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Washington, D.C.

Washington, D.C. Medicaid and the new work rules

DC Medicaid covers adults ages 21 to 64 without dependent children (the District calls this group "Childless Adults") and parents and caretaker relatives, both up to 138% of the federal poverty level as of January 1, 2026. Until December 31, 2025 the District covered these same adults far higher — to 215% of poverty for adults without children and 221% for parents — the most generous thresholds in the country. is run by Department of Health Care Finance (DHCF), the District's Medicaid agency, led by Wayne Turnage, Deputy Mayor for Health and Human Services. Melisa Byrd is Senior Deputy Director and Medicaid Director. Applications and renewals are processed by the Department of Human Services' Economic Security Administration. Washington, D.C. expanded Medicaid on January 1, 2014, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.

Work rules start January 1, 2027 Medicaid expanded 253,148 enrolled 78,322 in the expansion group

Start here

From January 1, 2027, most adults have to show 80 hours a month

The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 78,322 people in Washington, D.C. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.

Compliance is measured for one month, not continuously. A new applicant is checked against the month before the month of application; someone already enrolled is checked against one month in the certification period being renewed. CMS directs the District to use data it already holds — payroll data, payment records, Medicaid claims, and encounter data — to verify both activity and exemptions before asking the resident for anything.

If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.

June 1, 2026 · already happened

CMS published the interim final rule implementing the federal work requirement

June 2026 · already happened

CMS named the eight states whose section 1115 waiver populations must also meet the requirement; the District is not among them

July 2026 · already happened

The District published its overview page on the federal Medicaid changes and began briefing residents and stakeholders at biweekly eligibility meetings

September 5, 2026 · already happened

The Department of Health Care Finance mailed notices to every beneficiary it identified as affected by the work requirement, in an envelope marked with a blue mark; the same notices appear in District Direct accounts

September 2026 · already happened

The District's public advertising campaign on the work requirement went live, satisfying the federal requirement to begin outreach at least three months before the first look-back period

October 1, 2026 · already happened

Certain adult non-citizens lose DC Medicaid; the local DC Health Care Alliance reopens to new applicants aged 26 and over

January 1, 2027

The work requirement, six-month renewals, and shortened retroactive coverage take effect

March 2027

The first group actually tested — people whose certification date falls in March 2027 — must report work, school, or volunteer hours at renewal

January 1, 2028

The $1 million home equity cap for long-term care eligibility takes effect

You do not have to prove anything if any of these describe you

Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.

Children 18 and younger, and anyone 19 or 20 covered in the District's children's group

Anyone 65 or older

Parents and caretaker relatives of a minor child — in the District most are covered through the mandatory section 1931 category, which the requirement does not touch at all; federal law separately exempts parents and caretakers of a disabled child or a child 13 or younger who qualify through expansion

People who are pregnant or postpartum

People who are medically frail in a way that significantly affects their ability to meet the requirement, which the District spells out as being blind or disabled, having a substance use disorder, having a disabling mental disorder, having a physical, intellectual, or developmental disability that significantly impairs one or more activities of daily living, or having a serious or complex medical condition

Adults who qualify for Medicaid through disability or a health condition rather than through income (what the District calls non-MAGI)

Adults enrolled in a waiver program — the Elderly and Persons with Disabilities Waiver, Services My Way, the Individuals with Developmental Disabilities Waiver, or the Individual and Family Support Waiver

Adults in long-term institutional care, including nursing facilities and intermediate care facilities

Adults in the Program of All-Inclusive Care for the Elderly (PACE)

Adults entitled to Medicare Part A or enrolled in Medicare Part B, and adults in the Qualified Medicare Beneficiary or QMB+ programs

Current and former foster care youth who are enrolled in or eligible for Medicaid

American Indians and Alaska Natives eligible to receive services through the Indian Health Service

Veterans with a disability rated as total under section 1155 of title 38 of the U.S. Code

People already meeting SNAP or TANF work requirements

Short-term hardship, which the District may grant for a month in the look-back period if you received inpatient hospital, nursing facility, intermediate care facility, or inpatient psychiatric services or comparable care; if you live somewhere with a presidentially declared emergency or a high local unemployment rate; or if you or a dependent had to travel outside your community for an extended period for care for a serious or complex medical condition that is not available where you live

Income limits

What you can earn and still qualify

Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.

