• Income limits for individuals in the Parent/Caretaker relative Medicaid category will decrease from 221% to 138% of the federal poverty level (FPL). 

• Income limits for individuals in the Childless Adult Medicaid category will decrease from 215% to 138% of the federal poverty level (FPL).  

• Parent/Caretaker relatives or Childless adults over 138% FPL who receive Medicare will transition to a Qualified Medicare Beneficiary (QMB) program only.  

• Transitioning from Medicaid to the Healthy DC Plan or DC Health Link.  

Yes, an informational notice/letter was sent mid-September. Another notice about the end of your Medicaid will be mailed in early December. You may also view the notice in your District Direct account. This FAQ document will also address the upcoming changes.  

• Starting January 1, 2026, the income limits for the Parent/Caretaker and Childless Adults program will decrease to 138% (includes a 5% disregard) of the Federal Poverty Level. Please see the current and future income limits below.  

• For additional limits based on family size please, visit the DHCF website at Medicaid Health Care Coverage Changes (2025). 

• Your Medicaid coverage will terminate 12/31/2025. You will receive a termination letter in early December.  

• If your income is above 138% FPL and you are a Parent/Caretaker or Childless Adult who applies after 1/1/2026, you will be evaluated for other health care coverage options.  

• The following are alternative options for free to low-cost health coverage in the District. Please note that each program has an income limit and other eligibility criteria.  

• DC Medicaid offers Qualified Medicare Beneficiaries (QMB) for people who have Medicare and qualify  

• Healthy DC Plan, new starting January 1, 2026. This plan is for residents 21-64 with an annual income between 138% and 200% of the Federal Poverty Level. For more information, see Income Eligibility for Healthy DC Plan. 

No. Healthy DC Plan does not have monthly payments (also called premiums) or out-of-pocket costs for covered services. When you get care from participating doctors and hospitals, and community health centers, there is no out-of-pocket cost to you. 

• Yes. Use DC Health Link’s Plan Match tool to:  
  • Find out if you might qualify for lower monthly premiums and lower out-of-pocket costs.
  • Compare plan features, benefits, and costs side-by-side o Check to see if your doctors are in-network.
  • See if your prescription drugs are covered.

Healthy DC Plan coverage will be effective 01/01/2026  

• If you are losing Medicaid because Medicaid eligibility is changing, Healthy DC Plan will automatically enroll you into a Healthy DC Plan. Your Medicaid will end on December 31, 2025. Your Healthy DC Plan will begin on January 1, 2026. You will not have a gap in coverage.  

• If your Medicaid is with AmeriHealth Caritas DC or with MedStar Family Choice, Healthy DC Plan will automatically enroll you into a Healthy DC Plan with the same company you have your Medicaid coverage with now. Although your benefits and some providers will be different, the company providing your new coverage will be the same.  

• If your Medicaid is with Wellpoint DC, Healthy DC Plan will automatically enroll you into a Healthy DC Plan. 

If you have Medicare and your income is over 138% of the FPL, DC Medicaid will transfer you to a Qualified Medicare Beneficiary (QMB) program. QMB-only is not full Medicaid coverage but offers assistance with paying your Part A and Part B premiums and Medicare co-payments, co-insurance and deductibles. 

Medicaid will cover you, including delivery and 12 months of post-partum care.