Medicaid Eligibility Groups Overview
Medicaid coverage is divided into certain eligibility groups. These eligibility groups consist of MAGI Medicaid and Non- MAGI Medicaid. MAGI Medicaid includes children (newborn to age 20), Parents/Caretake Relatives with minor dependents, Pregnant Individuals, and non-disabled adults aged 21 to 64. Non-MAGI Medicaid categories include aged (65+), blind, disabled, individuals receiving Long Term Care Services and Supports, Katie Beckett children, and the Medicare Savings Programs which includes Qualified Medicare Beneficiaries (QMB).
For more information about Medicaid groups and eligibility, click here.
DHCF operates two locally funded health care programs, D.C. Health Care Alliance and Immigrant Children’s Program.
Medicaid Eligibility Groups Overview
Medicaid coverage is divided into certain eligibility groups. These eligibility groups consist of MAGI Medicaid and Non- MAGI Medicaid. MAGI Medicaid includes children (newborn to age 20), Parents/Caretake Relatives with minor dependents, Pregnant Individuals, and non-disabled adults aged 21 to 64. Non-MAGI Medicaid categories include aged (65+), blind, disabled, individuals receiving Long Term Care Services and Supports, Katie Beckett children, and the Medicare Savings Programs which includes Qualified Medicare Beneficiaries (QMB).
For more information about Medicaid groups and eligibility, click here.
DHCF operates two locally funded health care programs, D.C. Health Care Alliance and Immigrant Children’s Program.
The Renewal Process
The District conducts Medicaid renewals for each beneficiary once every twelve (12) months. The renewal process was put on hold during the Public Health Emergency, but our federal partners announced that states must restart renewals April 1, 2023. Not all beneficiaries will have to fill out a renewal form as DHCF will check eligibility using information collected by other systems. If DHCF is able to use information available through our eligibility system, District Direct, to continue eligibility, no additional information is required by the beneficiary. This process is referred to as No Touch or Passive Renewal.
For those who need to complete and submit their renewal form, you will be mailed one of the renewal forms to complete and return to the agency for processing. Renewal forms can also be completed online at District Direct, mail, drop off or by phone. Supplemental documents including residency and income verifications will need to be submitted with your renewal form.
The first renewal packages will be mailed to some beneficiaries on April 1, 2023, for households whose coverage is due to renew on May 31, 2023, and some households whose coverage is due to renew on June 30, 2023. Not all beneficiaries are scheduled to renew at the same time. Renewals will continue on a rolling monthly basis for the next year based on the date the beneficiary is scheduled to renew coverage.
For more information about the renewal process, click here.
Renewal Notice Descriptions and Examples
‘Medicaid Renewal Form’ Notices
- Passive Renewal Approval Notice: If the District can renew your Medicaid, DC Healthcare Alliance or ICP health care coverage based on reliable and current information available to our eligibility system, then you will be mailed a passive renewal notice. No action is required by beneficiaries to initiate the passive renewal process. Passive renewal notices will be issued 60 days before the beneficiary’s recertification period end date.
- Passive Renewal Notice Example, click here.
- Not all renewals will have enough information to complete a passive renewal. If the District cannot complete a passive renewal, the beneficiary will receive a renewal form in the mail to complete and submit for review and processing. For Non-MAGI beneficiaries whose eligibility was approved and determined prior to November 15, 2021, you will receive a Conversion Renewal Form Notice in the mail when it is time for you to renew your coverage.
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- Conversion Renewal Form Notice Example, click here.
If your Medicaid coverage was approved after November 15, 2021 in District Direct, District’s integrated eligibility system, one of the following forms will be mailed:
- For Families with children, Pregnant individuals, non-disabled Childless adults (21-64), and DC HealthCare Alliance and Immigrant Children Program (these are known as MAGI groups), you will fill out the D2 Renewal Form:
§ MAGI Renewal Form D2 Notice Example, click here.
- For Aged (65+), Blind, Disabled, Qualified Medicare Beneficiary (QMB), Katie Beckett, and Breast and Cervical Cancer individuals, you will fill out the “Non-MAGI” renewal form:
§ Non-MAGI Renewal Form for Medical Assistance Notice Example, click here.
- For beneficiaries receiving Long Term Care Services; Elderly and Persons with Disabilities (EPD)Waiver, Intellectual and Developmental Disabilities (IDD) Waiver, Nursing Facilities or Intermediate Care Facilities you will need to complete the LTC renewal form:
§ LTC Renewal Form Notice Example, click here.