Adults 19 to 64138% of the poverty line

1 person: $1,836
2 people: $2,489
3 people: $3,142
4 people: $3,795
5 people: $4,449
6 people: $5,102
7 people: $5,755
8 people: $6,408

Parents and caretakers138% of the poverty line

1 person: $1,836
2 people: $2,489
3 people: $3,142
4 people: $3,795
5 people: $4,449
6 people: $5,102
7 people: $5,755
8 people: $6,408

Pregnant319% of the poverty line

2 people: $5,843
3 people: $7,377
4 people: $8,910
5 people: $10,444
6 people: $11,978
7 people: $13,511
8 people: $15,045

Source: Department of Health Care Finance program pages for Adults Without Dependent Children, Parent or Caretaker Relative, Pregnant Individual, Infants and Children (0-20), Aged Blind and Disabled, and Long-Term Care, each stating that figures were compiled using 2026 federal poverty level numbers distributed by HHS as of January 16, 2026; the eligibility change itself is Medicaid Director Letter MDL 25-02, October 16, 2025, effective January 1, 2026. A note on precision: Four points where official District documents differ, each published as the District states it rather than reconciled by guesswork. We publish the state figure.

January 1, 2027

Two other changes land on the same day

Renewals get more frequent, and back-dated coverage gets shorter.

Renewals every six months From January 1, 2027, adults 19 to 64 without dependent children renew DC Medicaid every six months instead of once a year.

Back-dated coverage is changing on January 1 One month for adults without dependent children; two months for everyone else, including children, parents, people 65 and older, and people with disabilities. The Department of Health Care Finance states both figures on its own federal-changes page. If you have unpaid medical bills, applying sooner covers more of them.

P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.

Worth knowing

Washington, D.C. has no law that would end expansion automatically

It is not a guarantee.

D.C. Code § 1-307.03 (Medical assistance expansion program establishment), as amended by § 5042 of the Fiscal Year 2026 Budget Support Act of 2025, D.C. Law 26-55, effective December 6, 2025.

The District has nothing that works like North Carolina's G.S. 108A-54.3C, and KFF's August 2026 tracking table records the District as having adopted expansion with no trigger law in place. Nothing in the D.C. Code ends Medicaid expansion automatically if the enhanced federal match falls. What the Code does instead is make coverage above the federal minimum discretionary and tie it to money. Section 1-307.03(a) says the Mayor "may establish a program to expand medical assistance to adult District residents with an annual household income up to 200% of the federal poverty level." Subsection (c) lets the Mayor widen eligibility only "to the extent such expansion is consistent with the District's budget and financial plan." And subsection (e) says that nothing in the section "shall be deemed to create or constitute an entitlement or right to medical coverage.".

Where the protection stops. The risk here is not a trigger that fires on an FMAP cut. It is that the District's generosity above the federal floor was always a budget line the Mayor and the Council could move, and in 2025 they moved it. No change in the federal match rate was required or involved. The District's Chief Financial Officer revised the four-year revenue forecast down by more than $1 billion in February 2025, largely because of federal job losses among District residents, and the Mayor's response was to reduce Medicaid eligibility. The Department of Health Care Finance's budget testimony describes the logic plainly: it targeted "optional" groups not protected by federal maintenance-of-effort rules, aimed at the top of the income range, and chose people who had other coverage to fall back on. If the 90% match for the expansion group were cut, the same mechanism — the annual Budget Support Act — is what would decide what happens to the roughly 78,000 adults still covered, and it would not need a new law to act.

No attempt to add, remove, or soften a trigger law was found, because there is none to argue about. The live legislative fight has been over the eligibility cut itself and over the locally funded DC Health Care Alliance. There the Council pushed back and partly won: the Fiscal Year 2026 Budget Support Act closed Alliance to new adult applicants aged 26 and over, and the Fiscal Year 2027 Budget Support Act of 2026, Bill 26-661, reopened it effective October 1, 2026. The Department of Health Care Finance records that the Council, not the Mayor, added the reopening to the enacted budget.

As it stands. In force and already used. The cut from 215% to 138% of poverty took effect January 1, 2026 and removed about 25,575 people from DC Medicaid — 17,275 adults without children and 8,300 parents and caretaker relatives, roughly 9% of all District Medicaid beneficiaries — for about $42.8 million in first-year savings. District Medicaid enrollment fell from 271,979 in December 2025 to 253,148 in January 2026. Most of those who lost coverage were moved to Healthy DC Plan or referred to DC Health Link rather than left uninsured, which is the material difference between this and a trigger law firing.

Do this now

Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.

