How to Pay for In-Home Care
How to Pay for Home Care in District of Columbia
Jump to a state to see its Medicaid programs, waivers, and other ways to help pay for in-home care.
This directory lists District of Columbia-specific and federal payment sources that can pay for, reimburse, offset, or help plan for home care. Some are direct payment sources; others are indirect supports that reduce the amount of private home care a family must buy. The District's strongest pathways include the Elderly and Persons with Physical Disabilities (EPD) Waiver with Services My Way self-direction, state-plan Medicaid PCA and home health, the IFS Waiver with My Life, My Way self-direction, the broader IDD Waiver, DACL caregiver and aging supports, and various cost-offset programs, and VA benefits are broken out because they can be one of the strongest payment pathways for eligible District veterans and surviving spouses.
Updated August 2026
Reviewed by Valerie VanBooven, RN, BSN
DC Medicaid / LTSS
Elderly and Persons with Physical Disabilities (EPD) Waiver
YesHelps pay for: HCBS for eligible DC residents age 65+ or ages 18-64 with physical disabilities who would otherwise require nursing-home level care; services can be delivered at home or in qualifying community settings.
Who qualifies: DC residence, Medicaid/LTSS financial eligibility, nursing-facility level of care, assessment and authorization.
How to start: Call DACL for EPD screening/application help and complete the required clinical assessment process.
Good to know: Family caregiver payment: Service-specific; participant direction available
DC Medicaid / EPD
EPD Personal Care Aide (PCA) Services
YesHelps pay for: Hands-on assistance with ADLs such as bathing, dressing, eating, toileting, grooming and mobility when authorized in the EPD service plan.
Who qualifies: EPD enrollment, assessed need, prescription/order and service authorization.
How to start: Ask the EPD case manager for a PCA assessment and authorized hours.
Good to know: Family caregiver payment: Not through agency PCA; self-direction is a separate option
EPD Homemaker Services
Yes - homemakerHelps pay for: Meal preparation, limited housekeeping, grocery shopping, escort to appointments and care-related errands; homemakers do not provide hands-on personal care.
Who qualifies: EPD enrollment and assessed need/service-plan authorization.
How to start: Ask the EPD case manager whether homemaker services fit the assessed needs.
Good to know: Family caregiver payment: No direct family wage
EPD Chore Aide Services
Offsets care costHelps pay for: Authorized chore help can address heavier household tasks that support safe community living and reduce caregiver burden.
Who qualifies: EPD enrollment, assessed need and service authorization.
How to start: Ask the EPD case manager about chore aide coverage.
Good to know: Family caregiver payment: No
EPD Respite Services
Yes - respiteHelps pay for: Temporary care similar to PCA services can give an unpaid caregiver a break while maintaining the participant safely at home.
Who qualifies: EPD enrollment, caregiver need and prior authorization/service-plan inclusion.
How to start: Request respite through the EPD case manager before arranging care.
Good to know: Family caregiver payment: Program-specific; verify worker rules
EPD Adult Day Health Program
Offsets home-care hoursHelps pay for: Daytime therapeutic, nursing, rehabilitative and social supports can reduce the number of paid or unpaid home-care hours needed during the day.
Who qualifies: EPD/Medicaid eligibility, clinical need and program authorization.
How to start: Ask the EPD case manager about Adult Day Health Program placement.
Good to know: Family caregiver payment: No
EPD Personal Emergency Response Services (PERS)
Offsets care costHelps pay for: Emergency-response technology can reduce supervision burden and support safer community living.
Who qualifies: EPD enrollment and assessed/authorized need.
How to start: Ask the EPD case manager to include PERS if clinically appropriate.
Good to know: Family caregiver payment: No
EPD Environmental Accessibility Adaptations
Offsets care costHelps pay for: Authorized accessibility modifications can make the home safer and reduce hands-on assistance needs; EPD requires use of other applicable housing modification resources first.
Who qualifies: EPD enrollment, documented need, prior authorization and program sequencing rules.
How to start: Coordinate with EPD case management before beginning any modification.
Good to know: Family caregiver payment: No
EPD Community Transition Services
Offsets setup/care costHelps pay for: One-time supports can help an eligible person move from an institution back to a community residence when a safe plan is in place.
Who qualifies: EPD/LTSS eligibility, qualifying transition and authorization before expenses are incurred.
How to start: Ask DACL/facility discharge staff to coordinate the transition plan.
Good to know: Family caregiver payment: No
EPD Case Management
Offsets care-management costHelps pay for: A case manager coordinates waiver services, providers, reassessments and person-centered planning, reducing navigation burden and helping authorized services work together.
Who qualifies: EPD enrollment.
How to start: Use the assigned case manager to coordinate and document all waiver services.
Good to know: Family caregiver payment: No
EPD Assisted Living Services
Alternative to home careHelps pay for: For some EPD participants, Medicaid waiver services in an assisted-living setting can substitute for a higher-cost home-care arrangement or institutional care.