‘Confirmation of Returned Medical Renewal Form’ Notices
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Beneficiaries will be notified when the District has received their renewal form. MAGI beneficiaries will receive the following confirmation notice:
- MAGI Receipt of Renewal Notice Example, click here.
- Non-MAGI beneficiaries including those receiving Long Term Care services will receive the following confirmation notice:
- Non-MAGI Receipt of Renewal Form Notice Example, click here.
‘Renewal Forms not Returned’ Notices
If the District does not receive your completed renewal form, a termination notice will be sent thirty (30) days before the end of the certification period.
- MAGI beneficiary termination notice:
- MAGI Renewal Termination Notice Example, click here.
- Locally funded programs such as Alliance & Immigrant Children Program termination notice:
- MAGI Renewal Termination Notice (Locally Funded Programs) Notice Example, click here.
- Non-MAGI beneficiaries and those receiving Long Term Care services, will receive the following termination notice:
- Non-MAGI Renewal Termination Notice Example, click here.
‘Request for Additional Renewal Information’ Notices
Renewals that have been received and completed will be reviewed for completion and any outstanding information. After review, the District may need verification documents based on the information provided. A Request for Additional Information (RIF) notice will be issued. The Request for Information (RIF) notice will only populate the request for outstanding documents that you need to provide to process your eligibility.
MAGI beneficiaries will receive the following request notice:
- MAGI Request for Additional Information (RIF) Notice Example, click here.
- Non-MAGI beneficiaries including Long Term Care services, will receive the following request notice:
- Non-MAGI Request for Additional Information Notice Example, click here.
Renewal Eligibility Determination’ Notices
Once the District has received all requested information and determined eligible for continued Medicaid coverage, the beneficiary will receive an approval notice.
- MAGI beneficiaries who remain eligible will receive the following eligibility notice:
- MAGI Renewal Approval Notice Example, click here.
- Non-MAGI beneficiaries and those receiving Long Term Care services who remain eligible will receive the following eligibility notice:
- Non-MAGI Renewal Approval Notice Example, click here.
For beneficiaries who are no longer eligible, a termination notice will be mailed.
- MAGI beneficiaries who are no longer eligible will receive the following termination notice:
- MAGI Ineligibility Termination Notice Example, click here.
- Non-MAGI beneficiaries such as those aged (65+), blind, disabled individuals, and those receiving Long Term Care services who are no longer eligible will receive the following termination notice:
- Non-MAGI Ineligibility Termination Notice Example, click here.
- If income exceeds the income standard, beneficiaries may be eligible through Medically Needy Spend Down by submitting medical expenses to reduce their countable income. A beneficiary may receive the following notice:
- Non-Magi Spend Down Notice Example, click here.
- Some individuals who receive Long Term Care services like EPD/IDD waiver may have income too high to remain eligible for Medicaid but may qualify through Medically Needy Spend Down by using medical expenses to reduce their countable income. A beneficiary who may qualify for spend down may receive the following notice:
- Long Term Care & Support Services Spend Down Notice Example, click here.
Renewal and Verification Document Submission Options
(Only need to submit renewal and/or information to one of the options listed below)
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Online: At districtdirect.dc.gov
Note: If you apply online, you do not need to complete a paper application.
- Mobile App: Available on Google Play or Apple App stores.
- By Phone: Call the Department of Human Services Economic Security Administration Public Benefits Call Center
(202) 727-5355.
By Mail:
Download an application from districtdirect.dc.gov. Mail your original, signed application (and appendices, if applicable) to:
Department of Human Services Economic Security Administration Case Record Management Unit
P.O. Box 91560
Washington, DC 20090
In Person: You may apply at any of the ESA Service Centers listed below:
H Street Service Center
645 H St., NE
Washington, DC 20002
Phone: (202) 698-4350
Congress Heights Service Center
4001 South Capitol St., SW
Washington, DC 20032
Phone: (202) 645-4546
Anacostia Service Center
2100 Martin Luther King Ave., SE
Washington, DC 20020
Phone: (202) 645-4614
Fort Davis Service Center
3851 Alabama Ave., SE
Washington, DC 20020
Phone: (202) 645-4500
Taylor Street Service Center
1207 Taylor St., NW
Washington, DC 20011
Phone: (202) 576-8000