DC Child Health Insurance for Caregivers: Medicaid and Healthcare Alliance

Getting a Child Covered When You're Not the Parent

A child living with a grandparent or relative in DC may qualify for public health insurance if the child meets the applicable program's residency, income, and other eligibility requirements. The two main programs are DC Medicaid and the DC Healthcare Alliance, and you can apply for either through the District Direct portal (districtdirect.dc.gov) run by the Department of Human Services.

You don't need a court order or guardianship decree to apply for health coverage on behalf of a child in your care.

DC Medicaid — For Most Eligible Children

DC Medicaid covers eligible low-income children who are District residents. Eligibility depends on family size and the child's age-based income limit; DC uses MAGI rules to determine how household composition and income are counted. The child's income alone is not the whole test.

Coverage includes pediatric visits, immunizations, dental, vision, mental health services, prescriptions, emergency care, and specialist referrals. There's no premium for children's Medicaid in DC.

DC Healthcare Alliance — When Medicaid Doesn't Apply

The Healthcare Alliance is a District-funded program for residents who meet income guidelines but don't qualify for Medicaid — most commonly because of immigration status. If the child you're caring for isn't eligible for Medicaid, the Alliance covers a similar range of health services.

Enrollment is also through District Direct, and the child must be a DC resident.

Insurance Doesn't Equal Consent Authority

This is the point most caregivers miss: having health insurance for the child and having the legal authority to consent to treatment are two separate things. A Medicaid or Alliance card pays for the appointment, but the doctor still needs to know you can authorize the treatment.

If you have a signed medical consent form under D.C. Code § 16-4901 or a Custodial Power of Attorney, bring it to every appointment alongside the insurance card. Without one of those documents, the provider may treat the child for routine care but hesitate on anything that requires formal consent.

Applying for Coverage

Go to districtdirect.dc.gov or visit a DHS Economic Security Administration service center in person. Bring:

• The child's birth certificate or ID
• Proof that the child lives in DC (your lease or utility bill works)
• Your own ID as the applying caregiver
• Any income documentation requested by the agency for the eligibility determination

DHS says standard Medical Assistance applications should receive a decision within 45 days. If the child needs care before the card arrives, community health clinics in DC will typically see children who have a pending Medicaid application — bring the application confirmation.

The DC School and Medical Consent Guide walks through the health insurance application alongside the medical consent forms, so both pieces of the puzzle are in place before the first appointment.

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