EPD Waiver in the District of Columbia

The Elderly and Persons with Physical Disabilities (EPD) Waiver is DC's primary alternative to nursing home placement. It lets your parent receive long-term care services at home or in an assisted living community — at Medicaid's expense — instead of in a facility.

The catch: the program is capped at roughly 6,100 participant slots, and waiting lists are first-come, first-served rather than prioritized by medical urgency.

What the EPD Waiver Covers

The EPD Waiver (authorized under Section 1915(c) of the Social Security Act) covers a range of home and community-based services:

• Personal care aide (PCA) services — help with bathing, dressing, toileting, mobility, eating
• Homemaker services — meal preparation, light housekeeping, laundry
• Clinical case management — coordination of all care services
• Adult day health programs — structured daytime programs with medical oversight
• Physical environmental adaptations — wheelchair ramps, stair lifts, grab bars, bathroom modifications
• Personal emergency response systems (PERS) — wearable alert devices
• Respite care — temporary relief for primary caregivers

Through the "Services My Way" program, participants can also self-direct their care — hiring, scheduling, and managing their own caregivers, including family members.

Eligibility Requirements

To qualify for the EPD Waiver, your parent must meet both criteria:

Clinical: Require a Nursing Facility Level of Care (NFLOC), demonstrated by needing hands-on assistance with at least three Activities of Daily Living. This is assessed by Liberty Healthcare through a face-to-face evaluation.

Financial: Countable assets below $4,000 (individual) and monthly income at or below $2,982. If income exceeds the limit, the medically needy spend-down pathway applies.

How to Apply

The intake process runs through a split-agency model:

1. Start with DACL. Contact the Department of Aging and Community Living through the Aging and Disability Resource Center (ADRC). They manage intake, options counseling, and clinical enrollment tracking.

2. Get the Prescription Order Form (POF). Your parent's primary care physician must complete and sign this mandatory form.

3. Submit the POF to the DACL Medicaid Services Enrollment Unit at (202) 724-5626 or [email protected] to request the Liberty Healthcare face-to-face assessment.

4. Complete the clinical assessment. A Liberty Healthcare nurse visits the parent's home to evaluate their functional needs. Have a family member present to describe the worst days accurately.

5. Financial review. Once clinical eligibility is established, DHCF processes the financial eligibility determination through DHS Economic Security Administration.

The Waiting List Reality

The EPD Waiver is enrollment-capped. When all slots are filled, new applicants go on a waiting list managed on a first-come, first-served basis. There's no priority system for medical urgency — someone with moderate needs who applied six months ago gets a slot before someone in crisis who applied last week.

If your parent is on the waiting list and their condition deteriorates to the point where they need immediate 24-hour care, the alternative is applying for Institutional Medicaid (nursing home Medicaid), which is an entitlement program with no enrollment cap.

The DC Medicaid Long-Term Care Guide maps out both the EPD Waiver pathway and the institutional backup plan, with step-by-step timelines for each.

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