Does your agency have to file with District of Columbia?
District of Columbia requires entities that provide minimum essential coverage to District of Columbia residents to report it to the DC Office of Tax and Revenue (OTR). In practice that means:
| Your situation | Who files | What gets filed |
|---|---|---|
| ALE (50+ FTE) that covered any DC resident, insured or self-insured | You, the employer | Your 1094-C/1095-C data via MyTax.DC.gov within 30 days after the federal deadline, separately from anything your carrier files |
| Self-insured or level-funded plan, under 50 FTE | You, the employer | 1094-B/1095-B data via MyTax.DC.gov, same deadline (OTR: all self-insured employers file regardless of ALE status) |
| Fully insured plan, under 50 FTE | The carrier | You have no OTR filing; the carrier reports covered DC residents |
| Any employer with ≤50 full-time employees buying group coverage | You, the employer | Must purchase through DC Health Link SHOP (a market-access rule unique to DC, not a filing) |
"DC resident" for this purpose means employees for whom you withheld and paid DC income tax, so a Maryland or Virginia agency with DC-resident caregivers is in scope. OTR has confirmed that the employer's submission is a separate obligation even when the carrier also reports.
District of Columbia deadlines and penalties
| Date | Obligation | Applies to | Penalty |
|---|---|---|---|
| ~April 30, 2026 (30 days after the federal e-file deadline, including any IRS extension) | Submit 1094/1095 data to OTR via MyTax.DC.gov | ALEs covering DC residents; all self-insured employers; carriers | None. OTR has confirmed there are no penalties for employers that fail to submit; the obligation stands but is not fined |
DC gives you a month after the IRS deadline, so the same file you e-filed with the IRS on March 31 can be uploaded to OTR in April. DC does not impose a separate furnishing deadline; the federal March 2 statement to employees is treated as sufficient.
Is your agency an Applicable Large Employer?
Count full-time employees (30+ hours a week or 130+ a month) and add full-time equivalents from everyone else: total part-time hours in the month ÷ 120. Average the monthly totals over the prior calendar year.
Worked example. A District of Columbia agency has 30 caregivers and office staff at 130+ hours a month, plus 60 part-time caregivers averaging 44 hours a month.
- Full-time employees: 30
- Part-time FTEs: 60 × 44 = 2,640 hours ÷ 120 = 22
- Total: 52 → the agency is an ALE.
Two home care specifics. Entities under common ownership are combined under the controlled-group rules, so multiple agency LLCs or franchise territories with the same owners count as one employer. And caregivers with variable hours can be classified using the IRS look-back measurement method (a 3–12 month measurement period followed by a stability period), which is how most agencies decide who must be offered coverage without re-running the math every month.
What an ALE owes if it doesn't comply (2026 amounts)
- 4980H(a), no offer: if you don't offer minimum essential coverage to at least 95% of full-time employees and any one of them gets a subsidy on DC Health Link, you owe $3,340 per full-time employee minus the first 30. In the example above: (30 − 30) × $3,340 = $0 a year, triggered by a single subsidized caregiver.
- 4980H(b), unaffordable offer: if you offer coverage that's unaffordable or below minimum value, you owe $5,010 for each full-time employee who enrolls in a subsidized marketplace plan.
Which District of Columbia caregivers can actually trigger a penalty
Penalties are only triggered when a full-time employee actually receives a premium tax credit on the marketplace. Who can get one depends on income:
| Caregiver household income | Can they get a marketplace subsidy? | Can they trigger a penalty for you? |
|---|---|---|
| Below 215% FPL | No. DC Medicaid covers childless adults to about 215% FPL | No |
| 215%–400% FPL | Yes | Yes — each one is a potential $5,010 (b) trigger, or the single trigger for the (a) penalty |
| Above 400% FPL | Generally no in 2026, now that the enhanced credits have expired | No |
DC expanded Medicaid with among the most generous eligibility in the nation (childless adults to about 215% FPL), so most low-wage caregivers qualify for Medicaid rather than subsidized exchange plans. kff.org ↗
DC Health Link is the District's exchange, and uniquely, employers with 50 or fewer full-time employees must purchase small-group coverage through DC Health Link's SHOP - direct off-exchange small-group purchase is not available in the District. dchealthlink.com ↗
What counts as "affordable" for a District of Columbia caregiver in 2026
Coverage is affordable if the caregiver's self-only contribution is no more than 9.96% of household income. Since you can't know household income, the IRS provides three safe harbors:
| Safe harbor | How it's calculated | 2026 monthly ceiling for a District of Columbia caregiver |
|---|---|---|
| Federal poverty line | FPL × 9.96% ÷ 12 | $129.89 regardless of wage |
| Rate of pay | Lowest hourly rate × 130 hours × 9.96% | $238.24 at the $18.40 minimum (rate shown is the July 1, 2026 figure) |
| W-2 wages | 9.96% of Box 1 wages | Varies; known only after year-end |
The District of Columbia-specific point: because the state minimum wage is $18.40, the rate-of-pay safe harbor gives District of Columbia agencies far more room than the $129.89 FPL figure most national guides quote. An agency paying $18.40 can charge up to $238.24 a month for self-only coverage and still be safe from the (b) penalty. Use each caregiver's actual lowest hourly rate; where local minimums are higher, the ceiling is higher still.