Who qualifies: EPD eligibility plus assisted-living criteria, provider availability and authorization.
How to start: Ask EPD case management about assisted-living options if home care is no longer sufficient.
Good to know: Family caregiver payment: No direct family wage
DC Medicaid / Self-Direction
EPD Services My Way (Participant-Directed Services)
YesHelps pay for: EPD participants living in a natural home can exercise more choice and control over selected long-term care services and employ participant-directed workers.
Who qualifies: Must be enrolled in the EPD Waiver, live in a natural home and meet Services My Way requirements.
How to start: Tell the EPD case manager you want Services My Way and participant-directed services.
Good to know: Family caregiver payment: Potentially; worker relationship rules must be verified
Participant-Directed Community Supports
YesHelps pay for: Self-directed service similar to PCA; the participant or authorized representative is the common-law employer of the participant-directed worker.
Who qualifies: EPD + Services My Way enrollment, assessed need, approved budget and worker enrollment.
How to start: Enroll in Services My Way before hiring or scheduling a worker.
Good to know: Family caregiver payment: Potentially; verify legally responsible-person/family rules
EPD Individual-Directed Goods and Services
Offsets care costHelps pay for: Approved goods, equipment or services not otherwise available through the waiver/state plan when tied to the person-centered plan and expected to reduce Medicaid use, increase inclusion or improve safety.
Who qualifies: EPD + Services My Way; item must meet program criteria and be authorized before purchase.
How to start: Request through the support broker/case manager before spending funds.
Good to know: Family caregiver payment: No direct wage
DC Medicaid / State Plan
Medicaid State Plan Personal Care Aide (PCA) Services
YesHelps pay for: DC Medicaid separately covers medically necessary PCA services under the State Plan, in addition to PCA available through the EPD Waiver.
Who qualifies: Medicaid eligibility, clinical order/assessment, plan of care and prior authorization requirements.
How to start: Ask the treating provider/DHCF or DACL how to request a PCA assessment and authorized services.
Good to know: Family caregiver payment: No self-direction under standard agency delivery
Medicaid Home Health Aide Services
Yes - home healthHelps pay for: Home health aide services are covered by DC Medicaid when medically necessary and authorized as part of home health care.
Who qualifies: Medicaid eligibility, medical necessity, ordering provider and applicable prior authorization.
How to start: Ask the treating provider for a home-health order and use a Medicaid-enrolled agency.
Good to know: Family caregiver payment: No
Medicaid Skilled Home Health (Nursing / PT / OT / ST)
Yes - skilled careHelps pay for: DC Medicaid home health can include skilled nursing and therapies delivered in the home when medically necessary.
Who qualifies: Medicaid eligibility, medical necessity, plan of care and authorization/provider rules.
How to start: Ask the physician or other qualified ordering provider for a home-health referral.
Good to know: Family caregiver payment: No
Private Duty Nursing
Yes - skilled nursingHelps pay for: Medicaid may authorize extended skilled nursing in the home for beneficiaries who meet medical-necessity and prior-authorization standards.
Who qualifies: Medicaid eligibility, high-acuity nursing need, physician order/plan of care and prior authorization.
How to start: Ask the treating clinician and Medicaid care team about private-duty nursing criteria.
Good to know: Family caregiver payment: No
DC Medicaid / Hospice
DC Medicaid Hospice
Yes - hospice servicesHelps pay for: Medicaid hospice can cover end-of-life clinical and supportive services for eligible beneficiaries who elect hospice and meet certification requirements.
Who qualifies: Medicaid eligibility plus hospice medical/certification requirements.
How to start: Ask the treating clinician or Medicaid plan about hospice evaluation/referral.
Good to know: Family caregiver payment: No
DC Medicaid / Transportation
Medicaid Non-Emergency Medical Transportation
Offsets care/transport costHelps pay for: DC Medicaid provides transportation to covered medical appointments for eligible beneficiaries who need it, reducing out-of-pocket ride costs.
Who qualifies: Active Medicaid and trip to a covered medical service; advance scheduling rules apply.
How to start: Call the transportation broker with appointment/provider details.
Good to know: Family caregiver payment: No
DC Medicaid / Eligibility
Long-Term Care Medicaid Financial Eligibility / Spend-Down Planning
Enables LTSS coverageHelps pay for: Current DC LTC Medicaid rules generally use an income ceiling of 300% of the SSI federal benefit rate and resource limits of $4,000 individual / $6,000 married couple, with other rules applying.
Who qualifies: District residence, immigration/citizenship requirements, financial rules, medical need and program-specific criteria.
How to start: Screen with DACL/DHS before transferring assets or assuming income is too high; ask how spend-down applies.
Good to know: Family caregiver payment: No
DC Medicaid / Transition
Money Follows the Person / Medicaid Rebalancing
Offsets setup/care costHelps pay for: Eligible Medicaid LTSS residents in institutions may receive transition help to return to community-based waiver services when a safe plan is possible.
