District Of Columbia Has Accepted Federal Medicaid Expansion
- 282,901 Number of DC residents covered by Medicaid/CHIP as of July 2021
- 47,115 Increase in the number of DC residents covered by Medicaid/CHIP fall 2013 to July 2021
- 54% Reduction in the uninsured rate from 2010 to 2019
- 13% Increase in total Medicaid/CHIP enrollment in DC since Medicaid expansion took effect
How Does The District Of Columbia Regulate Long
As the U.S. population ages, a growing percentage of people reach a point when they need long-term care. In fact, 20 percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015. Medicare, for the most part, does not cover long-term services and supports . Medicaid fills these gaps in Medicares coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult.
Medicaid nursing home coverage
Most seniors used to receive long-term care in nursing homes. Today, more enrollees receive these services in their homes. But some enrollees have medical or living situations that make nursing home care a better choice.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married and both spouses are applying. If only one spouse needs Medicaid, the single applicant income limit applies and usually only the applying spouses income is counted.
Even though the income limit is $2,349 a month , nursing home enrollees are not allowed to keep most of their income up to this limit. Instead, they have to pay all but a small portion of it toward their care, but can keep money to pay for health insurance premiums as well as a personal needs allowance of $70 each month.
A first home will not disqualify an applicant from receiving nursing home benefits if they have less than $893,000 in home equity.
Medicaid coverage for Home and Community Based Services waivers
Estate recovery in DC
Apply To Become A Service Provider
To become a RSA provider requires interested individuals and businesses to complete forms and undergo a rigorous review and approval process.
Contact the Office of Contracts and Procurement
Thank you for your interest in becoming a provider of services for the DDA Home and Community Based Services Medicaid Waiver program. Prospective providers should ensure that they meet the requirements to become enrolled as a Home and Community Based Services Medicaid Waiver Provider as outlined in General Provisions. Interested organizations and licensed clinicians must refer to the waiver service descriptions and rules for detailed requirements to become enrolled as a Home and Community Based Services Medicaid Waiver Provider. Please read the materials carefully to determine what services you or your organization may be eligible to provide.
Department on Disabilities Services / Developmental Disabilities Administration are working to implement Person Centered Thinking philosophy throughout all enrolled HCBS providers. Person-Centered Thinking philosophy must be demonstrated by leadership and personnel that directs as much attention to the individual as to the team, requires senior leadership to be responsible for empowering people at all levels of the organization and this philosophy guides service delivery.
Provided below is the information on the submission of the Medicaid waiver application for new and existing Home and Community Based Waiver providers.
Recommended Reading: Inpatient Drug Rehab Illinois Medicaid
Who Are Dc Medicaid And Dc Healthy Families Intended To Help
In order to qualify for Medicaid and CHIP, individuals must meet certain financial and non-financial requirements. Because of the impact of historic and current racism, in DC people who meet the income requirements are disproportionately Black and Latinx. According to the most recent Census estimates, the median income for DCs white households is almost four times that of Black households and over twice that of Latinx households , with even bigger gaps for households with children. Given that disparity, Black residents are more than four times and Latinx residents are twice as likely as white residents to live in poverty .9
Non-financial requirements for Medicaid include being a resident of the District and being a US citizen or meeting a specifically eligible immigration status, such as a lawful permanent resident .10 Non-financial requirements used to also include being part of certain populations . In 2010, however, the District became one of the first jurisdictions to enact Medicaid expansion under the Affordable Care Act to all adults under age 65 meeting income requirements .11
Medicaid expansion also increased the income threshold for low-income adults to help them qualify for Medicaid.14 Financial eligibility for DC Medicaid and DC Healthy Families is calculated as a percentage of the Federal Poverty Level. Different age groups and populations are subject to different income limits, described in the addendum below.
Whos Eligible For Medicaid For The Aged Blind And Disabled In The District Of Columbia
Medicaid for the aged, blind, and disabled can help pay for Medicare cost sharing, and cover some services not covered by Original Medicare like vision and dental care. Medicare beneficiaries who meet Medicaid income limits can receive coverage for those additional services if theyre enrolled in Medicaid ABD.
Because QMB also covers Medicare cost sharing and is available to enrollees with incomes up to three times the poverty level and has no asset limit Medicaid ABD enrollees in D.C. primarily benefit from Medicaids coverage for services that Medicare does not cover.
In D.C., the Medicaid program includes a comprehensive dental benefit, which covers fillings, restorative care, and preventive visits. Medicaid also covers eyeglasses for enrollees who require at least one diopter of vision correction.
In Washington, D.C., Medicaid ABD includes QMB benefits and is called QMB Plus.
Income eligibility: The income limit is $1,063.33 a month if single and $1,436.67 if married.
Asset limits: The asset limit is $4,000 if single and $6,000 if married.
Assistance with prescription drug costs in Washington, D.C.
