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 mandatory Medicaid benefit, 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 for adults 21 and over is a mandatory benefit: it is part of the minimum the District's Medicaid plan must furnish to categorically needy beneficiaries. Home and community-based care, by contrast, is an optional benefit the District chooses to offer, here through a waiver.

The practical difference is important. Nursing-facility Medicaid is an entitlement: for categorically needy beneficiaries who meet its 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 different: a waiver lets the District cap enrollment, 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 $2,982 a month for a single applicant in 2026. DHCF uses the same Special Income Standard for nursing-facility care.

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. DHCF's spend-down runs in six-month periods, and when one ends you have to file a new application for the next, so the coverage does not roll over on its own.

There is also a countable-asset test. For nursing-facility and waiver care, DHCF caps countable resources at $4,000 for a single applicant, and it does not count the home, one vehicle, or ordinary household and personal goods. If you already receive SSI, neither the income standard nor the asset limit applies to you, because SSI recipients are categorically eligible for Medicaid. A married applicant whose spouse will stay at home should read the spousal rules below rather than treat any single figure as the couple's limit, and can confirm what counts with DHCF.

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 that the District's plan must furnish to categorically needy beneficiaries, which is why qualifying applicants are not put on a waitlist for the coverage itself. Eligibility has a financial side, the income and asset tests above, and a care side: under federal Medicaid rules, nursing-facility services are for people who do not need a hospital but whose physical or mental condition requires care above the level of room and board that only an institution can provide.

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.

The District's Department of Aging and Community Living lists seven conditions, and meeting the age and residency ones alone does not make you eligible. You must be a U.S. citizen or have a qualified immigration status; live in the District; be 65 or older, or 18 to 64 with a physical disability; have a DC Medicaid provider complete a Prescription Order Form; have Liberty Healthcare complete a face-to-face assessment of your level of need; have countable assets, such as savings or checking accounts, of no more than $4,000 for an individual; and have countable income under the monthly limit, or be able to meet a spend-down obligation instead. Services available include case management, personal care aide services, a personal emergency response system, the self-directed Services MyWay option, and assisted living. Because the EPD Waiver is a home- and community-based waiver rather than an entitlement, the District may cap its enrollment, 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. Federal estate recovery law requires the District to seek repayment from a deceased recipient's estate in set cases, chiefly a recipient who was 55 or older when Medicaid paid for nursing-facility or home- and community-based care (plus related hospital and prescription drug costs), and a recipient in a nursing home or other institution who was not expected to return home. Recovery has to wait until any surviving spouse has died, cannot be made while a child under 21 or a blind or permanently and totally disabled child survives, and must be waived where it would cause undue hardship. It is worth understanding before you plan, because it shapes decisions about the home.

Where to Start

For care at home, begin with the District's Department of Aging and Community Living, which publishes the EPD Waiver's qualifying conditions. Expect two sides to that process: a financial review of income and assets, and a Prescription Order Form from a DC Medicaid provider followed by Liberty Healthcare's face-to-face level-of-need assessment. For nursing-facility coverage, the income, asset and spend-down rules are DHCF's, so take questions about them to DHCF.

Frequently Asked Questions

Does DC Medicaid pay for a nursing home?

Yes. Nursing-facility care is a mandatory Medicaid benefit, so the District's plan must furnish it to categorically needy beneficiaries who meet the financial rules and whose condition requires 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 $2,982 a month for a single applicant, which is 300% of the SSI federal benefit rate. DHCF applies the same Special Income Standard to nursing-facility care, and if your income is higher, a medically needy spend-down may still let you qualify.

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, pass a face-to-face level-of-need assessment, and meet its asset and income tests or a spend-down. As a waiver, its enrollment can be capped, 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?

For nursing-facility and waiver care, DHCF's countable-resource limit is $4,000 for a single applicant, and the home, one vehicle, and ordinary household and personal goods are excluded. SSI recipients face no Medicaid asset limit at all, and a married applicant whose spouse stays at home is also covered by the federal spousal-impoverishment rules.

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. Care TypesMemory Care vs. Nursing Home in Washington, DCMemory care vs. nursing home in Washington, DC turns on skilled nursing need. Compare DC costs and what DC Medicaid pays for in each setting.

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.

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