Apply, renew or update details District Direct District Direct works in a browser and as a free mobile app for iPhone and Android, and the app is the fastest way to confirm what address and immigration information the District has on file. The state's own work-rules page Read Washington, D.C.'s guidance Updated as rules are finalized Talk to a person 202-727-5355 Public Benefits Call Center (apply, renew, report a change, get help with District Direct) — Monday to Friday, 7:30 am to 4:45 pm Department of Health Care Finance main line, for Medicaid policy and program questions 202-442-5988 Monday to Friday, 8:15 am to 4:45 pm DC Healthy Families Enrollment Office, to pick or change a managed care plan 202-639-4030 Monday to Friday, 8 am to 6 pm

About the phone numbers: The Public Benefits Call Center posts live hold times at esacallcenter.dhs.dc.gov, which is worth checking before you dial. The 202 numbers are ordinary local numbers and work from outside the District; 1-877-685-6391 and 855-532-5465 are toll-free. If a call does not resolve your problem, the Department of Human Services takes written tickets at dhs-asks.dc.gov, which the District recommends for SNAP, TANF, and Medicaid issues that are stuck.

Deaf, hard of hearing or speech-impaired: 711 (DC Relay). The Public Benefits Call Center also lists TDD 1-800-537-7699.

EnglishSpanishAmharicChineseFrenchKoreanVietnamese

The District's Language Access Act of 2004 requires District agencies to interpret and to translate vital documents for any language group that reaches 3% or 500 people of the population they serve, and the Office of Human Rights identifies six such languages District-wide besides English: Spanish, Amharic, Chinese, French, Korean, and Vietnamese. District Direct runs in English, Spanish, Amharic, French, and Chinese. Interpretation is free and you should not be asked to bring your own interpreter: every DC Medicaid provider is required to connect you to a live telephone interpreter at no cost, including when you call to make an appointment. Ask for your language when you call 202-727-5355, and deaf and hard-of-hearing callers can use DC Relay at 711. The Department of Health Care Finance publishes its Alliance handbook and its benefit-change notices in Spanish and Amharic, and the notices in Korean, Chinese, and Vietnamese as well, and holds a monthly evening residents' meeting with live Spanish interpretation.

If a letter arrives

Most people who lose coverage lose it over paperwork, not eligibility

Nationally, most people who lose Medicaid lose it over paperwork rather than because they stopped qualifying. From January 1, 2027 that matters more, not less.

Department of Health Care Finance (DHCF), the District's Medicaid agency, led by Wayne Turnage, Deputy Mayor for Health and Human Services. Melisa Byrd is Senior Deputy Director and Medicaid Director. Applications and renewals are processed by the Department of Human Services' Economic Security Administration. · Notice of action

NOTICE OF ELIGIBILITY DETERMINATION

Case number: ███████
Date of this notice: 1January 12, 2027

Our records do not show that you met the community engagement requirement for the reporting period.

2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.

3Coverage for other members of your household is not affected by this notice.

The clock starts on this date. Not the day it reached you. Assume you have less time than it feels like.

"Our records do not show" is not the same as "you did not".The state is matching against databases that are often out of date. If you worked those hours, or an exemption fits you, say so — call 202-727-5355.

Your children's coverage is separate. The work requirement does not apply to them. A notice about you does not end their coverage.

You can ask for a fair hearing. It's free, you don't need a lawyer, and asking can keep your coverage running while it's reviewed.

Know your state

What the federal data says about coverage here

Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.

Primary care supply · America's Health Rankings

549 /100k

Provider supply here is around the national middle. Nurse practitioners also need physician supervision in this state, which narrows your options further.

Book an appointment before you need one, not when you do.

How care is delivered

Managed care

Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.

Check your doctor is in the plan before you choose it.

Where you live in this state changes what coverage is worth. The District is 68 square miles and nothing in it is far away, so the access problem here is not distance — it is which side of the Anacostia River you live on. Medicaid enrollment is heavily concentrated east of the river: the Department of Health Care Finance's own ward table, drawn from its claims system, put 59,047 enrollees in Ward 7 and 70,496 in Ward 8, together about 42% of all District Medicaid enrollees, against 7,994 in Ward 3. The agency states flatly that "most Medicaid beneficiaries continue to reside in Wards 7 and 8." Provider supply runs the other way. DC Health reports that the District has nine federally designated Health Professional Shortage Areas and eight Medically Underserved Areas or Populations — six primary care shortage areas, two dental, and one mental health — and the single mental health shortage area is Anacostia. The consequences show up in how long people live: DC Health's Community Health Needs Assessment found life expectancy of 70.5 years in Ward 8 against 86.0 years in Ward 3, a gap of about 15.5 years inside one city. District-wide numbers hide all of this. The District has 548.9 primary care providers per 100,000 residents, the highest figure in the country against a national 291.4, and yet HRSA's own District narrative records that only 56% of DC Medicaid and Alliance enrollees had a primary care visit in a 12-month period. One thing has changed for the better. Cedar Hill Regional Medical Center GW Health opened on the St. Elizabeths East campus in Ward 8 on April 15, 2025 — 136 beds expandable to 184, a 54-bay emergency department, maternity care and a Level II NICU — which the Mayor's office describes as the first new hospital built in the District in 25 years. It opened the same day United Medical Center, the only hospital east of the Anacostia for 60 years, shut its doors. DHCF, FY2023-24 Performance Oversight Hearing testimony of Wayne Turnage, February 2024, ward distribution table from the Medicaid Management Information System; DC Health, Shortage Designation (dchealth.dc.gov/service/shortage-designation); DC Health, Community Health Needs Assessment Executive Summary, 2019, using 2017 data; America's Health Rankings on CMS National Plan and Provider Enumeration System data, September 2025; HRSA Maternal and Child Health Bureau Title V narrative for the District of Columbia; Office of the Mayor, press release on the opening of Cedar Hill Regional Medical Center GW Health, April 10, 2025