Who qualifies: Generally requires at least 90 continuous days in a qualifying institution, recent Medicaid LTSS and eligibility for a DC HCBS waiver.
How to start: Ask DACL or DDS transition staff about MFP eligibility before discharge.
Good to know: Family caregiver payment: No
DC DDS / Medicaid
IDD Home and Community-Based Services Waiver
YesHelps pay for: HCBS waiver for eligible adults with intellectual/developmental disabilities who meet ICF/IID level of care and choose community services.
Who qualifies: DDA eligibility, age 18+, DC residence, Medicaid financial eligibility, ICF/IID level of care and voluntary waiver choice.
How to start: Apply through DDS/DDA Intake & Eligibility and ask about IDD Waiver enrollment.
Good to know: Family caregiver payment: Service-specific
Individual and Family Supports (IFS) Waiver
YesHelps pay for: HCBS waiver for eligible adults with IDD who live in a natural home and need supports while remaining with family or in their own home.
Who qualifies: DDA eligibility, Medicaid/waiver eligibility, natural-home setting and assessed need.
How to start: Apply through DDS/DDA and ask whether IFS or IDD Waiver best matches the support needs.
Good to know: Family caregiver payment: Includes participant-directed option
DC DDS / IDD
IDD In-Home Supports
YesHelps pay for: Authorized support in the home can assist with daily living, community participation and independence for IDD Waiver participants.
Who qualifies: IDD Waiver enrollment, assessed need and ISP authorization.
How to start: Ask the service coordinator to assess and add in-home supports to the ISP.
Good to know: Family caregiver payment: Provider/service rules apply
IDD Live-In Caregiver
YesHelps pay for: Waiver service designed to support an eligible person living in the community with an on-site caregiver arrangement.
Who qualifies: IDD Waiver enrollment and service-plan criteria for live-in caregiver supports.
How to start: Ask DDS service coordination whether this service fits the person’s residential/support plan.
Good to know: Family caregiver payment: Potential caregiver compensation through approved service model; verify rules
IDD Personal Care Services
YesHelps pay for: Personal care can support ADLs and daily living needs for eligible IDD Waiver participants.
Who qualifies: IDD Waiver enrollment, assessed need and authorization in the ISP.
How to start: Request through the DDS service coordinator.
Good to know: Family caregiver payment: Provider/service rules apply
IDD Respite
Yes - respiteHelps pay for: Temporary support can give family/unpaid caregivers a break while maintaining the participant safely in the home/community.
Who qualifies: IDD Waiver enrollment, assessed respite need and ISP authorization.
How to start: Ask the service coordinator to include respite in the ISP.
Good to know: Family caregiver payment: Provider/service rules apply
IDD Supported Living / Host Home
Alternative/offsetHelps pay for: Residential/community support models can reduce the need for privately purchased around-the-clock home care.
Who qualifies: IDD Waiver enrollment, residential need, service-plan approval and provider availability.
How to start: Discuss supported/shared living with the DDS service coordinator.
Good to know: Family caregiver payment: Service model-specific
IDD Environmental Accessibility Adaptations / Assistive Supports
Offsets care costHelps pay for: Authorized adaptations and assistive supports can improve independence and reduce hands-on caregiver needs.
Who qualifies: IDD Waiver enrollment, documented need and prior authorization/ISP inclusion.
How to start: Request assessment through service coordination before purchase or construction.
Good to know: Family caregiver payment: No direct family wage
IDD One-Time Transitional Services
Offsets setup costHelps pay for: One-time transition assistance can help an eligible participant establish a community residence after institutional/residential transition.
Who qualifies: IDD Waiver eligibility and qualifying transition with authorized expenses.
How to start: Coordinate through DDS before the transition and before incurring costs.
Good to know: Family caregiver payment: No
DC DDS / Self-Direction
My Life, My Way (IFS Participant-Directed Services)
YesHelps pay for: IFS participants can act as employer of record (or use a representative) and hire, train and evaluate participant-directed workers.
Who qualifies: IFS enrollment, natural-home setting, PDS enrollment, employer responsibilities and worker qualifications.
How to start: Tell the DDS service coordinator you want My Life, My Way/PDS.
Good to know: Family caregiver payment: Yes, with exclusions
IFS In-Home Supports - Participant Directed
YesHelps pay for: Participant-directed in-home supports can be delivered by a chosen worker under My Life, My Way.
Who qualifies: IFS + My Life, My Way enrollment; worker must be 18+, pass background checks, be work-authorized and complete required training/certifications.
How to start: Choose a qualified PDW and complete fiscal/employer enrollment before services begin.
Good to know: Family caregiver payment: Friends/family may be hired except legally responsible persons identified by program rules
IFS Companion Services - Participant Directed
Yes / supportHelps pay for: One-to-one companion support under My Life, My Way can help with community inclusion and daily routines.
