Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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District of Columbia program

Free health insurance for your child (DC Healthy Families)

Government health coverage for children and young people under 21 [DC Healthy Families], with a higher income limit before age 19. It can work alongside work insurance.

What it is

Government health coverage for children and young people under 21 [DC Healthy Families], with a higher income limit before age 19. It can work alongside work insurance.

DC Healthy Families covers children whose household income fits the District's limit. A drop in pay can change the answer. The benefits office decides who belongs in your child's household and which income counts.

Eligibility rules
  • Birth through age 20. Ages 0–18 use the higher children’s table; ages 19–20 use a separate, lower table.
  • Free-coverage limit by household size, per month (2026): 1: $4,310 · 2: $5,843 · 3: $7,377 · 4: $8,910 · 5: $10,444 · 6: $11,978. Your child must live in the District.
  • Having work insurance does not by itself rule out Medicaid. The work plan is normally billed first.
  • For applications made through December 31, 2026, DC Medicaid can cover eligible care in the three months before the application month. For a child’s application made on or after January 1, 2027, that look-back becomes two months. The child must have met the rules in each earlier month; earlier bills are not covered automatically.
Why families with work insurance consider Medicaid
  • Your work plan is billed first. For covered, properly approved care through a DC Medicaid health plan, the clinic generally cannot collect protected cost sharing from you, even when Medicaid pays nothing extra.
  • Keeping both plans means checking that the cancer team can bill both and managing two sets of plan rules.
Before changing coverage
  • Ask the financial counselor to compare the exact hospital, doctors, medicines and treatment approvals under each option.
  • Ask your employer how removing a child would change the premium and when the child could return to the plan.
What you get
  • Covered hospital care, cancer treatment, medicines and tests; the benefits office confirms any age-specific charges.
  • Dental and vision care, plus rides to covered appointments.
  • Nursing at home when your child's medical needs meet the separate care rules.
Coverage and earlier bills
  • For children under 21, the federal child health benefit covers medically necessary services within Medicaid benefit categories. It does not guarantee every requested service.
  • Approved children under 19 have 12 months of continuous eligibility.
  • Bills from up to three months before you apply can be covered through 2026, two months from January 2027, for months your child was eligible.
  • Coverage for an earlier month depends on eligibility during that month and whether the care is covered. The application date determines which look-back period applies.
If you decide to apply
  1. Ask the hospital financial counselor to help with District Direct and check temporary hospital coverage.
  2. Have current pay information, birth dates, insurance cards and earlier bills ready.
  3. Ask which health plan includes your child's cancer team, hospital and pharmacy.

District benefits office (ESA/DHS): 202-727-5355 · Official page ↗

After you apply
  • Ordinary applications have a published decision standard of up to 45 days, or 60 days on a disability basis.
  • A qualified participating hospital may start temporary Medicaid coverage after a preliminary eligibility check. The hospital’s notice gives the start date and the deadline for a full application: normally the last day of the following month. A full application submitted by that deadline keeps this temporary period open until the eligibility decision.
  • If the plan refuses, cuts or stops a service, you have 60 days to appeal; the answer is due within 30 days, or 72 hours when urgent. To keep an existing service running meanwhile, ask within 10 days of the notice.
Good to know

Your work insurance gets billed first. Having both plans does not mean every bill is covered.

Income table and billing
  • The 2026 monthly limits for households of 1 through 8 are $4,310, $5,843, $7,377, $8,910, $10,444, $11,978, $13,511 and $15,045. The five-point income allowance is already included.
  • Your child must live in the District; being treated at a DC hospital is not enough.
  • Your work plan is billed first. For covered care from a clinic in your child's Medicaid plan, the clinic cannot bill you the deductible, coinsurance or copay the work plan left, even when Medicaid pays nothing extra, and a form you signed at check-in does not change that. Worked example (illustrative figures): the work plan applies $3,000 of a $5,000 bill to your deductible and pays $2,000; Medicaid allows $1,500, less than what was paid, so it adds $0, and the clinic still cannot bill you the $3,000. (two bullets in place of three)

Federal background: Medicaid can work alongside private insurance. Federal child health rules also apply.

Official sources
Ask your social worker

“Could DC Healthy Families reduce our child’s bills alongside any insurance we have? What would change about care, and could you help us decide whether to apply?”

Why I’m asking: I want to understand how Medicaid could reduce treatment bills without disrupting our child's care.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on District Direct, give this month's income for everyone in the household, and say which hospital is treating your child.

