In Washington, DC, Medicare does not pay for long-term custodial care, and DC Medicaid, run by the DC Department of Health Care Finance (DHCF), is the payer that covers it., At CareScout's 2025 median, a semi-private nursing home room in the Washington, DC metro area costs $146,730 a year. For help sorting out how to pay for senior care in Washington, DC, there is no county Area Agency on Aging to call: the DC Department of Aging and Community Living (DACL) is both the State and the Area Agency on Aging for the whole District, and its 2024-2027 State Plan on Aging says "DC is a single planning and service area and does not have Area Agencies on Aging." If you're reading this after a hospital call you didn't expect, take a breath. The payers come in a knowable order: your own funds and Medicare first, then DC Medicaid for the long haul.

In This Guide

What Senior Care Costs in Washington, DC

CareScout's 2025 Cost of Care Survey, released March 2, 2026, reports each Washington, DC median as an annual figure.

Type of care Washington, DC annual median (2025) Basis CareScout uses
Assisted living community $77,934 12 months, private one-bedroom
Nursing home, semi-private room $146,730 365 days of care
Nursing home, private room $173,740 365 days of care
Non-medical in-home caregiver $86,944 44 hours a week for 52 weeks
Adult day health care $28,600 5 days a week for 52 weeks

For comparison, CareScout's 2025 national medians are $74,400 a year for assisted living and $114,975 a year for a semi-private nursing home room, so a year in a District nursing home runs well above the national figure.

One caution on reading those numbers. CareScout collects its rates at the metropolitan-area level, its one DC region covers the Washington, DC, Arlington and Alexandria metro area, and CareScout says its regions can include counties from other nearby states. So the DC median describes the metro area, not only providers inside the District line. Our guide to the cost of senior care in Washington, DC goes through each type of care in more depth.

Those are the numbers a parent's savings run against until another payer steps in.

Who Pays for Senior Care in Washington, DC

These payers are rarely used one at a time: private funds often hold the line while a Medicaid application is processed, Medicare covers a rehab stay, and DC Medicaid carries the long haul.

Payer What it covers The limit that catches families Where it runs
Private funds Anything, immediately, with no eligibility test A District nursing home runs $146,730 a year at the 2025 semi-private median Directly with the provider
Medicare Skilled nursing facility care on a short-term, post-acute basis, up to 100 days per benefit period No long-term custodial care, and days 21 through 100 carry a $217 daily coinsurance in 2026 Federal, through Medicare
DC Medicaid Long-term care in a nursing facility, or at home through a waiver 2026 income standard of $2,982.00 a month and a $4,000 countable resource limit for one person DHCF
District programs Property tax relief, DACL services, and DC Paid Family Leave for a working caregiver Each has its own test District agencies

The sections below explain the Medicare and DC Medicaid rows in full.,, If your parent is a veteran or a veteran's surviving spouse, our guide to VA Aid and Attendance covers that route.

Paying Out of Pocket Is a Bridge, Not a Plan

Paying privately for a few months is a plan. Paying privately for a few years is what drains a lifetime of savings, and at the District's 2025 median of $173,740 a year for a private nursing home room, that happens fast.

The useful way to think about private funds is as the bridge that holds while an application is decided. DC Medicaid has a pathway built for the family whose income is too high for the standard limit but whose medical bills are large: the Medically Needy spend-down, with a 2026 DC Medicaid medically needy income level of $856.90 a month for an individual and $902.00 for a household of two or more, measured over a six-month budget period. In the District, spending on care can also be the mechanism that gets your parent qualified.

What Medicare Covers, and Where It Stops

Medicare Part A covers skilled nursing facility (SNF) care on a short-term, post-acute basis, and it does not cover long-term custodial care, meaning ongoing help with activities of daily living when that's the only care needed.

To get the Medicare SNF benefit, a beneficiary generally needs a qualifying inpatient hospital stay of at least three consecutive days, then has to enter a Medicare-certified SNF within a short time, generally 30 days, for skilled care related to that stay. Time under observation or in the emergency room before admission does not count toward the three days, "even if you're there overnight."

A parent without a qualifying three-day stay should not conclude they simply don't qualify. Medicare.gov names four routes. A doctor in an Accountable Care Organization approved for a Skilled Nursing Facility 3-Day Rule Waiver, or a Medicare Advantage plan, may waive the three-day minimum. Re-entering the same or another SNF within 30 days of leaving one needs no new three-day stay. If a hospital changes a patient's status from inpatient to outpatient getting observation services, Medicare's fast appeal is open while the patient is still in the hospital; the separate retrospective track for past stays closed to new filings on January 2, 2026, and a late request is denied unless good cause for filing late is established. And a family can ask whether another program, such as Medicaid, can cover the SNF care.

