Medicaid Eligibility in D.C.: Income Limits & How to Apply

Medicaid Eligibility in District of Columbia

District of Columbia has expanded Medicaid under the Affordable Care Act. This means adults aged 19-64 with household income at or below 138% of the federal poverty level (FPL) qualify for DC Medicaid. This is approximately $21,597 per year for an individual or $44,367 per year for a family of four in 2026.

The following residents are eligible for DC Medicaid:

• Adults aged 19-64 with income up to 138% FPL
• Children in families with income up to 200-300% FPL (varies by age)
• Pregnant women with income up to 185-200% FPL
• Seniors and people with disabilities who meet income and asset requirements

About 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 $20,400 in 2025. 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 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 $419/month (for a 27-year-old in 2026, the benchmark Silver plan is $449.95), 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.

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.

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 2026

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

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.

At $419/month for a benchmark Silver plan, District of Columbia has some of the more affordable marketplace premiums in the country. Residents just above the Medicaid threshold often pay very little out of pocket after subsidies.

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 $419/month for a 40-year-old in 2026.

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 after subsidies:

These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. 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 operates its own state-based marketplace, DC Health Link, which manages enrollment and plan selection independently from HealthCare.gov. This can mean different plan options and deadlines than the federal marketplace.

District of Columbia's Medicaid program goes beyond the ACA's minimum requirements. DC Medicaid includes comprehensive benefits, and the state's investment in its own marketplace reflects a broader commitment to accessible healthcare coverage.

How to Apply for DC Medicaid

1. Online application — Start at DC Health Link. Your Medicaid eligibility is checked automatically when you enter your income details.
2. State Medicaid office — Apply directly through District of Columbia's Medicaid agency at any time during the year. Unlike marketplace insurance, Medicaid has no enrollment deadline.
3. Phone assistance — Call District of Columbia's Medicaid helpline for guided help completing your application.
4. In-person help — Visit your county human services office or a local navigator for face-to-face support.

You will need to provide proof of income (pay stubs, tax returns), proof of District of Columbia residency, Social Security numbers for household members, and information about any current health coverage.

Frequently Asked Questions

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