District of Columbia Nursing Home Medicaid

Assessment process and current vendor caution

Older DHCF guidance calls the clinical decision a level-of-need determination completed through a face-to-face nurse assessment after a Prescription Order Form. DHCF’s January 2025 operational bulletin says Telligen assumed Independent Assessment services for DHCF Long-Term Care Support Services on February 1, 2025, replacing Liberty Healthcare for that work. Because referrals and contracts can change, applicants should obtain the current assessment directions from DHCF rather than submit a form based solely on an older PDF (DHCF nursing-facility eligibility FAQ; DHCF 2025 assessor transition bulletin).

The medical assessment is not a measure of family preference or a facility’s available bed. It is a needs-based determination. A person can be financially eligible but not meet the required level of care, or meet the level of care while needing to use the spend-down pathway to address income. Coordinate the clinical and financial applications early (DHCF Medically Needy Spend-Down).

Personal-needs allowance and patient liability

DHCF Transmittal 26-02 states that, effective January 1, 2026, the monthly personal-needs allowance for institutionalized long-term-care residents increased to $109. This is the protected amount in the resident’s post-eligibility income calculation; it should not be confused with a resource limit or a complete list of allowable deductions. Current notices should be checked for Medicare premiums, community-spouse income allowances, and any other individual deductions (DHCF Transmittal 26-02; 29 DCMR § 966).

Before admission, ask the facility and DHCF about Medicaid certification, the assessment status, pending application coverage, the patient-liability calculation, and whether a new assessment is needed after a hospital discharge.