Washington DC Medicaid Definition
Medicaid in Washington DC is administered by the Department of Health Care Finance (DHCF) agency.
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, health coverage is provided for varying groups of Washington DC residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. While there are differing eligibility groups, this page is focused strictly on Medicaid eligibility for Washington DC elders, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Washington DC seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Washington DC offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program. This means anyone who meets the eligibility requirements will receive assistance, which is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are a limited number of participant enrollment slots. Therefore, wait lists may exist. Benefits are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged, Blind and Disabled (ABD) – this is an entitlement program, which means as long as eligibility requirements are met, one will receive assistance. Benefits are provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from an Washington DC Medicaid program. Alternatively, persons can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible in the District of Columbia. More.
|2020 Washington DC Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,349 / month*||$4,000||Nursing Home||*$4,626 / month (Each spouse is allowed up to $2,349)||$6,000||Nursing Home||$2,349 / month for applicant*||$4,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$4,000||Nursing Home||*$4,626 / month (Each spouse is allowed up to $2,349)||$6,000||Nursing Home||$2,349 / month for applicant||$4,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,063.33 / month||$4,000||None||$1,436.67 / month||$6,000||None||$1,436.67 / month||$6,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, railroad retirement, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends.
When only one spouse of a married couple is applying for Medicaid (institutional or HCBS Medicaid waiver), only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. However, income is treated differently for a married couple with one spouse applying for regular Medicaid. In this case, the income of both the applicant and non-applicant spouse is counted towards the income limit. For more information on how Medicaid counts income, click here.
For married couples with non-applicant spouses’ of nursing home Medicaid or Medicaid waiver applicants, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). This income allowance is intended to ensure the non-applicant spouses have sufficient income from which to live. Simply put, if the non-applicant spouse, also called the community spouse or well spouse, has income under $2,155 / month (this figure will change in July 2021), he or she is entitled to a portion of the applicant spouse’s income, bringing his or her income to $2,155 / month. Based on the non-applicant’s shelter and utility costs, he or she may be entitled to a greater portion of his or her applicant spouse’s income. As of January 2020, the maximum monthly maintenance needs allowance is $3,216 / month (this figure will change in January 2021.) To clarify, this spousal income allowance does not extend to non-applicant spouses of those applying for regular Medicaid.
*Please note that while there is an income limit of $2,349 / month (in 2020) for nursing home Medicaid, a beneficiary is not able to keep up to this amount of income. Instead, with the exception of a personal needs allowance of approximately $70 / month, and potentially a non-applicant spousal income allowance, all of a beneficiary’s income must be paid to the nursing home residence.
What Defines “Assets”
Countable assets (also called resources) include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility purposes, there are many assets that are not counted. In other words, they are exempt from the eligibility limit. Exemptions include personal belongings, such as clothing, household furnishings, a vehicle, a burial plot for the applicant and spouse, and life insurance, given the face value is not greater than $1,500. One’s primary home is also exempt if the Medicaid applicant is married and his or her spouse lives in the home. The home may also be exempt for single Medicaid applicants, given the applicant lives in it or expresses an “intent” to return to it, and his / her home equity interest in the home is not more than $893,000 (in 2020). (Equity interest is the amount of the home’s value owned by the applicant).
In 2020, for married couples with one spouse applying for nursing home Medicaid or a HCBS Medicaid waiver, the community spouse can retain half of the couples’ joint assets (up to a maximum of $128,640), as the chart indicates above. However, if a couple’s joint assets are equal or less than $25,728, the non-applicant spouse can keep all of it. This is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from becoming impoverished. As with the spousal income allowance, this spousal resource allowance is not relevant to married couples with one spouse as a regular Medicaid applicant.
It is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Washington DC has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past asset transfers to ensure no assets were sold or given away for less than they are worth. This includes asset transfers that one’s non-applicant spouse may have made. If a Medicaid applicant is found to be in violation of the look-back period, a penalization period in the form of Medicaid ineligibility will result.
Qualifying When Over the Limits
For Washington DC elderly residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In Washington DC, the Medically Needy Pathway, also commonly referred to as the Medically Needy Spend Down Program, allows those who would otherwise be over the income limit to qualify for Medicaid if they have high medical expenses. In simple terms, one may still qualify for Medicaid services by “spending down” their excess income (the amount that is over the medically needy income level) on private health insurance, prescription medications, unpaid medical bills, and medical expenses that Medicaid does not cover. (The amount one must “spend down” can be thought of as a deductible.) As of February 2020, the medically needy income limit is $682.42 / month for a single applicant and $718.33 / month for a married couple. Once one has spent his or her income down to the medically needy income level, Medicaid will kick in for the remainder of the spend down period, which is six months in the District of Columbia.
Make note, the Medically Needy Pathway does not assist one in spending down assets for Medicaid qualification. Said another way, if one meets the income requirement for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in reducing excess assets to meet the asset limit. However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. As mentioned previously, when spending down assets, it’s important that one does not give away assets or sell them for less than they are worth. This is because in Washington DC, Medicaid has a “Look-Back” period of 5 years, and if one is in violation, a period of Medicaid ineligibility will result.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Washington DC Medicaid Programs
1) Adult Day Health Care & Personal Care – part of the state Medicaid plan, adult day health care and personal care assistance is available as nursing home diversion services. Personal care assistance, which provides aid with activities of daily living, such as bathing, grooming, dressing, eating, and mobility, is available both in-home and in adult day health care. Additional benefits are provided in adult day health care and include supervision, meals, and therapeutic activities.
2) Elderly and Persons with Disabilities Medicaid Waiver – abbreviated as the EPD Waiver, benefits promoting independent living at home or in assisted living are provided to delay and prevent institutionalization of seniors and disabled individuals. An option, Services My Way, allows program participants to hire the individual of their choosing, including adult children, to provide personal care services. Other benefits include adult day health, personal emergency response systems, home modifications, respite care, and homemaker services.
How to Apply for Washington DC Medicaid
To apply for Medicaid in the District of Columbia, seniors need to submit a “Combined Application for Benefits” either by mail to the Department of Human Services, Economic Security Administration, Case Record Management Unit, P.O. Box 91560, Washington, DC 20090 or by fax to 202-671-4400. Alternatively, seniors can return the completed application to their local Economic Security Administration (ESA) Service Center. Find yours here. Persons might find their local Area Agency on Aging office helpful with the application process. Currently, elderly applicants do not have the option of applying for Medicaid benefits online.
Prior to submitting a Combined Application for Benefits in Washington DC, senior applicants should be certain that they meet all eligibility requirements (as discussed above) for the program in which they are applying. Being over the income and / or asset limit(s), or being uncertain if eligibility criteria are met, can result in a denial of benefits. In these cases, persons should seriously consider Medicaid planning for the best chance of acceptance into a Medicaid program. For additional information about applying for long-term care Medicaid, click here.