DC Medicaid long-term care is available two ways: in a nursing home, or at home through the Elderly and Persons with Physical Disabilities (EPD) Waiver. Nursing-facility coverage is a guaranteed benefit for people who qualify, and the home-care waiver is the alternative for those who would rather stay in their own home or an assisted-living community. Which one fits, and whether you qualify, turns on your income and a medical assessment of the care you need.

In This Guide

How DC Medicaid Pays for Long-Term Care

DC Medicaid long-term care comes in two forms, and knowing which one fits is the first decision. Under federal Medicaid rules, nursing-facility care is a mandatory benefit that every state and the District must cover, which makes it the primary way Medicaid pays for long-term care. Home and community-based care, by contrast, is an optional benefit the District chooses to offer through a waiver.

The practical difference is important. Nursing-facility Medicaid is an entitlement: if you meet the financial and medical rules, the District must cover it, and there is no waitlist for the benefit itself. The EPD Waiver, which delivers that same level of care at home, is capped, so it can carry a wait when its slots are full.,

How the Financial Limits Work

For the District's home- and community-based waivers, DC applies the federal Medicaid special income level: 300% of the Supplemental Security Income (SSI) federal benefit rate, which works out to about $2,982 a month for a single applicant in 2026.

One honest note worth knowing: the District's own EPD Waiver page still lists the older figure of $2,743 a month, which was the 300%-of-SSI amount back in 2023. The standard rises every year with the SSI cost-of-living adjustment, so the current 2026 number is the higher one. If your income is above the limit, you may still qualify by meeting a spend-down obligation, and it is worth asking the District's Department of Health Care Finance (DHCF) how that works for your household.

There is also a countable-asset test: savings, checking, and similar resources have to fall below a set limit, while the home you live in and one vehicle are the kinds of assets Medicaid programs typically exclude. Because the District publishes the exact asset figure only on its own agency pages, and those pages are not always current, confirm the amount and what counts directly with DHCF or the Department of Aging and Community Living before you plan around a number.

Nursing-Facility Medicaid

If you meet the financial rules and need a nursing-home level of care, DC Medicaid covers care in a licensed nursing facility. Nursing-facility care is a mandatory Medicaid benefit the District must cover, which is why it is the primary way Medicaid pays for long-term care and why qualifying applicants are not put on a waitlist for the coverage itself. As with long-term-care Medicaid anywhere, expect two sides to eligibility: a financial review of your income and assets, and a clinical assessment confirming you need that level of care before Medicaid pays for a nursing home.

Care at Home Instead of a Nursing Home

Many people who would qualify for a nursing home would rather stay in their own home or an assisted-living community. That is what the Elderly and Persons with Physical Disabilities (EPD) Waiver is for. It lets DC residents who would otherwise require nursing-home care receive services and supports at home instead, and it is operated by the Department of Long-Term Care within DHCF.

To qualify, you must be a District resident who is elderly (65 or older) or 18 to 64 with a physical disability, and financially eligible for Medicaid. Covered services include personal care, assisted living, and other in-home supports. Because the EPD Waiver is a home- and community-based waiver rather than an entitlement, it serves a limited number of people, so ask about current availability when you apply.

Protecting a Spouse and the Home

When one spouse needs long-term care and the other stays in the community, federal spousal-impoverishment rules protect a share of the couple's income and assets for the at-home spouse, so they are not left with nothing.

Families also ask what happens to the home. After a Medicaid recipient who received long-term care dies, estate recovery allows the program to recover what it paid for that care from the person's estate, subject to federal protections. It is worth understanding before you plan, because it shapes decisions about the home.

Where to Start

The place to begin is the District's Department of Aging and Community Living and its Aging and Disability Resource Center, which can point you to the right application and assessment. Expect the long-term-care process to have two sides: a financial review of income and assets, and a medical assessment of whether you need a nursing-facility level of care.

Frequently Asked Questions

Does DC Medicaid pay for a nursing home?

Yes. Nursing-facility care is a mandatory Medicaid benefit the District must cover for residents who meet the financial rules and are assessed as needing that level of care. Because it is an entitlement, there is no waitlist for the coverage itself.

What is the DC Medicaid income limit for long-term care?

For 2026, the income standard for the District's Medicaid waivers is about $2,982 a month for a single applicant, which is 300% of the SSI federal benefit rate. If your income is higher, a spend-down may still let you qualify; ask DHCF how it applies to you.

Does DC Medicaid pay for home care instead of a nursing home?

Yes, through the EPD Waiver, for DC residents 65 or older or 18-64 with a physical disability who would otherwise need nursing-home care and are financially eligible. It has a limited number of slots, so ask about availability when you apply.

What is the DC EPD Waiver?

It is the District's Elderly and Persons with Physical Disabilities Medicaid waiver. It pays for nursing-home-level care at home or in an assisted-living community, and it is run by the Department of Long-Term Care within DHCF.

What is the DC Medicaid asset limit for long-term care?

DC applies a countable-asset limit on savings and similar resources, while typically excluding the home you live in and one vehicle. The District publishes the exact figure on its own agency pages, which are not always current, so confirm the amount directly with DHCF or the Department of Aging and Community Living.

Learn More

MedicaidMedicaid and Nursing Homes by StateMedicaid pays for nursing-home care in every state, but the income cap, level-of-care test, and rules vary. The federal floor, what changes, and your state. Care TypesAssisted Living vs. Nursing Home by StateAssisted living is custodial care; a nursing home is 24/7 skilled care. See what each costs, who pays (Medicaid differs by state), and your state's guide. MedicaidMedicaid Spousal Impoverishment ExplainedWhen one spouse needs Medicaid for long-term care, spousal impoverishment rules let the at-home spouse keep income and assets. Here's how the 2026 limits work. MedicaidMedicaid Estate Recovery ExplainedMedicaid estate recovery explained: federal law, 51-state matrix, categorical protections, hardship waivers, and 2025-2026 reform updates. Verify before acting. Care TypesCost of Senior Care by StateThe 2026 national median cost of assisted living, memory care, nursing homes, and in-home care, why your state differs, and your state's own cost guide.

Find personalized help understanding your DC Medicaid options 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.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.