Medicaid/DC Healthy Families: Know Your Rights

Medicaid and DC Healthy Families provide health insurance to people who live in D.C. and have low income. The programs pay for doctor and hospital visits, dental and eye care, home health care, prescription drugs, and other services. If you get Supplemental Security Income (SSI), you get Medicaid. If you do not get SSI, you must have low income to qualify. 

Starting in January 2027, there are new work requirements for some adults age 64 and younger. Exemptions are available.

Note: This flyer only talks about Medicaid, not Medicare or Healthy DC. Medicare is for people who are 65 or older, have disabilities, or have End Stage Renal Disease or ALS. Healthy DC is for people who do not qualify for Medicaid but still have limited income.

• If you get SSI, you get Medicaid.
• Without SSI, you must have low income and few assets (things you own). See below.

You can apply for yourself or others. Some people in your family might be able to get Medicaid, even if you can’t get it for everyone. See the charts below:

You might be able to get Medicaid too. If you are under age 21 or pregnant, you may still qualify for full Medicaid. 

*To get regular Medicaid, you also can’t have assets worth more than $4,000 (for an individual) or $6,000 (for a couple), not counting some assets like a car or house.

**The Qualified Medicare Beneficiary (QMB) Program helps pay for costs not covered by Medicare, like premiums and deductibles. 

Yes. The law says the government has to help you in your language. Just tell the agency you want help in your language.

You may be able to get Medicaid if you're not a U.S. citizen. Even if you can't, you can still apply for your children or other household members. You only have to write the immigration status of the people you're applying for. The government can't ask for more information.

If you can't get Medicaid because of your immigration status, you may be eligible for insurance through the DC Healthcare Alliance or Healthy DC.

If you have a medical bill from up to three months before your application date, you may be able to get Medicaid to cover the bill. Use District Direct to apply.

You can apply for all public benefits, including food stamps, TANF, Medicaid, and D.C. Healthcare Alliance on the same application.

Step 1: Get the documents you need. Don’t send the originals! Take a picture or make a copy.

• Your photo ID
• Your Social Security Card (if you have one)
• Proof of income (such as pay stubs)
• Your utility bill or other proof of address
• Birth certificates of everyone in your household

Step 2: Apply in one of five ways:

In person: Go to one of these ESA service centers. Ask for a receipt when you apply.

• Anacostia Service Center
  2100 Martin Luther King Jr. Avenue SE
  (202) 645-4614
• Congress Heights Service Center
  4001 South Capitol Street SW
  (202) 645-4546
• H Street Service Center
  645 H Street NE
  (202) 698-4350
• [Closed] Fort Davis Service Center
  3851 Alabama Avenue SE
  (202) 645-4500
• [Closed] Taylor Street Service Center
  1207 Taylor Street NW
  (202) 576-8000

Smartphone: Download the District Direct app in the app store. Apply through your phone. Write down your confirmation number, and save a copy of what you submit.

Online: Apply online through District Direct at https://districtdirect.dc.gov/ua/. Write down your confirmation number, and save a copy of what you submit.

Mail: Get the application at https://dhs.dc.gov/page/apply-recertifybenefits. Send in the application and copies of your documents to a Service Center (listed above). (This option isn't recommended. If you apply through mail, keep proof through a mail tracking number.)

Fax: Fax the completed application to DHS ESA at (202) 671-4400. (This option isn't recommended. If you apply by fax, keep proof that the fax was successfully delivered.)

If you’re approved, you’ll get a notice in the mail or through the app. You’ll get enrolled in managed care plan with a Managed Care Organization (MCO). The three MCO plans are Wellpoint, AmeriHealth Caritas, and MedStar Family Choice. To learn more about the plans, go to dchealthyfamilies.com or call DC Families Customer Service at (800) 620-7802.

You have the right to appeal. You need to appeal within 90 days of the notice that your Medicaid was denied, cut off, or reduced. There are three steps to appeal.

Step 1: Get the appeal form online at https://oah.dc.gov/publication/request-hearing-public-benefits-case

Step 2: Fill out the appeal form.

Step 3: File the form in one of these ways (always keep a copy of the form for yourself when you file):

Email it to oah.filing@dc.gov.

Bring it in person to the Office of Administrative Hearings, 441 Fourth Street NW, Suite 450N.

Mail it to the Office of Administrative Hearings at the address above (This option isn't recommended) 

Once you get Medicaid, you have rights. if you can’t get a service or see a doctor, file a “grievance” with your Managed Care Organization (MCO). A grievance is a formal way to complain about an issue with your MCO. If the grievance is denied, you can appeal the denial through a “fair hearing” at Office of Administrative Hearings (see the information above).