Long-term care in the United States is paid for primarily by Medicaid, not by Medicare or by private insurance.1DC is no exception, though the size and density of the jurisdiction give it some unusual characteristics — a high share of dual-eligibles (DC residents on both Medicare and Medicaid), strong concentrations of federal-employee benefits coordination, and a smaller absolute provider base than neighboring Maryland or Virginia.

How DC Medicaid LTC works

DC Medicaid covers long-term care in two main ways:

The DC Department of Health Care Finance (DHCF) is the state Medicaid agency — or, in DC's case, the equivalent. The DC Department on Aging and Community Living (DACL) administers many aging-related Medicaid programs and operates the Aging and Disability Resource Center (ADRC) as the intake point.

The three eligibility tests, in order

1. Medical eligibility (level of care)

Before the financial math starts, your parent needs to meet DC's nursing-facility level-of-care threshold. DC uses a standardized assessment, conducted by DACL or a contracted agency, that scores the applicant on activities of daily living — bathing, dressing, transferring, toileting, eating — and instrumental activities of daily living. The assessment is typically completed in person at home or in the facility being applied for.3

Schedule this assessment early. Wait times vary depending on intake capacity at DACL and the contracted agency.

2. Income

DC uses the standard 300% of SSI federal benefit rate as its income cap for long-term care Medicaid — approximately $2,901/monthin 2026. If your parent’s gross monthly income from all sources (Social Security, pension, IRA distributions, annuity payments) exceeds this cap, they’re not automatically disqualified. DC allows the use of a Qualified Income Trust (QIT), sometimes called a Miller Trust, to handle excess income.

3. Assets

The applicant’s countable assetsmust be at or below $4,000 at the moment of application. “Countable” is doing the real work in that sentence.

Not counted (in most cases):

Counted:

The 5-year look-back, in DC

DC applies the same 60-month look-back as every state. Any transfer of assets for less than fair market value in the 60 months prior to the application generates a penalty period— a window during which your parent is otherwise eligible but Medicaid will not pay for long-term care.

The penalty math is straightforward: the value of the transfer divided by DC’s penalty divisor. DC’s penalty divisor is set annually by DHCF and approximates the district-wide average private-pay nursing home rate — which is high. Figure approximately $13,000/month in 2026 . A $100,000 gift produces roughly an 8-month penalty. The clock does not start until your parent is otherwise eligible — meaning they’ve spent down to the asset limit and are in care.

The community-spouse situation

If one spouse needs long-term care and the other doesn’t, DC follows the federal framework for community-spouse protections:

Estate recovery in DC

Federal Medicaid law requires every state to attempt recovery from the estate of a deceased Medicaid LTC recipient for services paid after age 55. DC pursues recovery through probate assets only — meaning assets held in revocable trust, transferred during life, or passing outside probate (joint tenancy, beneficiary designations) are generally not subject to recovery. Recovery is deferred when there is a surviving spouse, disabled child, or minor child.4

Dual-eligibles and Medicare coordination in DC

DC has a higher share of dual-eligible Medicare-Medicaid beneficiaries than most states — reflecting the jurisdiction’s significant low-income elderly population. For dual-eligibles, Medicare is primary for medical care and Medicaid covers the gaps (Part B premium, deductibles, coinsurance) plus long-term care. DC has tested a Medicare-Medicaid Plan model in the past; whether DC currently operates a Financial Alignment Initiative MMP depends on current procurement status.

What to do this month

For the broader national Medicaid context, see our Medicaid pillar overview. For DC-specific legal planning — including the DC estate tax, which catches many DC families off guard — see Legal & Financial in DC.