On cost, days 1 through 20 of a covered Medicare SNF stay in 2026 are "$0 each day after you pay the $1,736 deductible," and a beneficiary who already paid that Part A deductible for hospital care in the same benefit period does not pay it again. Days 21 through 100 carry a daily coinsurance of $217 in 2026, and after day 100 Medicare pays nothing for that benefit period.

DC Medicaid Through DHCF: The Main Way to Pay for Senior Care in Washington, DC

DHCF is the District of Columbia's state Medicaid agency. For most families it ends up carrying the cost of care.

For DC Medicaid long-term care in the aged, blind and disabled category, whether in a nursing facility or at home through a waiver, the 2026 countable resource limit is $4,000 for one person and $6,000 for a married couple, and the home, one vehicle, and ordinary home and personal goods are excluded from that count. DC Medicaid covers institutional and waiver long-term care through a Special Income Standard equal to 300% of the Supplemental Security Income (SSI) federal benefit rate, which is $2,982.00 a month in 2026.

Three things those limits hide, each on DHCF's long-term care page.

SSI recipients. An SSI recipient is not subject to either DC Medicaid limit. For the SSI covered group, DHCF states there is no income limit and no asset limit, "because SSI recipients are categorically eligible for Medicaid." If your mother already receives SSI, nobody should be telling her to spend down to $4,000.

Spend-down renewal. Medically Needy enrollment does not renew itself. Once the six-month DC Medicaid Medically Needy spend-down obligation is met, DHCF enrolls the individual from the first day of the month in which it was met through the rest of that six-month period. At the end of it, in DHCF's words, "the individual must file a new application for Medicaid to re-determine their eligibility and/or spend down obligation for the next six month period." Put the re-application date in your calendar the day you're approved.

Married couples. The $6,000 married-couple figure is the DC Medicaid resource limit DHCF publishes for the applicant's own countable resources, not a community spouse's ceiling, and DHCF's page says nothing about the federal spousal-impoverishment rules that apply when one spouse enters a nursing facility and the other stays home. If you're the spouse staying in the District home, read our guide to DC Medicaid spousal impoverishment rules before assuming $6,000 is what your household may keep.

A DC Medicaid resident of a nursing facility keeps a Personal Needs Allowance of $109 a month, effective January 1, 2026.

The EPD Waiver, if the goal is staying home

The District's home and community-based services program for older adults and people with physical disabilities is the Elderly and Persons with Physical Disabilities (EPD) Waiver. The District applies the same income standard to its Medicaid home and community-based services waivers, 300% of the SSI federal benefit rate, which is $2,982 a month for an individual in 2026.

One detail is easy to misread. DACL's EPD Waiver page still lists a monthly countable-income limit of $2,743, its stated 2023 value, or the ability to meet a spend-down obligation. That 2023 figure has not been updated, and the spend-down route on the same line means income above it is not by itself disqualifying. If someone tells you your father earns too much for the waiver, that is the line to point at. Our guide to how DC Medicaid pays for care at home covers the EPD Waiver's services and assessment, and How to Pay for Assisted Living in Washington, DC covers the assisted living side.

How a DC resident applies

You can apply for DC Medicaid online at District Direct, by phone through the DC Department of Human Services (DHS) Economic Security Administration Public Benefits Call Center at (202) 727-5355, by mail, or in person at any Economic Security Administration service center, and the District does not require in-person interviews. The step-by-step version is in our guide to applying for DC Medicaid.

Long-Term Care Insurance and the Tax Rules That Bite

If your parent bought a tax-qualified long-term care (LTC) insurance policy, federal tax rules shape how far it goes.

The first governs benefits paid out. Per-diem, or indemnity, benefits are excluded from income only up to the per diem limitation of 26 USC section 7702B(d), which is the greater of the indexed dollar amount or the costs actually incurred for qualified long-term care services, reduced by reimbursements. For calendar year 2026, the federal per-diem limit on tax-free long-term care insurance benefits under 26 USC section 7702B(d) is $430 a day, so it binds only where a policy pays more per day than the care actually costs.

The second governs premiums. Eligible LTC insurance premiums count as a medical expense under section 213(d) only up to age-banded federal limits that are re-indexed each year.