Who qualifies: IFS + PDS enrollment, assessed need, authorized service and qualified PDW.
How to start: Include companion service in the ISP and complete PDW onboarding.
Good to know: Family caregiver payment: Friends/family may be hired subject to exclusions
IFS Daily Respite - Participant Directed
Yes - respiteHelps pay for: Self-directed daily respite provides temporary relief to unpaid caregivers using a participant-selected worker.
Who qualifies: IFS + PDS enrollment, authorized respite and qualified participant-directed worker.
How to start: Ask the service coordinator to authorize respite and enroll the PDW first.
Good to know: Family caregiver payment: Friends/family may be hired subject to exclusions
IFS Individual-Directed Goods & Services (IDGS)
Offsets care costHelps pay for: My Life, My Way includes IDGS for approved participant-directed goods/services; DDS currently describes a $2,500 limit.
Who qualifies: IFS + PDS; must meet IDGS criteria and be tied to authorized supports/person-centered outcomes.
How to start: Request approval through the PDS/service coordination process before purchase.
Good to know: Family caregiver payment: No direct wage
DC DDS / IFS
IFS Individualized Day Supports
Offsets home-care hoursHelps pay for: Individualized day supports can reduce the amount of private supervision needed during daytime hours and may be participant-directed in qualifying 1:1 arrangements.
Who qualifies: IFS enrollment, assessed need, ISP authorization and applicable PDS rules.
How to start: Ask the service coordinator about individualized day supports and PDS delivery.
Good to know: Family caregiver payment: Potentially under PDS 1:1 rules
IFS Assistive Technology / Remote Supports
Offsets care costHelps pay for: Assistive technology and newly updated remote-support options can improve independence, safety and caregiver efficiency when authorized.
Who qualifies: IFS enrollment, documented need and ISP/service authorization; remote-support rules effective under current waiver descriptions.
How to start: Request assessment and authorization through DDS service coordination.
Good to know: Family caregiver payment: No direct wage
DC Aging / Caregiver
DACL Caregiver Respite Programs
Yes - respite / supportHelps pay for: DACL caregiver programs include respite resources designed to give unpaid caregivers of older adults and adults with disabilities a break.
Who qualifies: Program-specific age/disability/caregiver criteria and available funding/provider capacity.
How to start: Call DACL I&R and ask specifically for caregiver respite screening.
Good to know: Family caregiver payment: Not an ongoing family wage
DC Caregivers Institute (DCCI)
Offsets caregiver burdenHelps pay for: Caregiver training, problem-solving, education and support can reduce burnout and help families safely sustain care at home.
Who qualifies: Caregiver program criteria; availability may vary.
How to start: Call DACL and request caregiver-program/DCCI information.
Good to know: Family caregiver payment: No
DC Aging / Navigation
DACL Case Management
Offsets navigation/care-management costHelps pay for: Case management for seniors 60+, adults 18-59 with disabilities and caregivers can coordinate benefits, housing, transportation, nutrition and long-term services.
Who qualifies: District residence and DACL case-management criteria based on age/disability/complex needs.
How to start: Call DACL I&R and request case-management screening.
Good to know: Family caregiver payment: No
DC Aging / Nutrition
DACL Home-Delivered Meals
Offsets care costHelps pay for: Prepared home-delivered meals for eligible adults 60+ can reduce meal-preparation workload and preserve caregiver time/cash for hands-on care.
Who qualifies: Generally age 60+ and home-delivery eligibility; spouses/disabled household members may qualify in certain circumstances.
How to start: Call DACL I&R for nutrition screening/referral.
Good to know: Family caregiver payment: No
DC Aging / Home Mods
DACL Safe at Home
Offsets care/home-mod costHelps pay for: Preventive home adaptations such as grab bars, handrails, bathtub cuts, shower seats and stair lifts can reduce fall risk and hands-on assistance needs.
Who qualifies: DC resident age 60+ or adult with disability, primary residence and current income/program criteria; additional rules apply.
How to start: Call DACL before purchasing modifications to confirm eligibility and current income threshold.
Good to know: Family caregiver payment: No
DC Aging / Transition
DACL Community Transition Program
Offsets setup/care costHelps pay for: Guidance, assessment, documentation and coordination can help eligible older adults/adults with disabilities move from nursing or rehabilitation settings to community services.
Who qualifies: DC resident 60+ or adult 18+ with disability, assessed nursing-home level of care and program-specific transition criteria.
How to start: Call DACL I&R from the facility or community to request transition screening.
Good to know: Family caregiver payment: No
DC Transportation
Senior MedExpress
Offsets transport/care costHelps pay for: Eligible DC residents age 60+ with a certified medical condition can receive free round-trip rides to essential medical appointments and certain public-benefits appointments.
Who qualifies: Age 60+, DC residence, qualifying medical condition/appointment and program rules.
How to start: Call DACL for referral/application details before arranging rides.
