Skilled nursing Medicaid rates in the District of Columbia are built facility by facility through a peer group system, and that is the first thing to understand about DC. DHCF, the District's Medicaid agency, sets nursing facility payment using peer group specific factors and floor percentages, which it updates by public notice. The one figure on file in our nursing facility comparison is $9.07 under code G0471, effective April 1, 2026. That is a service-level amount, not the daily per diem, so the District is not placed in the 21-state ranking, where the national median is $282.59.
For an operator, the practical answer to "what does DC Medicaid pay per day" lives in the facility's own rate notice and the peer group factors that drive it. This page explains that structure, the record of changes behind it, and the October 2026 update.
Under a peer group system, facilities are grouped, and each group carries its own factors that shape the per diem. A floor percentage sets a minimum relationship between a facility's payment and a benchmark. The District has revised these factors repeatedly:
- DC Register Vol 72/42, DHCF Public Notice N142722, published October 17, 2025 and effective October 1, 2025: Updates To The Medicaid Nursing Facilities Peer Group Specific Factors And Floor Percentages.
- DC Register Vol 69/7, DHCF Public Notice N119360, published February 18, 2022 and effective October 1, 2021: the same type of update.
- DC Register Vol 66/40, DHCF Public Notice N0086420, published September 27, 2019 and effective October 1, 2019: updates to peer group factors and floor percentages, and to the behaviorally complex and bariatric care rates.
Every rate on the District of Columbia Medicaid rates page links to its source document.
A peer group system recognizes that not all nursing facilities are alike. Facilities with similar characteristics are compared with each other rather than with every facility in the jurisdiction.
Peer groups
Grouping lets the payer set cost limits and adjustments that suit each kind of facility. A factor specific to a group can raise or lower the recognized cost for every facility in it.
Floor percentages
A floor percentage protects facilities at the low end. It sets a minimum share of a benchmark that a facility's payment component will not fall below, so a building with unusually low reported costs in one year is not paid far less than its peers.
For an operator, the takeaway is that the per diem depends on which peer group the facility falls in, the factors for that group and the facility's own reported costs. Changes to any of the three can move the rate.
DHCF Transmittal 26-25, published September 30, 2026, announced skilled nursing rate changes effective October 1, 2026. That fits the District's pattern: peer group updates in 2019, 2021 and 2025 all took effect on October 1, the start of the District's fiscal year.
For a DC facility, the October 1 date is the one to build the budget around. Practical steps:
- Obtain the new rate notice for the facility and compare it with the prior year's.
- Update billing so claims for October 2026 dates of service price at the new rate.
- Recheck early remittances to confirm the new rate was applied.
The same date anchors other DHCF payment updates. Hospital inpatient and outpatient payment parameters for fiscal year 2027 also took effect October 1, 2026. For a nursing facility, that matters when residents are transferred to and from hospitals: bed-hold rules, readmission timing and the coordination of hospital and facility claims all fall under the new fiscal year at once. A facility that reviews its admission and transfer procedures each autumn, alongside its new rate notice, avoids carrying last year's assumptions into the new year.
Two DHCF transmittals sit between the peer group updates:
- DHCF Transmittal 24-17: Nursing Facility Rate Increase effective May 1, 2024, published April 23, 2024.
- DHCF Transmittal 24-20: Public Notice of Intent to Submit State Plan Amendment, published May 31, 2024 with an effective date of June 1, 2024.
The pattern is a rate increase in 2024, a peer group recalibration effective October 1, 2025 and a further set of skilled nursing rate changes effective October 1, 2026. The District revisits nursing facility payment often, which rewards facilities that keep their cost reports accurate and current.
The 2019 notice is a reminder that DC pays separately for residents with behaviorally complex or bariatric care needs. These residents require more staff time, specialized equipment or both, and a standard per diem may not cover that extra cost.
A facility serving these residents should confirm three things: that each qualifying resident is documented to the standard DHCF requires, that the correct rate is billed for each qualifying day, and that the facility's staffing and equipment meet the program's expectations. The rates themselves are listed on the District's Medicaid rates page.