Medicaid spend-down for regular Medicaid for the aged, blind and disabled and LTSS benefits
Don’t Miss: Psychiatrist In Nyc That Take Medicaid
Learn About Chip In Washington Dc
Each year, the DC Childrens Health Insurance Program provides affordable health care coverage to thousands of children living in low-income households. The DC CHIP program, in partnership with the federal government, helps fill the gap between Medicaid and private insurance for those children living in families that make too much money to meet Medicaid qualifications, but not enough to buy private health insurance directly from the Marketplace. Applying for CHIP and Medicaid enrollment in Washington DC is a relatively simple process, as DC is one of the few areas that offers its CHIP program through an expansion in Medicaid, rather than as a separate or combined program, giving a succinct answer to the popular question, Is CHIP considered Medicaid in Washington DC? The following paragraphs offer helpful information regarding the Childrens Health Insurance Program in DC, while briefly reviewing the programs relationship to Medicaid. Read more about CHIP coverage in DC in the sections below.
Information About DC CHIP
What is CHIP Medicaid in Washington DC?
Learn About Washington DC CHIP Requirements
How to Apply for CHIP in DC
Department of Human Services
How Do I Apply For Medicaid In Washington Dc
Medicaid is administered by the Department of Health Care Finance in D.C. You cant currently apply for Medicaid ABD or an MSP online. But this website contains a printable Medicaid application you can submit at an Economic Security Administration service center.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also been in the consulting world, including at Sachs Policy Group, where he managed projects for Medicare and Medicaid clients.
Recommended Reading: Vein Clinics That Take Medicaid
What Is Washington Dc Medicaid
Washington D.C. Medicaid is a joint program between the Washington D.C. government and the Centers for Medicare & Medicaid Services, the federal agency responsible for administering the Medicare program for older adults and adults with certain disabilities.
The aim of the program is to ensure that low-income residents of Washington D.C. have coverage for the professional services they need to stay healthy, from preventive screenings to treatment for chronic health conditions.
How Do Medicaid And Healthy Families Operate
Medicaid is a joint program between federal and state governments. The U.S. Department of Health and Human Services Centers for Medicaid and Medicare Services is responsible for establishing the Medicaid requirements at the federal level.23 In Washington DC, the Department of Health Care Finance is responsible for meeting these requirements as it administers the Medicaid program.24
States have the option of providing CHIP as part of Medicaid expansion or as a separate program. The District of Columbia chose a Medicaid expansion CHIP as opposed to a separate program.25 Therefore, DC Healthy Families shares many characteristics with Medicaid , but is available to working families whose incomes exceed DC Medicaid eligibility.
CHIP spending in fiscal year 2019 was $55.3 million, the vast majority of which was paid for with federal dollars.29 However, the portion of CHIP costs that the federal government covers dropped to around 90% in fiscal year 2020 and then to 79% in fiscal year 2021, where it will remain.30 While the matching rate may be decreasing, Congress Budget includes enough federal dollars to continue funding CHIP through fiscal year 2027, which is important. The reduced matching rate does not necessarily mean reduced federal dollars if enrollment or usage increases.31
Recommended Reading: Does Medicaid Cover Gastric Bypass In Michigan
Dc Medicaid Hcbs Waiver Program
Washington, D.C. operates a Medicaid Home and Community-Based Services waiver program, which is designed to provide eligible individuals assistance so that they can remain living independentlyâin their homes and communitiesâinstead of in nursing homes. Assistance offered under one of these program waivers, called the Elderly and Individuals with Physical Disabilities Waiver, may include adult day care, personal care assistance, alternative care facilities, in-home support services, and personal emergency response systems, among others.
Generally, the EPD Waiver program offers services that accompany or add to services applicants receive through D.C. Medicaid, other government programs, and family- and community-based supports.
Notably, the EPD Waiver offers a component called “Services My Way” for program participants who live in their homes to retain more choice and control of their Medicaid LTC services. Services My Way, or Participant-Directed Services , allows EPD Waiver enrollees the option to choose and oversee their service-providers.
To qualify for the EPD Waiver, applicants must meet certain financial and program criteria, and they must be willing to receive services in the home or community. For more information about the EPD Waiver, visit the DHCF web page or contact the EPD Waiver program at 724-5626.
Who Is Eligible For Medicaid In The District Of Columbia
To receive federal Medicaid funding, the states and the District of Columbia must provide Medicaid to mandatory eligibility groups, including low-income children, pregnant women, parents of minor children, elderly people, and people with certain disabilities. States have the option of covering other eligibility groups, such as individuals receiving hospice care or certain women being treated for breast or cervical cancer.
While the mandatory and optional covered populations are consistent across the country, each state and DC set eligibility guidelines for the groups they cover. Medicaid eligibility levels in DC are among the most generous in the nation, and about one in three DC residents is covered by Medicaid.
The following are the District of Columbias Modified Adjusted Gross Income limits for some of the main groups covered by Medicaid :
- 324% of the federal poverty level for children 0-18
- 324% of FPL for pregnant women
- 221% of FPL for parents with dependent children
- 215% of FPL for other, non-elderly adults
You May Like: Medicaid Free Cell Phone Application
How To Apply / Learn More
To apply for Medicaid, a senior must fill out the Combined Application for Medical Assistance. One can call the DC Department of Human Services Division of Economic Security Administration at 202-727-5355 with questions or if assistance is needed. The application needs to be submitted to ones local ESA Service Center, which can be done via mail or in person.
