DC Health Care Alliance Changes Since October 1, 2026

The DC Health Care Alliance (Alliance) provides locally funded health coverage to eligible District residents who do not qualify for Medicaid or other qualifying health coverage.

Thanks to the public advocacy efforts of the Keep DC Healthy Coalition and directly impacted community members, from the Fiscal Year 2027 (FY 2027) funding period of October 1, 2026 through September 30, 2027, Former Alliance enrollees that are over 21 years old are once again eligible for the medical services provided through this DC locally funded public insurance program. This is a return to the Alliance eligibility criteria that extends to adult populations that were established prior to October 1, 2025, offering former enrollees who went uninsured in FY 2026 to have the opportunity to once again have full medical coverage with the exception of access to non-emergency medical transportation services. (D.C. Law Library) However, the moratorium on new adult applicants over 21 years old to the Alliance program continues in FY 2027.

According to the DC Department of Health Care Finance (DHCF), the District maintains in FY 2027 the income eligibility from the last fiscal year that allows coverage for those with household income up to 133 percent of the federal poverty level (FPL), rather than the anticipated decrease to 19 percent. Also, the FY 2027 budget reverses the planned elimination of Medicaid Expansion in FY 2029, which impacts mixed-status households with working age adult US citizens with incomes below 133 percent of the FPL and allows for their continued access to quality and affordable health care. (DC Fiscal Policy Institute)

What do these changes mean for current Alliance enrollees?

If you already have Alliance coverage, it is important to:
1. Renew your coverage on time.
2. Read all notices from DC Health Care Finance (DHCF) sent via email or snail mail.
3. Report changes to your household, income, address, or other health coverage.
4. Ask questions if you receive a notice saying that your coverage or eligibility is changing.
5. Seek help if you are unsure whether you qualify for Alliance, DC Medicaid, or another publicly-backed coverage option by calling the DC Public Benefits Call Center at 202-727-5355.

Children enrolled in Alliance are not affected by the October 1, 2026 changes to adult enrollment. DHCF specifically states that there are no changes to the Alliance program for eligible children and youth enrolled in the Children and Adolescent Supplemental Income Program (CASSIP).

DC Medicaid Changes Starting October 1, 2026
Not all of the changes are reductions in coverage.

Effective October 1, 2026, DC Medicaid Fee-for-Service members no longer have cost-sharing requirements for prescription drugs or eyeglasses. (DHCF)

DC Medicaid managed care plans are also expanding coverage for certain in-patient behavioral health services.

For Medicaid enrollees ages 21–64, managed care plans must cover eligible stays in “Institutions for Mental Diseases” (IMD) for up to 60 days, compared with the previous 15-day limit. (DHCF)

These changes are important reminders that Medicaid policy is changing in multiple ways at once—some expanding access to services while others create new eligibility and administrative requirements.

What families should do now:

1. Keep your contact information updated
Make sure DC Medicaid and District benefits systems have your current mailing address, phone number, and email address. This helps ensure that you receive renewal notices and other important information.

2. Open every notice you receive
Do not assume that a letter from DHCF or the District is routine. Notices may contain deadlines that affect your health coverage.

3. Don’t wait to renew
If you receive a renewal notice, respond as soon as possible. The new six-month renewal schedule for some adults means that people will have more frequent opportunities—and responsibilities—to confirm their eligibility.

Other DC Medicaid Changes Coming January 1, 2027

While October brought changes to Alliance and certain Medicaid eligibility rules, another major set of changes to DC Medicaid is scheduled for January 1, 2027 as a result of federal guidelines set in H.R. 1. These changes will particularly affect some adults ages 19–64 who do not have dependent children in the home, with disparate impact on non-custodial fathers and parents of low needs adult CYSHCN who may not be eligible for adult disability services in the District.

New work and community engagement requirements

Beginning January 1, 2027, most adults ages 19–64 without dependent children in the home will generally need to complete at least 80 hours per month of qualifying work, education, training, volunteering, or similar activities to maintain Medicaid coverage. There will be exceptions and exemptions to these work requirements for certain individuals, so people should not assume that they will automatically lose Medicaid because of the new requirement. (DHCF)

More frequent Medicaid renewals

For most adults ages 19–64 without children, Medicaid renewals will change from once a year to every six months. This means keeping your contact information current and responding quickly to renewal notices will become even more important. Missing a notice or deadline could result in a loss of coverage even when someone remains eligible. (DHCF)

Changes to retroactive Medicaid coverage

The amount of time Medicaid can cover eligible medical expenses from before someone applies will also change.
Beginning January 1, 2027:
– Adults without children in the home will generally be eligible for up to one month of retroactive coverage.
– Children, parents, seniors, and other groups will generally remain eligible for up to two months of retroactive coverage.

This makes it increasingly important for people to apply for DC Medicaid as soon as they believe they may be eligible rather than waiting until medical bills accumulate. (DHCF)