The $9.07 value is tied to code G0471, a HCPCS code for a specific billable service. Codes like this are paid in addition to, or apart from, the daily rate. It has no prior authorization rules and no limits attached in the published data.
Because the figure is not a per diem, the District is better compared on its full peer group per diems, which vary by facility. An operator benchmarking a DC building against another market should use its own rate notice for the DC side and the published per diem for the other state, so that both sides of the comparison describe a full resident day.
District wages are above the US median at every nursing level, according to May 2025 federal occupational data.
| Role | District of Columbia | US median |
|---|---|---|
| Registered nurse | $49.30 | $46.90 |
| Licensed practical nurse | $36.42 | $30.96 |
| Nursing assistant (CNA) | $22.93 | $20.32 |
Nursing assistants provide most hands-on care, and the District's CNA wage of $22.93 an hour sits above the US median of $20.32. Licensed practical nurses at $36.42 carry a large premium over the US median. For a peer group system, these wages matter because floor percentages and group factors determine how much of a facility's cost the per diem recognizes.
In a cost-based system like the District's, the cost report is the facility's most important rate document. It is where wages, benefits, supplies and capital costs enter the calculation.
- Report completely. Costs left off a report are costs the rate cannot recognize.
- Classify correctly. Placing a cost in the wrong area can move it under a different limit.
- File on time. Late or incomplete reports can delay rate updates.
With wages above the national median at every level, accurate reporting of labor cost is the most direct way a DC facility can make sure its rate reflects what care actually costs.
Our data counts 6 plans in the District, including AmeriHealth Caritas District of Columbia, MedStar Family Choice DC, Health Services for Children with Special Needs (HSCSN), Edenbridge PACE and UnitedHealthcare of the Mid-Atlantic D-SNP. For nursing facilities, the District's rule is that they are paid directly by the state, outside managed care, and the program list includes DC Medicaid FFS (nursing facility) as its own fee-for-service program.
Under Transmittal 26-19, Wellpoint DC exited and its enrollees were auto-assigned to AmeriHealth Caritas DC effective August 1, 2026. That change affects residents' other services, not the nursing facility rate. PACE and the D-SNP are the arrangements to watch, since they cover care for their own enrollees under their own contracts. The District of Columbia managed care page lists the plans and rules.
DHCF also updated rates for community care in July 2026: Transmittal 26-15 for assisted living residences, Transmittal 26-16 for home health aide services and Transmittal 26-17 for PCA services, all effective July 1, 2026. The Elderly and Persons with Physical Disabilities (EPD) waiver funds many of these services.
These programs are the main alternatives to a nursing home stay. When they are well funded, residents who enter a nursing facility tend to have higher needs. The DC home health rates page and DC home care rates page cover those lines.
The ranked states run from New Mexico's $826.00 at the top, followed by Colorado ($419.22), Rhode Island ($381.06), Washington ($373.84) and Kentucky ($365.78), down to Connecticut ($107.21), Michigan ($99.90) and Arkansas ($70.00). Michigan and Connecticut are the closest parallels to DC, since their ranked figures are also tied to specific codes. Maryland, the District's neighbor, publishes a ranked daily figure of $351.63.
- Budget from the facility's own rate notice and the October 1 update cycle.
- Treat cost reports as rate documents, since they drive the peer group calculation.
- Bill specialty days correctly for behaviorally complex and bariatric residents.
- Track community rate changes, which shape who enters a nursing home.
All 87,654 current District of Columbia Medicaid rates, with source links, are available with a MedicaidRate plan.
Rates on this page are compiled from official state Medicaid publications from DHCF, including DC Register public notices on peer group factors and floor percentages and DHCF transmittals, and each rate links to its source document. Wages are May 2025 federal occupational medians. The national skilled nursing overview compares all states, and the methodology explains why only 21 of 44 states can be ranked on a single daily figure.