A CHOICE (formerly known as ICHRA) counts as an offer of coverage. It's affordable if the caregiver's cost for the lowest-cost self-only silver plan on DC Health Link for their rating area, minus your monthly allowance, stays within the 9.96% test.
IRS Rev. Proc. 2025-25 ↗ · IRS HRAs ↗ · minimum wage → see the District of Columbia wage & hour page
2026 compliance calendar: District of Columbia and federal together
| Date | Obligation | Who | Authority |
|---|---|---|---|
| Ongoing | Track caregiver hours under your measurement/stability periods | ALEs | IRS |
| Mar 2, 2026 | Furnish Form 1095-C to full-time employees, or post a website notice and furnish within 30 days on request | ALEs | IRS |
| Mar 31, 2026 | E-file Forms 1094-C/1095-C with the IRS (e-filing required at 10+ returns) | ALEs | IRS |
| ~Apr 30, 2026 | Submit 1094/1095 data to DC OTR via MyTax.DC.gov | ALEs covering DC residents; self-insured employers; carriers | DC OTR |
The District of Columbia rows apply to self-insured/level-funded sponsors (and to every employer for any item marked as such above); the IRS rows apply to ALEs. If you also employ caregivers who live in other reporting states under a self-insured plan, see the state-by-state ACA hub.
Other District of Columbia benefit mandates that touch home care agencies
These aren't ACA rules, but they land on the same desk.
- Universal Paid Leave. DC Paid Family Leave is funded by a 0.75% employer payroll tax (no employee share) and provides up to 12 weeks of parental, family, or medical leave and 2 weeks of prenatal leave through DOES. does.dc.gov ↗
- No auto-IRA. The District has no auto-IRA mandate for private employers. cri.georgetown.edu ↗
Frequently asked questions
We're a Maryland agency with caregivers who live in DC. Do we file with OTR?
If you're an ALE and withheld DC income tax for those caregivers, yes, whether your plan is insured or self-insured. If you're under 50 FTE, you file only if the plan is self-insured.
Our carrier already reports to DC. Do we still have to?
Yes, if you're an ALE or self-insured. OTR treats the employer's submission as a separate obligation from the carrier's.
Is there a penalty for missing the OTR filing?
OTR has said there isn't one. It remains a legal requirement, and the data is used to enforce the individual mandate on your employees' DC returns, so a missed filing invites inquiries rather than fines.
Can we buy a small-group plan directly from a carrier in DC?
No. Employers with 50 or fewer full-time employees must purchase small-group coverage through DC Health Link's SHOP.
We have 48 full-time caregivers and a handful of part-timers. Are we under the threshold?
Probably not. Add the part-timers' monthly hours and divide by 120. Two part-timers at 120 hours a month between them add one FTE, which puts you at 49; a third pushes you to 50 and ALE status the following year.
Can a caregiver on Medicaid trigger a penalty against us?
No. Penalties are triggered only by full-time employees who receive a marketplace premium tax credit. District of Columbia caregivers below 215% FPL qualify for Medicaid or the state program noted above instead, so they can't trigger 4980H. Caregivers between 215% and 400% FPL can.
We pay the District of Columbia minimum of $18.40. What's the most we can charge for self-only coverage?
Under the rate-of-pay safe harbor, $18.40 × 130 hours × 9.96% = $238.24 a month in 2026. That's well above the $129.89 FPL figure, so rate of pay is the better harbor for District of Columbia agencies.
Not legal advice. Confirm details with the cited official sources or counsel. Full disclaimer
- https://cri.georgetown.edu/states/
- https://does.dc.gov/page/dc-paid-family-leave
- https://otr.cfo.dc.gov/sites/default/files/dc/sites/otr/publication/attachments/TY2025%20DC%20Health%20Care%20Info%20Returns%20Instructions_0.pdf
- https://www.dchealthlink.com
- https://www.hubinternational.com/products/employee-benefits/compliance-bulletins/2026/01/state-health-insurance-reporting-requirements-and-deadlines-2025/
- https://www.irs.gov/affordable-care-act/employers/identifying-full-time-employees
- https://www.irs.gov/affordable-care-act/employers/information-reporting-by-applicable-large-employers
- https://www.irs.gov/newsroom/health-reimbursement-arrangements-hras
- https://www.irs.gov/pub/irs-drop/rp-25-25.pdf
- https://www.irs.gov/pub/irs-drop/rp-25-26.pdf
- https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/