DISTRICT OF COLUMBIA LONG-TERM CARE/WAIVER MEDICAID - dhcf dc 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by reviewing the application instructions on page 6. Ensure you understand the eligibility requirements for Long-Term Care services.
3. Fill out Section 1: Application Information, indicating whether you are applying for Institutional Care or Home and Community-Based Waiver services.
4. Complete Section 2: Applicant Information, providing your personal details such as name, date of birth, and Social Security Number.
5. In Section 3: Applicants’ Address, enter your current address and contact information. If applicable, provide your previous address if you are in a nursing facility.
6. Proceed to Section 4: Benefit Status to disclose any current Medicaid benefits you receive. This section is crucial for determining your eligibility.
7. Continue filling out subsequent sections regarding income, assets, and any additional required documentation as outlined in the checklist provided on page 5.
8. Once all sections are completed, review your application for accuracy. Sign and date the form before submission.

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