Good to know: Family caregiver payment: No
ConnectorCard
Offsets transport/care costHelps pay for: Cost-share transportation program gives qualifying adults age 60+ a subsidized debit card for ground transportation; subsidy uses a sliding fee scale.
Who qualifies: DC resident age 60+ and program eligibility/cost-share rules.
How to start: Ask DACL about ConnectorCard enrollment and current subsidy rules.
Good to know: Family caregiver payment: No
Transport DC / MetroAccess Alternatives
Offsets transport/care costHelps pay for: Eligible DC MetroAccess customers can use Transport DC for subsidized taxi trips under current location/time rules, reducing transportation costs for medical and daily needs.
Who qualifies: DC resident and current MetroAccess/Transport DC eligibility.
How to start: Confirm current ride rules before scheduling.
Good to know: Family caregiver payment: No
Medicare Savings / DC Medicaid
Qualified Medicare Beneficiary (QMB) - DC
Offsets care/medical costHelps pay for: DC’s QMB program pays Medicare Part A/B premiums, Medicare deductibles and coinsurance for covered services and provides Extra Help; DC currently uses a 300% FPL income threshold.
Who qualifies: Medicare eligible, DC resident, eligible status and income within current DC QMB limit; other rules apply.
How to start: Apply through DC benefits channels or get help from DC SHIP/DACL.
Good to know: Family caregiver payment: No
Medicare Counseling
DC State Health Insurance Assistance Program (SHIP)
Offsets care costHelps pay for: Free unbiased Medicare counseling can identify QMB, Extra Help, Medicare Advantage and drug-plan savings that preserve funds for home care.
Who qualifies: Medicare beneficiary/family/caregiver in DC; counseling itself is free.
How to start: Call DC SHIP for benefit screening and plan comparison.
Good to know: Family caregiver payment: No
Medicare / Prescription
Medicare Part D Extra Help
Offsets care costHelps pay for: Federal Low-Income Subsidy reduces Medicare prescription premiums, deductibles and copays for qualifying beneficiaries, preserving cash for care.
Who qualifies: Medicare Part D and income/resource rules; many Medicaid/QMB beneficiaries qualify automatically.
How to start: Apply through Social Security/Medicare or ask DC SHIP for screening.
Good to know: Family caregiver payment: No
Medicare / Home Health
Medicare Home Health Benefit
Yes - limited/skilledHelps pay for: Medicare can cover intermittent skilled nursing, therapy and certain home health aide services when home-health eligibility and plan-of-care requirements are met.
Who qualifies: Homebound/skilled-care and other Medicare home-health requirements; does not cover 24/7 custodial care.
How to start: Ask the treating clinician to certify/order Medicare home health when criteria are met.
Good to know: Family caregiver payment: No
Medicare / Caregiver Support
Medicare Caregiver Training Services
Offsets caregiver training costHelps pay for: Medicare may cover caregiver training ordered as part of a beneficiary’s treatment when needed to help the caregiver safely provide care.
Who qualifies: Medicare coverage and provider/order requirements.
How to start: Ask the treating clinician whether caregiver training can be ordered and billed to Medicare.
Good to know: Family caregiver payment: No wage
Medicare / Dementia
GUIDE Dementia Care Model
Offsets care/respite costHelps pay for: Participating GUIDE organizations provide dementia care coordination and caregiver supports; some participants may receive respite services depending on model tier and eligibility.
Who qualifies: Traditional Medicare, dementia diagnosis and participation through a GUIDE provider/model participant.
How to start: Use CMS GUIDE resources or ask the clinician/Medicare plan about participating organizations serving DC.
Good to know: Family caregiver payment: No direct family wage
Medicare / Hospice
Medicare Hospice Benefit
Yes - hospice / respiteHelps pay for: For eligible terminally ill beneficiaries who elect hospice, Medicare covers interdisciplinary hospice services and may include short-term inpatient respite.
Who qualifies: Medicare hospice eligibility, physician certification and hospice election.
How to start: Request hospice evaluation through the treating clinician or hospice provider.
Good to know: Family caregiver payment: No wage
Medicare Advantage
Medicare Advantage Supplemental Benefits
Offsets care costHelps pay for: Some MA plans offer in-home support, meals, transportation, OTC or other supplemental benefits that can reduce household/care costs; benefits vary by plan and year.
Who qualifies: Enrollment in a plan offering the specific benefit and meeting any qualifying criteria.
How to start: Review the Evidence of Coverage or compare plans with DC SHIP before relying on a benefit.
Good to know: Family caregiver payment: No
DC Employment / Caregiving
DC Paid Family Leave - Family Leave
Indirect - replaces wagesHelps pay for: Covered DC workers can receive up to 12 weeks of wage-replacement benefits in a year to care for or provide companionship to a family member with a serious health condition.
Who qualifies: Covered worker, qualifying family relationship/serious health condition and claim/certification rules.
How to start: Notify the employer, then file after the qualifying event through DC Paid Family Leave.
