EPD Waiver District of Columbia

The Program That Keeps Parents Out of Nursing Homes

The Elderly and Persons with Physical Disabilities (EPD) Waiver is DC's primary mechanism for funding nursing-home-level care in community settings — your parent's own home or a participating Assisted Living Residence. It exists because the federal government allows states to redirect Medicaid dollars from institutional care to home- and community-based services, and the District uses this flexibility to serve seniors who would otherwise face nursing home placement as their only publicly funded option.

For families navigating a care transition in DC, the EPD Waiver is often the difference between sustaining a care plan financially and watching savings evaporate at $8,725 per month for assisted living or $12,623 for nursing home care.

Who Qualifies

The EPD Waiver has two gates: clinical and financial. Your parent must clear both.

Clinical eligibility. Your parent must meet a Nursing Facility Level of Care (NHLOC) — meaning they need the kind of care that would justify nursing home admission. This is determined through a face-to-face assessment conducted by Liberty Healthcare, the District's contracted assessment agency. The assessor evaluates the parent's ability to perform Activities of Daily Living (bathing, dressing, eating, toileting, mobility) and documents the clinical conditions that make lower-level support insufficient.

Financial eligibility (2026 limits):

• Individual countable assets: $4,000 maximum
• Monthly income: $2,982 maximum (300% of SSI)
• If married, couple asset limit: $6,000 (both applying) or the Community Spouse Resource Allowance of up to $162,660 protects the at-home spouse's assets

Key exclusions from countable assets: the primary home (up to $1,130,000 in equity), one vehicle, personal property, and irrevocable burial contracts.

If your parent's income exceeds $2,982 per month, they're not automatically disqualified — but they must use the Medically Needy Spend-Down pathway. This requires spending all income above $856.90 per month on qualifying medical and care expenses before Medicaid covers the remaining balance. DC does not allow Miller Trusts (Qualified Income Trusts) as an alternative to spend-down, which makes the income limit a harder barrier here than in many states.

The Application Pipeline

The EPD Waiver application moves through a specific sequence of agencies. Understanding this pipeline prevents the circular referrals that frustrate most families.

Step 1: DACL intake. Contact the Aging and Disability Resource Center (ADRC) at (202) 724-5626 or visit 250 E Street SW. DACL conducts a preliminary screening and opens your parent's case.

Step 2: Prescription Order Form. Your parent's primary care physician — who must be an enrolled DC Medicaid provider — completes and submits an electronic Prescription Order Form (POF). This is the clinical trigger that authorizes the functional assessment. The POF goes through DC Care Connect, or by email to [email protected], or by fax to (202) 698-2075.

Step 3: Liberty Healthcare assessment. Liberty schedules a face-to-face evaluation in the parent's home or hospital room. A family member should be present to provide specific, concrete details about the parent's daily care needs. Vague descriptions produce weaker documentation. Describe exactly what your parent can and can't do: how many times they've fallen, whether they can sequence the steps of bathing, whether they wander or leave the stove on.

Step 4: Financial determination. Simultaneously, submit the Supplemental Form for Long-Term Care Benefits and the Combined Application for Benefits. Family members can submit directly through the consumer portal at districtdirect.dc.gov. Professional care managers use the District Direct Partner Portal at partnerportal.dc.gov. The Economic Security Administration (ESA) has 45 days to determine financial eligibility (up to 90 days if a disability review is required).

Step 5: Case manager assignment. Once approved, your parent is assigned a case manager from an approved EPD Case Management Agency. Care is delivered through fee-for-service waiver providers or coordinated through a Dual-Eligible Special Needs Plan (D-SNP).

What the Waiver Covers

The EPD Waiver funds a range of services designed to support nursing-home-eligible seniors in community settings:

• Personal care aide hours (help with ADLs at home)
• Adult day health program attendance
• Skilled nursing visits
• Case management and care coordination
• Home health aide services
• Respite care for family caregivers
• Environmental accessibility adaptations

In an assisted living setting, the waiver covers the care services but not room and board. This is the most common misunderstanding families encounter. Your parent or the family must cover the housing and meal costs separately.

The Waitlist Reality

Unlike standard Institutional Medicaid for nursing homes — which is a mandatory federal benefit with no waitlist — the EPD Waiver has capped enrollment slots. When all slots are filled, new applicants go on a waitlist.

The waitlist length fluctuates and isn't published in real time. When you contact DACL, ask directly about current wait times. If your parent is in active crisis, communicate the urgency — hospital discharge situations and imminent safety risks can sometimes accelerate the timeline.

During the waiting period, if your parent's needs are urgent, the alternative is private-pay care or nursing home placement through standard Institutional Medicaid (if they meet the financial criteria). Some families bridge the gap with private-pay home care while the waiver application processes.

The DC Care Decision Toolkit includes an EPD Waiver pipeline tracker that walks through each step of the application with the specific forms, contact information, and documentation checklists — plus a Medicaid eligibility prescreen worksheet to determine whether your parent is likely to qualify before starting the process.

See more District of Columbia guides →