Medicaid in D.C.: What You Need to Know

Medicaid isn’t one-size-fits-all — and in Washington, D.C., it’s especially layered. If you’re trying to understand how coverage works, whether for yourself, a loved one, or a client, it helps to break it down by program, eligibility, and income.

In 2026, there are some changes to DC Medicaid, so let’s walk through what it looks like now, and what’s new.

1. Adults Without Disabilities (Standard Expansion)

Historically, D.C. has had some of the most generous adult Medicaid eligibility rules in the nation. In 2025, adults without disabilities could qualify for coverage up to 200% of the Federal Poverty Level (FPL).

2026 Update:

• DC is adjusting the eligibility threshold for adults without disabilities to 138% of FPL, aligning more closely with other Medicaid expansion states.

• Example for 2026 (single adult): 138% FPL ≈ $21,597/year (~$1,800/month)

• Example for a household of 2: 138% FPL ≈ $29,146/year (~$2,429/month)

Why this matters: The change helps keep program costs manageable while still providing coverage for many adults.

Healthy DC Plan:

• Healthy DC is designed to fill the gap for adults who lose full Medicaid eligibility under the new threshold.

• It provides limited coverage for preventive and primary care services, ensuring that adults don’t go without essential health care while they may still be adjusting to changes in income or employment.

• This program helps reduce gaps in care, particularly for people who are transitioning off Medicaid or who need continuity in chronic care or preventive services.

2. Adults with Disabilities / MBIWD

For adults with disabilities, DC Medicaid works a little differently:

• Income Limit: 300% of SSI (2026 ≈ $2,982/month for an individual)

• Asset Limit: $4,000 for an individual; $6,000 for a couple

• MBIWD (Medically Benefited Individuals with Disabilities): A category that allows some adults with disabilities who work or receive other income to remain eligible for Medicaid while still maintaining critical services.

• Coverage: Full Medicaid benefits, including doctor visits, hospitalizations, prescriptions, and long-term care if needed.

Eligibility is determined based on disability criteria, not just income. This ensures that people living with disabilities can access comprehensive care regardless of employment status or earnings.

3. Family Planning Medicaid

For adults who need reproductive or family planning services but don’t qualify for full Medicaid:

• Income Limit: ~200% FPL

• Coverage Includes: Contraception, pregnancy testing, counseling, STI screening and treatment, and related exams

• Notes: This is a targeted program — it doesn’t cover hospitalizations or routine primary care.

4. Pregnancy Medicaid

Pregnant people in D.C. can qualify for full Medicaid coverage regardless of disability:

• Income Limit: Up to ~250% FPL (MAGI-based)

• Coverage: Prenatal care, labor & delivery, postpartum care, prescriptions, hospitalizations

• Duration: Through pregnancy and up to 60 days postpartum

• Notes: No asset test; household size matters for income calculations

Pregnancy Medicaid ensures comprehensive coverage even if an adult would otherwise not qualify under the new 138% FPL standard.

5. Children’s Health Insurance Program (CHIP)

CHIP in D.C. covers children who fall above Medicaid income limits:

• Eligibility: Children up to age 19

• Income Limit: ~317% FPL

• Coverage: Routine checkups, immunizations, dental, hospitalizations, emergency care, vision and hearing

CHIP and pregnancy Medicaid can overlap if a baby is born while the parent is enrolled in pregnancy coverage.

6. Why This Matters

Understanding these different Medicaid tiers is key because:

• Coverage looks different depending on your situation. What counts for a standard adult may not apply to a person with a disability or a pregnant parent.

• Income and asset limits matter. Many people assume Medicaid is just “free healthcare,” but each program has specific thresholds.

• 2026 changes could affect eligibility. Adults without disabilities will see lower thresholds, but programs like Healthy DC, Family Planning Medicaid, and Pregnancy Medicaid provide important safety nets.

• Disability-specific programs like MBIWD exist to protect access to care even if you’re working or have other income.

7. Bottom Line

DC Medicaid is multi-layered:

• Standard adult coverage is decreasing slightly in 2026 (138% FPL), but Healthy DC fills critical gaps

• Disability Medicaid, including MBIWD, ensures access for adults with disabilities

• Family planning and pregnancy programs ensure reproductive health coverage

• CHIP covers children in families above standard Medicaid thresholds

Whether you’re navigating this for yourself, a loved one, or a client, knowing the program that fits your needs is the first step to making sure you get the care and support you deserve.