Good to know: Family caregiver payment: Pays caregiver’s lost wages, not care hours
Food Assistance
Supplemental Nutrition Assistance Program (SNAP)
Offsets care costHelps pay for: Monthly food assistance can reduce grocery spending and preserve household cash for home care; 2026 work-requirement changes may affect some adults but exemptions can apply.
Who qualifies: Household income/eligibility rules; current ABAWD work requirements apply to certain non-exempt adults.
How to start: Apply through District Direct/DHS or get application help from DACL.
Good to know: Family caregiver payment: No
Utility Assistance
Utility Discount Program (UDP)
Offsets care costHelps pay for: Income-eligible DC residents can receive discounts on electric, gas and water bills; FY26 thresholds are substantially higher than many means-tested programs.
Who qualifies: DC residence, income guidelines and utility account requirements.
How to start: Apply through DOEE and confirm current utility-specific discounts.
Good to know: Family caregiver payment: No
Weatherization
Weatherization Assistance Program (WAP)
Offsets care/home costHelps pay for: No/low-cost energy-efficiency improvements can reduce utility expenses and improve home comfort/safety; DOEE is accepting applications for waiting lists.
Who qualifies: DC residence and WAP income/property/program requirements.
How to start: Apply through DOEE Residential Services.
Good to know: Family caregiver payment: No
DC Property Tax
Senior Citizen or Disabled Property Owner Tax Relief
Offsets care costHelps pay for: Qualified senior or disabled homeowners can receive a 50% property-tax reduction; current tax-year 2026 household income threshold is $163,500, subject to ownership/residency rules.
Who qualifies: Age 65+ or disability, principal residence, required ownership share, DC domicile and household income rules.
How to start: Apply through MyTax.DC.gov/OTR before assuming the benefit is automatic.
Good to know: Family caregiver payment: No
Insurance
Long-Term Care Insurance
Often yesHelps pay for: Existing LTC insurance may reimburse eligible home-care, personal-care or caregiver services according to the policy’s benefit triggers, elimination period and covered-service definitions.
Who qualifies: Must own an in-force policy and satisfy policy benefit triggers/claim documentation.
How to start: Request the policy schedule and open a claim before committing to long-term paid care.
Good to know: Family caregiver payment: Policy-specific
Home Equity
HECM Reverse Mortgage
Cash / indirectHelps pay for: For eligible homeowners age 62+, a federally insured reverse mortgage can convert home equity to cash that may be used for home care, though fees, occupancy duties and long-term housing implications matter.
Who qualifies: Age, eligible principal residence, sufficient equity, counseling and FHA/HECM requirements.
How to start: Complete HUD-approved counseling and compare alternatives before using home equity for care.
Good to know: Family caregiver payment: Yes, indirectly
DC Disability / Independent Living
Independent Living Services / DC Center for Independent Living
Offsets support costHelps pay for: Independent-living services for DC residents with significant disabilities can provide advocacy, skills, peer support and community-resource connection that may reduce paid support needs.
Who qualifies: Significant disability and program/service criteria; all DC residents with a significant disability are eligible for core IL services.
How to start: Contact DDS/RSA or the DC Center for Independent Living for service connection.
Good to know: Family caregiver payment: No
Veterans / Self-Direction
Veteran-Directed Care (VDC)
YesHelps pay for: Flexible VA self-directed budget for eligible Veterans who need personal care and want more control over workers/services; family hiring may be permitted under local program rules.
Who qualifies: VA enrollment/community-care eligibility, clinical need and local VDC availability.
How to start: Ask Washington DC VA social work/geriatrics whether VDC is available for the Veteran’s location.
Good to know: Family caregiver payment: Yes, subject to program rules
Veterans / Cash Benefit
VA Aid & Attendance Pension Add-On
Cash / indirectHelps pay for: Additional VA pension payment for qualifying Veterans/survivors who need ADL help or meet other Aid & Attendance criteria; cash can help fund home care.
Who qualifies: Must qualify for VA pension plus Aid & Attendance medical and financial requirements.
How to start: Apply through VA or an accredited representative.
Good to know: Family caregiver payment: Yes, indirectly
VA Benefits
VA Homemaker & Home Health Aide
YesHelps pay for: VA may authorize community-based aides to help an eligible Veteran with ADLs and selected daily tasks in the home.
Who qualifies: VA enrollment/community-care eligibility, clinical need and local availability; copay may apply. Ask VA primary care/social work for assessment and referral.
How to start: Ask the VA social worker or care team about VA Homemaker & Home Health Aide.
Good to know: Family caregiver payment: No
Veteran-Directed Care
YesHelps pay for: Flexible self-directed budget for eligible Veterans who need personal care; the participant can hire workers, including family in many programs, subject to local rules.
Who qualifies: Enrolled Veteran, community-care eligibility, clinical criteria and local VDC availability. Ask Washington DC VA social work/geriatrics whether VDC serves the Veteran’s location.
