Combined Application for Food, Medical, & Cash Benefits - District of Columbia Department of Human Services

Sep 19, 2026

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District of Columbia DHS ESA provides a combined application used to apply for food benefits, medical assistance, and cash support. Applicants must answer only the questions related to the program(s) they are requesting so eligibility can be reviewed for all applicable programs. The form explains available benefit types for food (SNAP), medical (Medicaid, DC Healthcare Alliance/Immigrant Children’s Program, Marketplace plans, and premium tax credits), and cash assistance (TANF and other cash programs). It also includes agency-use fields, service center locations and contact options, language access support, and notes about optional steps and a mobile application.

LanguageEnglish

CategoryForms

FormatPDF

Pages68

Reading Time24 min

AccessFree to download

Programs Included

Food (SNAP)

Medical Assistance

Cash Assistance

Completing the Application

Required Sections by Program

Optional Steps

Where to Get Help

Service Centers and Hours

Mobile Application Option

Agency-Use Only Fields

Language Access Support

DISTRICT OF COLUMBIA Department of Human Services (DHS) Economic Security Administration (ESA) | Combined Application for Food, Medical, & Cash Benefits
This is a combined application for food benefits, medical, and cash assistance. We can provide information about other helpful services in your community. You can answer ONLY the questions related to the program(s) you are applying for. If you answer ALL the questions on the Assistance Application, we can see if you are eligible for all programs. A friend, relative, or anyone that you wish, may help you complete this application. | | | | | --- | --- | --- | --- | |
Food
Monthly Supplemental Nutrition Assistance (SNAP) benefits to put towards groceries. | |
Medical
(Doctors, hospitals, prescriptions, labs, and x-rays)
• free or low-cost insurance from Medicaid
• free or low-cost insurance from the D.C. Healthcare Alliance or Immigrant Children’s Program
• affordable, private health insurance plans through the Marketplace
• a tax credit that can immediately help pay your premiums for health coverage. |
Cash
Temporary Assistance for Needy Families (TANF) or other cash assistance benefits for households with needy children, and individuals waiting for a decision on their Supplemental Security Income (SSI) applications. | | | NOTE:
If you would like to apply for long-term care services, you will need to complete the Long-Term Care Program Medical Assistance Application. For an application, please contact the Department of Aging and Community Living (DACL) for Elderly and Persons with Physical Disabilities (EPD) waiver at (202) 724-5626 , the Department on Disability Services (DDS) for Individuals with Intellectual and Developmental Disabilities (IDD) waiver at 202.730. 1700, or if you are in a Nursing Facility or Intermediate Care Facility (ICF), contact your facility administrator for assistance.
You can also pick up this application at your nearest service center or call (202) 727-5355 to have one mailed to your home. | | | | Service Center Locations | | Monday – Friday | 7:30am – 4:45pm | | | --- | --- | --- | --- | | Anacostia Service Center | Taylor Street Service Center | H Street Service Center | | | 2100 Martin Luther King Jr. Ave. , SE | 1207 Taylor St. , NW | 645 H St. , NE | | | Washington, DC 20020 | Washington, DC 20011 | Washington, DC 20002 | | | Fax: (202) 727-3527 | Fax: (202) 576-8740 | Fax: (202) 724-8964 | | | Congress Heights Service Center
4049 South Capitol St SW
Washington, DC 20032
Fax: (202) 645-4524 | Fort Davis Service Center
3851 Alabama Ave. , SE
Washington, DC 20020
Fax: (202) 645-6205 | | Customers may call the ESA Call Center at (202) 727-5355 to learn which Service Center serves their address | | | NEW MOBILE APPLICATION:
You can now apply for Food, Medical, and Cash assistance, and some Medical programs online by downloading the District Direct mobile app from the Apple App Store or the Google Play Store on your smartphone. Check the app for more information about the scope of Medical program applications available. | | | | | --- | --- | --- | --- | --- | | FOR AGENCY USE ONLY | | Date Received: | Date Disposed: | Case Number: | | Programs Applied For: | | | | Application Type
Application Recertification | | Cash | | Approved Pended Denied | | | | Medical | | Approved Pended Denied | | | | Food | | Approved Pended Denied | | | | What sections of the application do I need to complete? | | | | | --- | --- | --- | --- | |
Medical Assistance

DC Health Link
To apply for affordable private health insurance, a tax credit
that can immediately help pay your household’s premiums for health coverage, orto see if your household qualifies for free or lowcost insurance from Medicaid DC Healthcare Alliance or, Immigrant Children’s Program.
Complete all the sections marked for Medical assistance. If the secti

FAQs

What programs can I apply for using this combined application?

You can apply for food benefits, medical assistance, and cash assistance. The document also notes that some medical programs may be available online through a mobile application.

Do I need to complete every section of the application?

Answer only the questions related to the program(s) you are applying for. If a section is marked for Food, Medical, and Cash assistance, complete all questions in that section unless the question says it is not required for your selected program(s).

Where can I get help or language assistance if I need support?

You can contact the ESA Call Center at (202) 727-5355 or use the listed service centers. Language access support is provided, including instructions to call for free language assistance and additional contact information if help is not received in your language.

Sep 19, 2026

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