- Be a resident of the District of Columbia;
- Be a US citizen or have eligible immigration status;
- Be eighteen (18) years old or younger;
- Have income less than 300% of Supplemental Security Income (SSI) and resources totaling less than $4000.
- Have a disability that is terminal or expected to last for more than (twelve) 12 months (or otherwise meet the definition of disabled under the Social Security Act);
- Require a level of care (LOC) that is typically provided in a hospital, skilled nursing facility, or intermediate care facility (including intermediate care facilities for people with intellectual disabilities);
- Be able to safely live at home; and
- Not be eligible for Medicaid under a different eligibility category.
Step 1: Log in to dchealthlink.com to complete an application for financial assistance to apply for Medicaid or complete the application process by phone, mail or in person if needed. Once an application is submitted:
- The applicant will be screened for MAGI Medicaid coverage and receive a decision within forty-five (45) calendar days.
- If the applicant meets all non-financial and financial requirements, the applicant will be determined eligible for MAGI Medicaid and will receive an approval notice.
- If applicant does not meet all non-financial and financial requirements, the Department will issue a notice to the applicant of their ineligibility for MAGI Medicaid and their opportunity to be evaluated for Medicaid through the TEFRA/Katie Beckett eligibility group.
- In cases where an applicant is denied for over income and there is a child with a disability in the household, a TEFRA/ Katie Beckett Application Packet will be mailed to the applicant.
Step 2: Once an applicant receives a TEFRA/Katie Beckett Application Packet, the applicant can submit the TEFRA/Katie Beckett Application Form to the Economic Security Administration (ESA) in one of the following ways:
- Fax the completed application to (202) 724-8963.
- Send by postal mail to:
DC Economic Security Administration
Attn: Medicaid Branch
645 H St. NE
Washington, DC 20002
- Submit by email by calling the ESA help desk for assistance at (202) 698-4220
- Submit in person at an ESA Service Center. Look for the nearest service center at https://dhs.dc.gov/service/find-service-center-near-you or call (202) 724-5506.
Step 3: An applicant must submit the following completed Level of Care (LOC) Determination documents to the Division of Children’s Health Services (DCHS) at the Department of Health Care Finance (DHCF) via email at [email protected]:
- Pediatric Level of Care Determination Form;
- TEFRA/Katie Beckett Care Plan Form; and
- Supporting documents, such as the Letter of Medical Necessity, the Individualized Education Program / Individualized Family Service Plan, therapy assessments, including diagnostic reports.
Step 4: The District will make an eligibility determination within sixty (60) calendar days of receipt of the completed TEFRA/Katie Beckett Application Packet.