An assessment of the need for assistance is required once accepted by the Medicaid program. To begin the process, a physician or registered nurse who is a DC Medicaid provider must fill out a Prescription Order Form.
To search for a list of Adult Day Health providers and PCA aides in the DC area, .
Learn About Requirements For Medicaid In Washington Dc
Meeting Medicaid benefits eligibility in Washington DC and qualifying for Medicaid paves the way for low-income candidates to receive vital health care coverage. In Washington, D.C., one out of every three residents in the city receives assistance from the program. What are the requirements for Medicaid? Procedures for how to qualify for Medicaid include an application form and submitting required details and items for officials who review each request for assistance. District of Columbia Medicaid is a joint program between the federal and district governments to provide programs for various individuals or families in need of health care coverage. Applicants who qualify for Medicaid will receive aid that pays for certain medical needs, such as prescriptions, hospital stays and doctor visits. Discover who is eligible for Medicaid in DC, how to meet Medicaid eligibility requirements and more on the page below.
Who qualifies for Medicaid in Washington DC?
How do I qualify for Medicaid in Washington DC?
What are the Medicaid application guidelines in Washington DC?
What are common Medicaid disqualifications in Washington DC?
Read Also: Does Medicaid Cover All Pregnancy Costs
Why Medicaid And Dc Healthy Families Are Important
In addition to the vast array of clinical services that DC Medicaid and Health Families provide, research demonstrates that there are significant longer term health benefits to enrollment. Medicaid expansion, like that in the District, has been shown to decrease mortality rates by up to 6%.19 For children, access to CHIP and/or Medicaid during childhood has been linked to improved educational attainment, including higher reading test scores and increased rates of high school and college completion fewer chronic conditions and less frequent hospitalizations.20
In addition to the health benefits, Medicaid has been proven to have positive outcomes on access to preventative care21 as well as the financial circumstances of adult enrollees, many of whom are parents and heads of households. Access to public health insurance significantly reduces medical debt and plays a significant role in decreasing poverty for many children and families when medical expenses are taken into account in defining the poverty rate.22 Access to CHIP in childhood is critical for low-income children and appears to have positive long-term effects on both health and economic outcomes in adulthood.
Who Benefits From Dc Medicaid & Dc Healthy Families
DC Medicaid and DC Healthy Families cover more than a quarter of a million people, or almost two in five District residents.32 Medicaid is also extremely important for workers more than 60% of adult Medicaid enrollees are actively working.33
These programs are incredibly effective and critical in covering children in the District 98% of all eligible children are enrolled the highest rate in the entire United States. Approximately 7 out of 10 of all children in the District are covered by these programs.34 By comparison, Medicaid coverage rates for children aged 0-18 in neighboring Maryland and Virginia are only 48% and 43%, respectively.35
Because Black children in DC are many times more likely as white children to be living in poverty , DC Healthy Families is a vital program for helping children and families of color have access to medical care.36 Due to the intersection of racism and socioeconomic status, 80% of children enrolled in Medicaid and Healthy Families in DC are Black and 17% are Latinx,37 providing a powerful opportunity for the city to address racial health disparities. However, there is concern that eligible families in which one or more adults or children are immigrants may stop participating due to the recent Public Charge rule .
While DC Medicaid enrollment has remained relatively stable between 2017 and 2019 and rose only slightly even during the pandemic in 2020, DC Healthy Families enrollment has increased each year:42
Recommended Reading: Alabama Medicaid Application For Child
How To Apply For Medicaid In Washington Dc
It is important for new applicants to understand how to apply for Medicaid in Washington DC, so they are prepared for the process when the opportunity arises. Filling out a Medicaid application form is not a lengthy or difficult process, but it does take a bit of understanding and know-how. For instance, learning the ways in which a Medicaid application can be submitted will make a huge difference for both new and seasoned applicants. Not all Medicaid applications can be submitted in the same ways, and differ state-by-state. Being prepared with the application for Medicaid by collecting required information and items can save a significant amount of time and hassle for everyone involved. By filling out the Medicaid application completely and thoroughly the first time, it saves the applicant the headache of having to wait to be notified of an incomplete form, along with omitting the hassle of the Medicaid office reaching out for more information, or denying the application immediately. To further understand areas of the program, such as where to apply for Medicaid in Washington DC, how to apply for Medicaid and what happens when a Medicaid form is denied, continue reviewing the information below.
Where do you sign up for Medicaid in Washington DC?
Department of Human ServicesP.O. Box 91560Washington, DC 20090
Information Required on the Medicaid Application Form in Washington DC
Where Can Medicare Beneficiaries Get Help In District Of Columbia
D.C. Health Insurance Counseling Project
Free volunteer Medicare counseling is available by contacting the D.C. Health Insurance Counseling Project at 202-727-8370. This is D.C.s State Health Insurance Assistance Program . HICP can with Medicare enrollment, evaluation of Medicare Advantage and Medicare Part D plans, and understanding Medigap options. They may also be able to offer referrals to local agencies for services like home care and long-term care.
You May Like: Medicaid Provider Phone Number Florida