What is Medicaid?
District of Columbia Medicaid is a joint federal-state health insurance program that provides health care coverage to low-income and disabled adults, children and families. To be eligible for DC Medicaid, you must be a resident of the District and must meet non-financial and financial eligibility requirements. Medicaid covers many services, including doctor visits, hospital care, prescription drugs, mental health services, transportation and many other services. Currently, one out of every three District residents receives quality health care through the Medicaid program. You may be eligible for Medicaid under the Modified Adjusted Gross Income (MAGI) Medicaid methodology or the Non-MAGI Medicaid methodology.
MAGI Medicaid vs. Non-MAGI Medicaid
Medicaid eligibility for children, pregnant women and families used to be based on the rules of Aid to Families with Dependent Children (AFDC) and then, in 1996, on the rules of Temporary Assistance for Needy Families (TANF). The ACA replaces almost all of the former eligibility rules with financial methodologies from the Tax Code, called Modified Adjusted Gross Income or MAGI for adults without dependent children, non-disabled children, pregnant women and parents/caretaker relatives.
MAGI rules apply to most people who are eligible for Medicaid, but do not apply to people 65 or older, people who may qualify for Medicaid based on a disability or in need of Long Term Care services, or for people who qualify for Medicaid for reasons other than income.
Effective October 1, 2013, the District of Columbia implemented the use of MAGI to determine Medicaid eligibility.
MAGI is a methodology for how income is counted and how household composition and family size are determined.
- MAGI is not a number on a tax return.
- MAGI is based on federal tax rules for determining adjusted gross income (with some modification).
- You do not have to file taxes to be eligible for MAGI Medicaid.
- No asset test or deductions – except for an across-the-board 5% deduction (known as “disregards”).
MAGI Groups include:
- Adults (age 21-64) without dependent children;
- Pregnant women;
- Parents/caretaker relatives; and
- Children under the age of twenty-one (21)
Medicaid categories exempt from applying the MAGI methodology.
Non-MAGI-based individuals include those who are:
- Age 65 or over, blind, or have a disability, with resources at or below $4,000 for a single person
- SSI recipients
- Home and community-based waivers participants
- Long Term Care beneficiaries
- Medicare Savings Program recipients (QMB and QMB Plus)
- Foster Care/Adoption Assistance
- Medically Needy Spend Down
- Former Foster Care Children
- Under 19 years of age and qualify for TEFRA/Katie Beckett
- Have been screened and need treatment for Breast and Cervical Cancer
Individuals who qualify for Medicaid for reasons other than income maintain existing rules for income and assets.
If you feel that you may qualify for Medicaid under a Non-MAGI eligibility category, you should submit the Combined Application for Medical Assistance.
If you feel that you may qualify for Medicaid under a MAGI category, you should submit a DC Health Link application https://dchealthlink.com/