How to start: Ask the VA social worker or care team about Veteran-Directed Care.
Good to know: Family caregiver payment: Yes
VA Skilled Home Health
Yes - skilled careHelps pay for: VA may purchase skilled nursing, therapy and related home-health services from authorized community providers.
Who qualifies: Clinical need, VA eligibility/authorization and provider availability. Ask the VA care team for a skilled-home-health referral.
How to start: Ask the VA social worker or care team about VA Skilled Home Health.
Good to know: Family caregiver payment: No
VA Respite Care
Yes - respiteHelps pay for: VA may provide in-home, adult-day or facility respite to give caregivers a break.
Who qualifies: Enrollment, clinical need and local availability/authorization. Ask VA social work or a Caregiver Support Coordinator.
How to start: Ask the VA social worker or care team about VA Respite Care.
Good to know: Family caregiver payment: No direct wage
VA Aid & Attendance Pension Add-On
Cash / indirectHelps pay for: Additional pension payment for qualifying Veterans/survivors who need ADL help or meet other Aid & Attendance criteria.
Who qualifies: Must first qualify for VA pension plus A&A medical/financial criteria. Apply through VA or an accredited representative.
How to start: Ask the VA social worker or care team about VA Aid & Attendance Pension Add-On.
Good to know: Family caregiver payment: Yes, indirectly
PCAFC Caregiver Stipend
Direct caregiver stipendHelps pay for: VA may pay an approved primary family caregiver a monthly stipend and provide training, counseling, respite and other supports.
Who qualifies: Veteran and caregiver must meet PCAFC eligibility and complete VA assessment/enrollment. Apply jointly through VA Caregiver Support.
How to start: Ask the VA social worker or care team about PCAFC Caregiver Stipend.
Good to know: Family caregiver payment: Yes
VA Community Care Network - Region 1
Pays authorized providerHelps pay for: VA-authorized community care can include home health and other approved services. The District of Columbia is in CCN Region 1, administered by Optum.
Who qualifies: VA referral/authorization and community-care eligibility generally apply. Obtain VA authorization before routine community care.
How to start: Ask the VA social worker or care team about VA Community Care Network - Region 1.
Good to know: Family caregiver payment: No
Home Based Primary Care (HBPC)
Home-based clinical careHelps pay for: Interdisciplinary VA primary care delivered in the home for eligible Veterans with complex chronic conditions.
Who qualifies: VA enrollment, clinical need and local program availability. Ask Washington DC VA primary care/social work about HBPC.
How to start: Ask the VA social worker or care team about Home Based Primary Care (HBPC).
Good to know: Family caregiver payment: No
Medical Foster Home
Residential care alternativeHelps pay for: Private-home residential option paired with VA Home-Based Primary Care for Veterans who need substantial assistance and prefer a small-home setting.
Who qualifies: Must be enrolled in VA HBPC; local program suitability/availability. The Veteran pays the foster-home caregiver directly under a private agreement. Ask Washington DC VA social work / Medical Foster Home coordinator.
How to start: Ask the VA social worker or care team about Medical Foster Home.
Good to know: Family caregiver payment: No direct family wage
VA Caregiver Support Program
Support / respite navigationHelps pay for: Coaching, education, peer support, respite navigation and caregiver services; also gateway to PCAFC screening.
Who qualifies: Veteran/caregiver relationship and program-specific criteria vary. Call the national line or Washington DC VA Caregiver Support.
How to start: Ask the VA social worker or care team about VA Caregiver Support Program.
Good to know: Family caregiver payment: PCAFC may pay stipend
VA Pension
Cash / indirectHelps pay for: Needs-based monthly pension for qualifying wartime Veterans/survivors; pension income can help fund home care.
Who qualifies: Service, age/disability, income/net-worth and other VA pension rules. Apply through VA or an accredited representative.
How to start: Ask the VA social worker or care team about VA Pension.
Good to know: Family caregiver payment: Yes, indirectly
Washington DC VA Medical Center / Benefits Navigation
Benefits accessHelps pay for: Local VA care teams and social workers can connect Veterans with home-based care, caregiver support, community care and earned benefits.
Who qualifies: Benefit-specific eligibility applies. Call the main medical center and request social work/caregiver/geriatrics navigation.
How to start: Ask the VA social worker or care team about Washington DC VA Medical Center / Benefits Navigation.
Good to know: Family caregiver payment: No direct wage
Where District of Columbia Families Can Start
Not sure where to begin? Match your situation to a contact below.
