Know Your Rights! Medicaid

Medicaid and DC Healthy Families provide health insurance to people who live in D.C. and have low income. The programs pay for doctor and hospital visits, dental and eye care, home health care, prescription drugs, and other services.

This flyer only talks about Medicaid, not Medicare. Medicare is for people who are 65 or older, have disabilities, or have End Stage Renal Disease or ALS.

• If you get SSI, you get Medicaid.
• Without SSI, you must have low income and few assets (things you own). See below.

You can apply for yourself or others. Some people in your family might be able to get Medicaid, even if you can’t get it for everyone. See the charts below:

Yes. The law says the government has to help you in your language. Tell the agency you want help in your language.

Maybe. Some people who aren’t U.S. Citizens can get Medicaid. Go to Legal Aid’s flyer, “Getting Public Benefits if You’re Not a U.S. Citizen.”

Even if you can’t get Medicaid, you can still apply for your children or other household members.

You only have to write the immigration status of the people you’re applying for. The government can’t ask for more information.

If you can’t get Medicaid because of your immigration status: apply for the DC Healthcare Alliance or for a private plan through D.C. Health Link (dchealthlink.com) (depending on your immigration status).

Yes. The law says the government has to help you in your language. Tell the agency you want help in your language.

You might be able to get Medicaid too. See below.

*To get regular Medicaid, you also can’t have assets worth more than $4,000 (for an individual) or $6,000 (for a couple), not counting some assets like a car or house.

If you have a medical bill from up to three months before your application date, you may be able to get Medicaid to cover the bill. Use District Direct to apply.

You can apply for all public benefits, including food stamps, TANF, Medicaid, and D.C. Healthcare Alliance on the same application.

Step 1: Get the documents you need. Don’t send the originals! Take a picture or make a copy.

• Your photo ID
• Your Social Security Card (if you have one)
• Proof of income (such as pay stubs)
• Your utility bill or other proof of address
• Birth certificates of everyone in your household

Step 2: Apply in one of five ways:

In person: Go to one of these ESA service centers. Ask for a receipt when you apply.

• Anacostia Service Center
  2100 Martin Luther King Jr. Avenue SE
  (202) 645-4614
• Congress Heights Service Center
  4001 South Capitol Street SW
  (202) 645-4546
• H Street Service Center
  645 H Street NE
  (202) 698-4350
• [Closed] Fort Davis Service Center
  3851 Alabama Avenue SE
  (202) 645-4500
• [Closed] Taylor Street Service Center
  1207 Taylor Street NW
  (202) 576-8000

Smartphone: Download the District Direct app in the app store. Apply through your phone. Write down your confirmation number.

Online: Apply online through District Direct at https://districtdirect.dc.gov/ua/. Write down your confirmation number. Save a copy of what you submit.

Mail: Get the application at https://dhs.dc.gov/page/apply-recertifybenefits. Send in the application and copies of your documents to a Service Center (listed to the left). Keep proof that you mailed in your application. This option isn’t recommended.

Fax: Fax the completed application to DHS ESA at (202) 671-4400.

If you’re approved, you’ll get a notice in the mail or through the app. You’ll get enrolled in managed care plan with a Managed Care Organization (MCO). The three MCO plans are AmeriHealth Caritas, CareFirst Community Health Plan, and MedStar Family Choice. To learn more about the plans, go to dchealthyfamilies.com or call DC Families Customer Service at (800) 620-7802.

You have the right to appeal. You need to appeal within 90 days of the notice that your Medicaid was denied, cut off, or reduced. There are three steps to appeal.

Step 1: Get the appeal form online at https://oah.dc.gov/node/154252.

Step 2: Fill out the appeal form.

Step 3: File the form in one of these ways:

Email it to oah.filing@dc.gov.

Bring it in person to the Office of Administrative Hearings, 441 Fourth Street NW, Suite 450N, Washington, DC 20001. Keep a copy of the form.

Mail it the address on the left. Keep a copy of the form. Write down the date you sent it. This option isn’t recommended.

Once you get Medicaid, you have rights. if you can’t get a service or see a doctor, file a “grievance” with your MCO. A grievance is a formal way to complain about an issue with your MCO. If the grievance is denied, you can appeal the denial through a “fair hearing” at OAH (see the information above).