Washington seeks Medicaid waiver for Wards 7 and 8 only

Washington, D.C. is seeking a federal waiver that would spare residents of Wards 7 and 8, east of the Anacostia River, from new Medicaid work requirements taking effect in January. City officials formally applied last month, arguing that unemployment in the two wards is high enough to qualify for a federal hardship exemption. (Photo: a street in Anacostia, file photo.)

The new rule: 80 hours a month to stay covered

The work requirements come from the One Big Beautiful Bill Act, passed by Congress in 2025, and apply to people who qualified for Medicaid under the Affordable Care Act expansion. They require childless adults aged 19 to 64 to work, volunteer or take part in training for 80 hours a month, or attend school at least half-time, or risk losing coverage. The rules take effect on January 1, 2027: new applicants will have to show they met the requirement, while current members will face the rule when they renew from March 1, 2027, with renewals moving from once a year to every six months.

Unemployment near 10% in the two wards, against 5.6% citywide

Federal law allows states to seek hardship exemptions for counties where unemployment is above 8%. Overall unemployment in D.C. was 5.6% in September, but it stood at 9.5% in Ward 7 and 10% in Ward 8 — both above the threshold. City officials argue the wards meet the definition of an “equivalent unit of local government” in federal guidance, so they can seek an exemption in the same way a county would. The city estimates about 75,000 Medicaid-eligible residents could be affected by the new rules, including about 30,000 who live in Wards 7 and 8.

City: the waiver is key to protecting coverage

Wayne Turnage, the deputy mayor for health and human services, said the waiver was “an important part of our broader effort to protect coverage while implementing the new federal requirements.” The Department of Health Care Finance (DHCF) confirmed the application in a presentation to the Council on October 29, setting out a three-tier approach to identifying people who are “medically frail” and should be exempt because of serious health conditions.

Waiver not yet approved, and legally untested

The waiver request has not yet been approved. City officials acknowledge that seeking an exemption in the name of wards is legally untested — the provision generally applies to counties, and D.C. is not a state. Whether it is granted will decide whether about 30,000 residents east of the river face losing Medicaid next year. The city says it will first try to verify compliance electronically, and will only ask residents to submit forms when it cannot.