Attained age 2026 eligible premium limit
40 or less $500
More than 40 but not more than 50 $930
More than 50 but not more than 60 $1,860
More than 60 but not more than 70 $4,960
More than 70 $6,200

Those age bands apply to tax years beginning in 2026. Counting as medical care is not the same as producing a deduction. The federal medical-expense deduction is itemized on Schedule A and reaches only the part of medical and dental expenses above 7.5 percent of adjusted gross income, so a taxpayer who takes the standard deduction deducts none of the premium by that route. See how long-term care insurance works for the policy mechanics.

District Programs That Cut the Cost of Care

The District runs these outside the Medicaid and Medicare tracks.

The property tax relief that halves the bill

The District's Senior Citizen or Disabled Property Owner Tax Relief cuts a qualifying owner-occupant's real property tax in half. The DC Office of Tax and Revenue (OTR) states that it "reduces a qualified property owner's property tax by 50 percent," and D.C. Code section 47-863(b)(1) computes it as the tax rate multiplied by 50% of the current tax year's taxable assessment.

The DC income test surprises people in two ways. OTR's published ceiling is that "The total household federal adjusted gross income for 2024 must be less than $163,500.00 for tax year 2026," and that 2024 income year is deliberate: section 47-863(a)(2) tests the household on the federal income tax year ending immediately before the tax year the relief applies to. The statute also indexes the ceiling every October 1, so the $163,500.00 figure is specific to DC tax year 2026 and a different figure governs tax year 2027. Check OTR's page for the figure in force when you apply.

The District's Homestead Deduction is a prerequisite, not an alternative, and both are claimed on OTR's ASD-100 form at MyTax.DC.gov. For DC tax year 2026 the Homestead Deduction reduces a property's assessed value by $91,950.00 before tax is computed, which OTR puts at a $781.58 saving on the annual bill.

Timing turns on when you file. Under D.C. Code section 47-863, a properly completed and approved application filed between October 1 and March 31 carries the relief for the entire tax year, while one filed between April 1 and September 30 carries half of it, applied to the second installment. The form isn't re-filed each year, but OTR requires an online cancellation request within 30 days of a change in eligibility. The disability route is a list, not a label: an owner who has a permanent and total disability determination from the Social Security Administration, or who receives SSI or Social Security Disability, railroad retirement disability benefits, or federal or District government disability payments, meets it, alongside the same income test. OTR also states that a property receiving the Disabled Veterans' Homestead Deduction can't also receive this relief. Our guide to DC's Disabled Veterans' Homestead Deduction covers that deduction.

For a lower-income household there's a separate program. OTR states that a household with total adjusted gross income under $50,000 may qualify for the District's Low-Income Senior Citizen Property Tax Deferral, which lets a senior defer the entire annual tax bill. Read this before you apply, because OTR's page does not say it: D.C. Code section 47-845.03(e) puts a lien on the property for the deferred tax plus interest and penalties, payable within 30 days of a transfer. On the applicant's death, the deferred balance under DC's Low-Income Senior Citizen Property Tax Deferral comes due within 90 days, or 30 days after a transfer or the end of probate if that is sooner, when the home does not pass to heirs, and within one year when it passes to heirs by trust, transfer on death deed or a similar instrument. A DC property tax deferral is a debt secured against the home, not a discount.

The services DACL provides, and the one that tests income

Most of what the District provides through DACL is age-based rather than income-tested. DACL runs Older Americans Act core services through its Senior Service Network, working with more than 20 community-based organizations, and serves "District residents 60 and older, adults living with disabilities, and those who care for them." For community dining, home-delivered meals, in-home help, case management, transportation to medical appointments, and caregiver respite and stipends, the criteria DACL publishes turn on age, District residence, disability, frail or homebound status, or caregiver status, with no income figure.

The exception is Safe at Home, DACL's home-modification program, whose adaptations include handrails, grab bars, bathtub cuts, shower seats and stair lifts. DACL puts the Safe at Home income limit at "A maximum of $99,600 for an individual or $113,850 for a household of two," tied to 100% of Area Median Income, and footnotes it with "Additional eligibility requirements apply." So a household under the Safe at Home ceiling should apply rather than assume it qualifies.

If you're the adult child doing the caregiving and you work in the District, DC Paid Family Leave can pay you while you care for a family member with a serious health condition, and the benefit changes on October 1, 2026. The DC Department of Employment Services (DOES) states that under the Fiscal Year 2027 Budget Support Act of 2026, DC Paid Family Leave's Family Leave runs up to 6 weeks in a year and the maximum weekly benefit is $1,100 for all claim types, where DOES's October 2025 notice gave 12 weeks and $1,190. Under the revised notice, the maximum for any combination of parental, family and medical leave is 12 weeks. DOES says the timing of your application matters under the change, so if your leave falls around October 1, 2026, confirm with the Office of Paid Family Leave which rule applies to your claim.