Your social worker

The oncology social worker or financial counsellor helps you file and asks the hospital to open temporary coverage for a child under 19 while the office decides.

The care team

Nothing is needed from the doctors for ordinary child coverage. Medical records are needed only for the Katie Beckett route.

Who decides
The Economic Security Administration (the District benefits office) checks the income. The Department of Health Care Finance and the health plan you choose run the coverage.
Ask your social worker
“Can you help me apply on District Direct today, and can the hospital open presumptive coverage for my child while we wait? Which health plan is the oncology team in?”

How to apply

First step: Apply at districtdirect.dc.gov or call 202-727-5355 this week, and ask the hospital financial counsellor today about temporary coverage.

  1. Apply on District Direct this week, or call 202-727-5355.
  2. Ask the hospital financial counsellor today whether they can open temporary coverage for your child.
  3. Pick the health plan that the oncology team and Children's National are in before you choose.

Official application / program page ↗

Where it starts: Apply at districtdirect.dc.gov or call 202-727-5355. Ask the hospital financial counsellor the same day about temporary coverage for a child under 19.

What to gather

  • The child's birth certificate or ID and Social Security number
  • Proof of a District address
  • This month's income for every adult in the household
  • Any insurance cards
  • Hospital bills already received

How long: DHCF publishes up to 45 days, or 60 days on a disability basis. Temporary hospital coverage can start the same day. Once approved, coverage runs 12 months without a new income check.

What a yes looks like

A notice with coverage dates and a choice of health plan. Check that the hospital and the oncology group are in that plan before you choose.

What a no looks like, and the next move

Read why. If it is income, ask about Katie Beckett and about Spend Down in the same call, and appeal by the date on the notice.

Watch out

  • DC prints one income column and the allowance is already inside it, so the printed figure is the real limit.
  • Your child can keep private insurance and have this too. Do not cancel the work plan to apply.
  • DC Medicaid is for District residents. A Maryland or Virginia family treated at a DC hospital applies at home, not here.
  • If the office says income is too high, ask about Katie Beckett by name in the same breath: it looks only at the child's income.

Dates that change this

2026-01-16: The income table names the January 16, 2026 federal poverty figures as its basis. DC did not publish its own start date for the table or the date of the next one.

2027-01-01: Child applications from January 1, 2027 have up to two months of retroactive eligibility. Applications through December 31, 2026 can reach back up to three months when eligibility and covered-care conditions fit.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full DC Medicaid with no premium. The monthly limit is $8,910 for four people and $7,377 for three, allowance included.

  • $5,843/month — Monthly income limit, household of 2 (ages 0-18, allowance included)
  • $7,377/month — Monthly income limit, household of 3
  • $8,910/month — Monthly income limit, household of 4
  • $10,444/month — Monthly income limit, household of 5
  • $11,978/month — Monthly income limit, household of 6
  • $4,310/month — Monthly income limit, household of 1
  • $13,511/month — Monthly income limit, household of 7
  • $15,045/month — Monthly income limit, household of 8
  • $45 — Published decision time for an ordinary application

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21 (the child health benefit) · Home nursing and home health aide hours when the plan approves them · Rides to appointments · Dental and vision

Legal protection: 12 months of coverage once approved, without a new income check

What it costs the family: DHCF describes DC Healthy Families as free health insurance. No published premium and no published copay for a child.

The eligibility facts, as published

Age
Birth through age 20: ages 0–18 use the higher published table; ages 19–20 use a separate lower youth category. The under-19 continuous-eligibility rule is not extended automatically to ages 19–20.
Age max exclusive
19
Income
Published monthly cells for households of 1 to 8; the page is headed "319% + 5% disregard*" with the footnote "* 5% income disregard is included"
Insurance status condition
none published: DC Medicaid sits behind an employer or marketplace plan
Residency
District of Columbia
Continuous eligibility
12 months for a child under 19
Retroactive months
Applications through December 31, 2026 may cover up to three months before the application month when eligibility and covered-care conditions fit. Child applications from January 1, 2027 use up to two months.
Processing standard
Up to 45 days, or 60 days on a disability basis

Decisions this site cannot make: Economic Security Administration income determination · Hospital-based presumptive eligibility for a child under 19

Expect friction on: Choosing a health plan the oncology team is in

The trap: DC publishes one column and says the 5-point allowance is already inside it, so the printed figure is the real ceiling. Do not cancel private insurance to apply: DC Medicaid sits behind it.

Where I read this

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