D.C. Medicaid Income Limits 2026: Eligibility & Requirements ($22,025/yr)

District of Columbia Medicaid Income Limits 2026

The following table shows the key income thresholds for District of Columbia in 2026:

Household Size	100% FPL	138% FPL (Medicaid Limit)	400% FPL (Subsidy Limit)
1	$15,960	$22,025	$63,840
2	$21,640	$29,863	$86,560
3	$27,320	$37,702	$109,280
4	$33,000	$45,540	$132,000
5	$38,680	$53,378	$154,720
6	$44,360	$61,217	$177,440

If your household income falls below the 138% FPL column, you qualify for DC Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.

About DC Medicaid

Who Qualifies for DC Medicaid

In the District of Columbia, DC Medicaid provides comprehensive health coverage to a significant portion of the population. As of 2024, approximately 271,400 residents, or 38.9% of the population, were covered by Medicaid, indicating a robust and accessible program. You generally qualify for DC Medicaid if you are an adult with income up to 138% of the Federal Poverty Level (FPL). For a single individual, this means an annual income of roughly $22,025. Eligibility is even more generous for other groups: children and pregnant women can qualify with household incomes up to 324% FPL, and parents/caretaker relatives up to 221% FPL. There is no asset test for most MAGI (Modified Adjusted Gross Income) based Medicaid categories, making it easier to qualify based on income alone.

If You're Near the Income Line

If your income is slightly above the DC Medicaid cutoff, you might transition to subsidized coverage through DC Health Link, the District's health insurance marketplace. For instance, while the benchmark Silver plan in DC is around $610/month, subsidies can significantly lower what you actually pay. This means that even if you don't qualify for Medicaid, you could still find affordable plans. The District's uninsured rate was approximately 3% in 2022, significantly lower than the national average of around 8%, which highlights the success of these programs in providing coverage. It's important to remember that changes in your household income can shift your eligibility between Medicaid and marketplace subsidies, so reporting any income changes is crucial. If you lost Medicaid coverage during the recent unwinding of pandemic-era continuous enrollment, you can reapply at any time if your circumstances change.

What DC Medicaid Covers

DC Medicaid offers extensive benefits, typically with no cost-sharing for most services. This means you generally won't have co-pays, deductibles, or premiums. The program covers doctor visits, hospital care, prescriptions, mental health services, and transportation. Beyond standard benefits, the District also has unique programs like the DC Healthcare Alliance, which provides medical assistance to low-income residents not eligible for Medicaid due to immigration status, covering those with incomes up to 215% FPL. Additionally, the Elderly and Persons with Physical Disabilities (EPD) Waiver helps seniors and adults with disabilities receive long-term care services at home or in assisted living, preventing nursing home admissions.

Tips for Applying

Be aware that while DC Medicaid is comprehensive, there can be state-specific considerations. For instance, while generally there's no asset test for MAGI-based Medicaid, specific programs like those for the aged, blind, and disabled (ABD Medicaid) or nursing home care do have asset limits (e.g., $4,000 for a single applicant in 2026). Also, the District of Columbia is planning to implement a Basic Health Program for adults with incomes between 138%-200% FPL starting January 1, 2026, which will reduce Medicaid eligibility for parents and other adults to 138% FPL. To ensure continuous coverage, respond promptly to any requests for information or renewal notices from DC Medicaid. If you need to apply, you can do so online via DC Health Link, by phone, or in person at an Income Maintenance Administration (IMA) Service Center.

District of Columbia Medicaid Income Limits for Children and Pregnancy

Children and pregnant women qualify for coverage in District of Columbia at higher incomes than other adults. Children under 19 are covered up to 324% of the federal poverty level, all through Medicaid. Pregnancy coverage runs up to 324% FPL.

Annual income limits for 2026, including the standard 5-point income disregard. A pregnant woman counts as at least two people, so the one-person row does not apply. Limits as of January 2026, from KFF's annual survey of state Medicaid and CHIP eligibility rules.

Marketplace Insurance in District of Columbia

District of Columbia residents who do not qualify for Medicaid can purchase private health insurance through DC Health Link. The average benchmark (second-lowest cost Silver) plan in District of Columbia costs approximately $610/month for a 40-year-old (2026 average; 2027 rates are published shortly before open enrollment begins November 1).

Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in District of Columbia might pay for a Silver plan after subsidies under the 2027 premium tax credit rules, based on the $610/month benchmark:

Income Level	Annual Income	Your Cost	Monthly Subsidy
150% FPL	$23,940	~$86/mo	$524/mo
200% FPL	$31,920	~$180/mo	$430/mo
250% FPL	$39,900	~$288/mo	$322/mo
300% FPL	$47,880	~$408/mo	$202/mo
400% FPL	$63,840	~$544/mo	$66/mo

These estimates are for a 40-year-old individual on a benchmark Silver plan in District of Columbia. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. District of Columbia runs its own marketplace through DC Health Link.

How to Apply for DC Medicaid

Medicaid enrollment is open year-round — there's no deadline. You can apply through any of these channels:

• Online: Apply through DC Health Link — the system automatically checks your DC Medicaid eligibility when you enter your income.
• Phone: Call District of Columbia's Medicaid helpline for guided help with your application.
• In person: Visit your local human services office or a certified application counselor.

You'll need proof of income (pay stubs or tax returns), proof of District of Columbia residency, and Social Security numbers for household members.