through DC Healthy Families, which is funded under the federal M-CHIP (Medicaid-funded CHIP) structure, up to 319% of the Federal Poverty Level. DC does not operate a separate stand-alone CHIP program. At 319% FPL, DC's children's coverage threshold reaches $105,270 per year for a family of four in 2026, one of the highest in the country. If your child's family income is above 319% FPL, they may be eligible for a subsidized plan through DC Health Link (dchealthlink.com). Premiums and cost-sharing on marketplace plans apply above the Medicaid threshold, but Advanced Premium Tax Credits may cover most or all of the premium depending on family income.

Compare Medicaid and CHIP income limits across all 50 states

If you are 65 or older with Medicare and limited income: DC Medicare Savings Programs

Washington DC operates one of the most generous Medicare Savings Programs (MSPs) in the nation. While most states run three separate MSP tiers (QMB, SLMB, and QI), DC has consolidated its MSP into an expanded Qualified Medicare Beneficiary (QMB) program that covers Medicare beneficiaries up to 300% of the Federal Poverty Level. In 2026, that means DC QMB covers individuals earning up to approximately $4,010 per month and couples earning up to approximately $5,430 per month. DC QMB pays Medicare Part A and Part B premiums, deductibles, and coinsurance, effectively eliminating out-of-pocket costs for Medicare-covered services. DC's QMB program has no asset limit, making it easier to qualify than the federal standard. Dual-eligible DC residents who qualify for both Medicare and DC Medicaid may access D-SNP (Dual Eligible Special Needs Plans) for coordinated care. Apply through DHCF at dhcf.dc.gov or call (202) 442-5988.

Read the Medicare eligibility guide

Frequently Asked Questions