No-wrong-door screening for EPD, caregiver support, case management, meals, Safe at Home, transportation and other aging/disability services
DACL Information & Referral / Assistance
EPD Waiver application coordination, assessment linkage and waiver case-management access
DACL EPD Waiver / Medicaid Services Enrollment
Medicaid eligibility/application, renewals, SNAP and other public benefits
DC Public Benefits Call Center (DHS)
Apply for DDA eligibility and begin IDD/IFS waiver screening
DDS/DDA Intake & Eligibility
IDD/IFS waiver questions and Medicaid waiver program support
DDS Medicaid Waiver Unit
Free Medicare counseling, QMB/Extra Help screening and plan comparisons
DC State Health Insurance Assistance Program (SHIP)
Schedule covered non-emergency medical transportation for eligible Medicaid beneficiaries
DC Medicaid Transportation Broker
Family-caregiver leave wage replacement and claim support
DC Paid Family Leave
Utility Discount Program applications/status and utility affordability resources
DOEE Utility Assistance / UDP
Weatherization, emergency mechanical systems and residential efficiency assistance
DOEE Weatherization Residential Services
Senior/disabled property-tax relief, homestead and tax-deferral questions
Office of Tax and Revenue
PCAFC stipend screening, caregiver support, respite navigation and local coordinator help
VA Caregiver Support / Washington DC VA
Before You Rely on Any Payment Source
Planning Point
Why It Matters
EPD Waiver and State Plan PCA are distinct pathways
DC Medicaid has Personal Care Aide services under the State Plan as well as PCA under the EPD Waiver. The assessment, authorization and service-delivery route can differ, so confirm which authority is paying for the hours.
Services My Way is self-direction, but do not promise a particular relative can be paid
EPD participants can employ participant-directed workers through Services My Way, but the current public EPD page does not spell out every family-relationship restriction. Verify the exact worker relationship and employer/FMS rules before hiring.
IFS My Life, My Way explicitly allows many family members
DDS states that friends and family may serve as participant-directed workers, but legally responsible people cannot: designated legal guardians, spouses, and parents of a minor child are specifically excluded. Worker age, background, work-authorization and training rules also apply.
IFS Individual-Directed Goods & Services has a defined limit
DDS currently describes My Life, My Way IDGS as limited to $2,500. It is for approved goods/services tied to the person-centered plan, not a general cash allowance.
Use current DHCF LTC financial limits, not the old dollar figure on the DACL EPD page
The DACL EPD webpage still displays a 2023 monthly income figure. DHCF’s current LTC page uses income up to 300% of the SSI federal benefit rate and resource limits of $4,000 individual / $6,000 couple. Verify the current-year amount during application.
DC QMB is unusually broad compared with standard federal MSP thresholds
For 2026, DC’s QMB page lists eligibility up to 300% FPL ($4,010/month for one person including the $20 disregard). This can materially reduce Medicare premiums and cost sharing and should be screened early.
Safe at Home should be authorized before buying modifications
The current DACL service page describes eligibility up to 100% of Area Median Income and includes adaptations such as grab bars, bathtub cuts, shower seats and stair lifts. Other eligibility requirements apply, so do not incur costs first.
LIHEAP is not counted as a currently open pathway in this workbook
DOEE says new FY26 LIHEAP applications are closed as of June 2026. The Utility Discount Program remains available, and WAP is accepting applications for waiting lists, so those are the active utility/home-efficiency rows used here.
DC Paid Family Leave replaces wages; it does not reimburse home-care invoices
Covered workers may receive up to 12 weeks to care for a family member with a serious health condition. Treat the benefit as lost-wage relief for the caregiver, not payment for agency or self-directed care hours.
Money Follows the Person is for qualifying institutional transitions
DHCF’s current LTC page describes a 90-continuous-day institutional stay and Medicaid LTSS/waiver eligibility conditions. Start transition planning before discharge so housing, waiver and one-time supports can be coordinated.
District of Columbia is in VA Community Care Network Region 1
Optum administers Region 1. Community care generally requires VA referral/authorization; do not assume a community home-care agency will be paid by VA without authorization.
Coordinate benefits before changing payroll, assets, housing or insurance
Medicaid LTSS, self-directed employment, VA benefits, tax relief, insurance and home-equity decisions can interact. Verify eligibility/authorization first, especially before hiring relatives, transferring assets, changing residence or paying for major home modifications.
Program rules, income limits, and availability change over time and can vary by county. Confirm current details with the program directly, or ask a home care provider in District of Columbia to help you navigate the application process.
← Back to How to Pay for In-Home CareHome Care Providers in District of Columbia
These providers serve families in District of Columbia and can help you apply what you've learned above to your specific situation.
Mercy Care Providers – Columbia, MD
Serving 2 states
Mercy Care Providers provides home care services in Columbia, MD and the surrounding communities it serves.
Services Available
24-Hour Home Care • Companion Care • Personal Care • Dementia & Alzheimer's Care • Respite Care
Communities Served
Montgomery County, Howard County, Prince George’s County and surrounding areas
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Thrive Healthcare Services – Washington, DC
Serving District of Columbia
Thrive Healthcare Services provides home care services in Washington, DC and the surrounding communities it serves.
Services Available
24-Hour Home Care • Companion Care • Personal Care • Dementia & Alzheimer's Care • Respite Care
Communities Served
Washington
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