The DC Paid Family Leave benefit replaces wages rather than paying a flat amount: 90% of wages up to 1.5 times the District's minimum wage and 50% above that, up to the weekly maximum. Coverage turns on where you work, not where you live. D.C. Code section 32-541.01(3) defines a covered employee by work time spent in the District or employment based there, so a Maryland or Virginia resident working in the District for a covered employer can qualify. The federal government and the District government are excluded from the definition of a covered employer, so their employees are not covered. The statutory definition of family member includes a parent, a parent-in-law, a stepparent, a grandparent and a sibling. You apply after the care need begins, online or by phone, and DOES's notice says to apply no more than 30 days after the event. DC Paid Family Leave does not provide job protection; DOES points to laws such as the FMLA for that.

Who to Actually Call in Washington, DC

The District gives a family two numbers, not one.

For aging services, assessment and a case manager, call DACL's Information & Referral/Assistance unit, which DACL calls its "intake assessment and referral unit for programs in health education and social services." Intake is open to adults 60 and older, people with disabilities aged 18 to 59, and their caregivers, Monday through Friday, 9:30 AM to 4:30 PM, at 202-724-5626. That is also DACL's answer to how you get a case manager or social worker.

For the DC Medicaid application itself, DACL sends you elsewhere. Asked how to apply for Medicaid, DACL's own page points to the DHS Public Benefits Call Center at (202) 727-5355, 7:30 am to 4:45 pm, Monday to Friday.

Beneath DACL, the District's layer is wards and contracted community organizations rather than county government. DACL describes its Lead Agencies as "neighborhood-based resource centers designed to help you find services without having to leave your own community."

Frequently Asked Questions

Does Medicare pay for a nursing home in Washington, DC?

Medicare Part A covers skilled nursing facility care only on a short-term, post-acute basis, up to 100 days per benefit period, and it does not pay for long-term custodial care. Long-term nursing home care in Washington, DC is paid by DC Medicaid through DHCF, by private funds, or by a long-term care insurance policy.

How long does DC Medicaid long-term care coverage last before you re-apply?

DHCF gives the SSI and Special Income Standard groups in DC Medicaid long-term care a one-year eligibility period, and the Medically Needy spend-down group a six-month period. At the end of a DC Medicaid spend-down period, DHCF says the individual must file a new application to re-determine eligibility.

Can DACL help my parent fill out a DC Medicaid application?

DACL's case managers and social workers help District residents fill out public benefits applications and apply to long-term programs and supports, and DACL says the way to get a case manager is to call its Information & Referral/Assistance line at 202-724-5626. The DC Medicaid application itself goes to the DHS Public Benefits Call Center at (202) 727-5355 or online through District Direct.

Where do I mail a DC Medicaid application?

A paper DC Medicaid application goes to the Department of Human Services, Economic Security Administration, Case Record Management Unit, P.O. Box 91560, Washington, DC 20090, and the District does not require an in-person interview.

How much is DC senior property tax relief worth?

The District's Senior Citizen or Disabled Property Owner Tax Relief cuts a qualifying owner-occupant's DC real property tax by 50 percent, and the District's Homestead Deduction is a prerequisite for it.

Learn More

Care TypesCost of Senior Care in Washington, DCCost of senior care in Washington, DC: in-home care $86,944 a year, a nursing home $146,730 a year, every setting compared, plus DC vs. Maryland and Virginia. MedicaidDC Medicaid Long-Term Care: Nursing Home and the EPD WaiverDC Medicaid pays for long-term care in a nursing home or at home through the EPD Waiver. See the 2026 income standard and how to qualify in the District. MedicareMedicare in Washington, DC: Costs, Plans, and Free Help ChoosingMedicare in Washington, DC for 2026: the $202.90 Part B premium, enrollment windows, Medicare Advantage vs. Medigap, and free DC SHIP plan counseling. MedicaidYour Guide to DC Medicaid Income and Asset LimitsDC Medicaid income limits for 2026: the 138% FPL adult cap with no asset test, the $4,000 asset limit, the $2,982 income standard, and spousal rules. Care TypesHow to Pay for Assisted Living in Washington, DCDC Medicaid's EPD Waiver pays for the care in assisted living, not the rent. How DC families cover the rest: OSSP, VA Aid and Attendance, insurance, savings. FinancialHow the District of Columbia Taxes Retirement Income for SeniorsDC doesn't tax Social Security, but it taxes pensions, military retirement and IRA income at 4% to 10.75%. Its old $3,000 pension exclusion ended in 2015.

Find personalized help working out which payer covers your parent's care in Washington, DC at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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