District of Columbia Elderly and Persons with Disabilities (EPD) Medicaid Waiver

Page Reviewed / Updated - Feb. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

 This program helps individuals who would otherwise require nursing home to remain living at home.

The DC Office of Aging offers a single Medicaid waiver that is relevant to aging District residents; the Elderly and Persons with Disabilities Waiver, more commonly referred to as the EPD Waiver. This waiver is intended to allow beneficiaries who would otherwise require nursing home care to receive care services outside of that environment and to remain living in their homes or communities.

Medicaid waivers, unlike Medicaid, are not entitlement programs. Each waiver is approved with a limited number of available slots. In previous years, a waiting list has existed for the EPD Waiver. In 2013, the number of available slots has been increased to 4,660. It is unclear whether this expansion will eliminate the wait list entirely. However if it does not, this increase will dramatically shorten the waiting period.

 

Eligibility Guidelines

EPD Waiver qualifications consider both the functional ability and the financial status of the applicant. Candidates must have a medically documented need for nursing home level care and be over 65 years of age or over 18 and be officially disabled.

From a financial perspective, the District considers the applicant's income, financial resources or "countable assets" and past asset transfers dating as far back as 60 months preceding their data of application. Monthly income for an individual applicant is limited to 3 times Supplemental Security Income. In 2014, this means monthly income cannot exceed $2,163. Countable assets, which exclude the value of the home and primary vehicle, cannot exceed $2,000.

It is worth noting that these limits are for a single applicant. Married couples with two applicants have higher limits and married couples with a single applicant are subjected to a different, more complicated rule set. These rules were created in order to enable the "well spouse" (the non-applicant spouse) to continue to live independently. Families in this situation and single applicants who are concerned they do not meet the DC Medicaid limits should consult with a Medicaid planner.

 Persons whose incomes or assets exceed Medicaid's limits but still cannot afford their care should consider working with a Medicaid Planner to become eligible.  Learn more.

Finally, another option exists for persons over the Medicaid financial limits. An applicant can be considered "medically needy" and can qualify for Medicaid if their medical expenses exceed their incomes even though their incomes exceed the Medicaid limits.

 

Benefits and Services

Each beneficiary of the EPD Waiver has different care requirements and will be approved for different care and support services by their case manager. Under the EPD Waiver, the following forms of assistance are available.

  • Assisted Living
  • Chore Services
  • Environmental Accessibility Adaptations (Home Modifications)
  • Homemaker Services
  • Light Housekeeping
  • Meal Preparation
  • Personal Care
  • Personal Emergency Response Services (PERS)
  • Respite Services (up to 480 care hours per year)

 

How to Apply / Learn More

To apply for the EPD Waiver, interested parties should contact the Washington DC Aging and Disability Resource Center at 202-724-5626.  More information about the application process is available on the District's Commission on Aging's website.   A complete handbook for the program which offers very detailed information is available for download here.

 Senior citizens living in the District that require assistance with their home may also be interested in the Senior Citizens' Home Repair and Improvement Program. Read more.