District of Columbia Medicaid HCBS Waivers: EPD Guide

The Elderly and Persons with Physical Disabilities (EPD) Waiver is how District of Columbia Medicaid pays for home care for about 3,000 residents who would otherwise need a nursing home. It is the District's main aged-and-disabled home and community-based services (HCBS) pathway, one of the Section 1915(c) Medicaid waivers that let a resident who would otherwise need nursing-facility care stay in their own home or an assisted-living community. When families search for District of Columbia Medicaid HCBS waivers, the EPD Waiver is almost always the program they mean. The EPD Waiver is overseen by the DC Department of Health Care Finance (DHCF).1

Here is what to know before you start: the EPD Waiver is not a separate insurance card or a second application in the usual sense. It sits on top of DC Medicaid, and it turns on two questions, whether you need a nursing-facility level of care and whether you meet the financial rules.

In This Guide

• What Are District of Columbia Medicaid HCBS Waivers?
• The EPD Waiver in Detail
• Who Qualifies for District of Columbia Medicaid HCBS Waivers
• What the EPD Waiver Covers
• How to Apply and Enroll

What Are District of Columbia Medicaid HCBS Waivers?

Home and community-based services are the long-term supports that Medicaid pays for outside of an institution, in your own home, a relative's home, or an assisted-living residence rather than a nursing facility. The legal engine behind them is Section 1915(c) of the Social Security Act, a provision that lets a state, or in this case the District, ask the federal government for permission to "waive" some ordinary Medicaid rules so it can fund community care for people who would otherwise qualify for nursing-home placement.

The core idea is a trade. To use a 1915(c) waiver, you have to be sick or disabled enough that you could be admitted to a nursing facility, what the rules call a nursing-facility level of care. In exchange, Medicaid pays for services that keep you at home instead. The District runs its aged-and-disabled version of this through the EPD Waiver, overseen by the DC Department of Health Care Finance and operated by DHCF's Division of Long-Term Care.1

One point worth settling early: "waiver" here does not mean a fee is being waived or that a rule is being skipped for your convenience. It is a formal federal authority that reshapes what Medicaid will pay for. Once you are enrolled, the waiver is simply the mechanism that lets a personal care aide come to your apartment on Medicaid's dime.

The EPD Waiver in Detail

The Elderly and Persons with Physical Disabilities Waiver is the District's home and community-based program for older adults and adults with physical disabilities. It lets DC residents who would otherwise require nursing-home care receive services and supports while living in their own home or in an assisted-living community instead of an institution.1

Two DC agencies share the work. The DC Department of Health Care Finance is the Medicaid agency responsible for the waiver, and its Division of Long-Term Care operates it. On the front end, the DC Department of Aging and Community Living (DACL) runs the enrollment process that gets people onto the waiver, a division of labor that trips up a lot of families, because the agency you apply through is not the same as the agency that ultimately administers the benefit. The EPD Waiver serves approximately 3,000 individuals.1

Who Qualifies for District of Columbia Medicaid HCBS Waivers

Qualifying for the EPD Waiver comes down to three separate tests, and you have to clear all of them: a residency-and-status test, a functional test, and a financial test.

Residency and status. You must be a District resident and either a US citizen or a qualified immigrant. On the age-and-disability side, you must be either 65 or older, or between 18 and 64 with a physical disability.1

The functional test, nursing-facility level of care. This is the heart of a 1915(c) waiver. You have to need the kind of help a nursing home provides. In the District, that need is established in two steps: a Prescription Order Form (POF) completed by a DC Medicaid provider, and a face-to-face "level of need" assessment carried out by Liberty Healthcare, the District's assessment contractor. Together they document that, without the waiver's supports, you would require nursing-home care.1

The financial test. Waiver applicants are held to income and asset limits. On assets, an individual's countable resources, things like a checking or savings account, cannot exceed $4,000.1 On income, the District applies the federal Medicaid special income level for waivers, which is 300% of the SSI federal benefit rate, equal to $2,982 a month for one person in 2026.2 The DACL EPD Waiver page still lists an older figure of $2,743 a month, its stated 2023 value, alongside the same spend-down alternative; that number reflects the 2023 SSI rate and rises each year with the SSI cost-of-living adjustment.2

If your income runs above the limit, you are not automatically shut out. The District lets you qualify by meeting a Medicaid spend-down obligation, which means using the income above the threshold on medical and care costs until you reach the eligibility line.1

What the EPD Waiver Covers

The waiver's job is to assemble the supports that make staying at home realistic. Its covered services include case management, personal care aide (PCA) services, personal emergency response services (PERS), assisted living, and a self-directed option called Services MyWay.1 In practice, participants receive personal care, assisted living, and other services that substitute for what a nursing facility would provide.1

A few of these are worth unpacking:

• Case management gives you a coordinator who builds and updates your plan of services and keeps the pieces working together.
• Personal care aide (PCA) services are the hands-on help with daily activities, bathing, dressing, moving around, that most people picture when they think of home care.
• Personal emergency response services (PERS) is the wearable button-and-monitor system that summons help if you fall or have a crisis when no one is with you.
• Services MyWay is the self-directed route. Instead of receiving services through an agency roster, you take on more control over who provides your care and how it is arranged.

Because assisted living is on the covered list, the EPD Waiver can pay for care in a participating assisted-living residence, not just care delivered to a private home.

How to Apply and Enroll

Enrollment runs through DACL, not DHCF. Applicants enroll through DACL's Medicaid Services Enrollment Unit (MES), which coordinates and submits the application and connects new enrollees to EPD Waiver case management.1 The clearest starting point is the DC Department of Aging and Community Living and its EPD Waiver page, which describes the program and the enrollment steps.

Because the waiver sits on top of DC Medicaid, part of the process is simply getting or confirming Medicaid eligibility. Federal rules give you options on how to apply for that underlying coverage: the District must accept a Medicaid application online, by phone, by mail, or in person.3 And once you apply, the agency is on a clock. Federal regulations require an eligibility decision within 45 days for most applicants, and within 90 days when eligibility depends on a disability determination.4

Here is a realistic sequence to expect: you contact DACL's enrollment unit, complete or confirm your Medicaid eligibility, have a DC Medicaid provider fill out the Prescription Order Form, and complete the Liberty Healthcare level-of-need assessment that documents your nursing-facility level of care.1 Capacity and any current wait for an opening are worth asking DACL about directly, since availability can change; confirm the present enrollment status with the agency before you plan around a start date.

Learn More

Find personalized help understanding District of Columbia Medicaid HCBS waivers and the EPD Waiver 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.