District of Columbia Medicaid for Infants and Children provides medical coverage for children up to age twenty-one (21). The income limit is determined by the family size and the age of the child(ren) for whom you are applying for coverage.
Who is Eligible?
Individuals who are under age twenty-one (21) are eligible for Medicaid in the District, if they:
- Are a District Resident;
- Are a US citizen or have eligible immigration status; and
- Meet income requirements
The District covers children (0-18) with household incomes up to 319% of the 2014 Federal Poverty Level. The District covers children (19 and 20) with household incomes with household incomes up to 216% of the Federal Poverty Level.
|Category||Threshold in FPL||1 person household, monthly||2 person household, monthly||3 person household, monthly||4 person household, monthly||5 person household, monthly||6 person household, monthly||7 person household, monthly|
|Childlren (0-18)||319% FPL||$3,320.26||$4,495.24||$5,670.23||$6,845.21||$8,020.19||$9,195.18||$10,370.16|
|Children (19-20)||216% FPL||$2,248.20||$3,043.80||$3,839.40||$4,635.00||$5,430.60||$6,226.20||$7,021.80|
*figures compiled using 2019 FPL numbers distributed by the U.S. Department of Health and Human Services
* 5% income disregard not included
What is covered?
Federal law requires Medicaid to provide all medically necessary health care services to Medicaid-eligible children under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services benefit.
EPSDT is important because it:
Provides early, regular and as-needed medical, behavioral, and dental screenings for all Medicaid eligible-children
Covers diagnostic and treatment services that are medically necessary to correct or improve conditions or problems that are identified through a screening examination.
What Treatment Services are covered?
Medically necessary services that a child needs to treat, correct or reduce a problem discovered in a screening exam are covered. Services must be ordered by the child's physician or another licensed clinician.
The services must meet all of the conditions stated below:
The service must be medically necessary to treat, correct or reduce a health problem, physical or mental illness or condition that is identified through a screening examination
If your income is over the Medicaid limit and have high medical bills, you may still qualify for Medicaid through the Spend Down program.
Children who have long-term disabilities or complex medical needs and live at home with families with household incomes over 319% of the FPL may also be eligible for DC Medicaid under TEFRA/Katie Beckett .
How to Apply
If you think your child may be eligible for Medicaid, please see “How to Apply” section.