Common questions

Questions people ask about this

Do the new Medicaid work rules apply to me in Washington, D.C.?

They apply to adults aged 19 to 64 who are covered through Medicaid expansion — about 78,322 people in Washington, D.C. Children, people over 65, and most people covered on grounds of disability or pregnancy are not in that group. There is also a long list of exemptions.

How many hours a month do I have to work?

80 hours a month. Work is not the only way to meet it — study, job training, volunteering and a combination of these count too, and earning at least $580 a month also satisfies it.

Who is exempt from the work requirement in Washington, D.C.?

Exemptions include: Children 18 and younger, and anyone 19 or 20 covered in the District's children's group; Anyone 65 or older; Parents and caretaker relatives of a minor child — in the District most are covered through the mandatory section 1931 category, which the requirement does not touch at all; federal law separately exempts parents and caretakers of a disabled child or a child 13 or younger who qualify through expansion; People who are pregnant or postpartum; People who are medically frail in a way that significantly affects their ability to meet the requirement, which the District spells out as being blind or disabled, having a substance use disorder, having a disabling mental disorder, having a physical, intellectual, or developmental disability that significantly impairs one or more activities of daily living, or having a serious or complex medical condition; Adults who qualify for Medicaid through disability or a health condition rather than through income (what the District calls non-MAGI); Adults enrolled in a waiver program — the Elderly and Persons with Disabilities Waiver, Services My Way, the Individuals with Developmental Disabilities Waiver, or the Individual and Family Support Waiver; Adults in long-term institutional care, including nursing facilities and intermediate care facilities.

When do the Washington, D.C. work rules start?

January 1, 2027. From January 1, 2027, adults 19 to 64 without dependent children renew DC Medicaid every six months instead of once a year. Keeping your address and phone number current with the state is the single most important thing to do before then, because everything arrives by mail.

What is the income limit for Washington, D.C. Medicaid?

For adults 19 to 64, about $1,836 a month for one person and $6,408 for a household of 8.

How do I apply for DC Medicaid covers adults ages 21 to 64 without dependent children (the District calls this group "Childless Adults") and parents and caretaker relatives, both up to 138% of the federal poverty level as of January 1, 2026. Until December 31, 2025 the District covered these same adults far higher — to 215% of poverty for adults without children and 221% for parents — the most generous thresholds in the country.?

Online at District Direct, or by phone on 202-727-5355. It is free and there is no open-enrollment window — you can apply at any time of year.

How often do I have to renew Washington, D.C. Medicaid?

Adults covered through Medicaid expansion move from a yearly renewal to one every six months starting with renewals due on or after January 1, 2027. Children, people over 65 and most people covered on grounds of disability stay on yearly renewals. Keep your address and phone number current so the renewal notice reaches you, and answer it before the date on the letter — most people who lose coverage lose it over paperwork.

Other states

Guides for neighboring states

The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.

MarylandThe new work rules VirginiaThe new work rules

See all 50 states and Washington, D.C. on the map →

If you are one of the roughly 78,000 District adults without dependent children on DC Medicaid, the Department of Health Care Finance already mailed you a notice about the work requirement on September 5, 2026 — look for an envelope with a blue mark, or check your District Direct account, because the same notice is there.

The requirement starts January 1, 2027 and the first group actually tested is people whose renewal comes due in March 2027. One trap is worth knowing now: if your renewal is due between October 2026 and February 2027, send the paperwork in on time. The District has 90 days of grace after your coverage ends, but if you use it and file on or after January 1, 2027, your renewal is treated as a brand-new application and the work rules apply to you months earlier than they otherwise would.

Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.

Go to District Direct →