 |
D.C. Municipal Regulations (Last Updated: September 13, 2017) |
 |
Title 22. HEALTH |
|
SubTilte 22-B. PUBLIC HEALTH AND MEDICINE |
|
Chapter 22-B33. HEALTH CARE SAFETY NET ADMINISTRATION |
Section 22-B3305. ELIGIBILITY PROCEDURES EFFECTIVE JUNE 1, 2006
-
3305.1Effective immediately, applicants shall complete, sign, and date an application form (as designated by the Mayor), present this form to the Department of Human Services (DHS), and complete a face-to face interview to establish eligibility for enrollment in the D.C. HealthCare Alliance Program (Alliance).
3305.2DHS shall determine eligibility and send a notice to applicants within the same timeframe as required under the Medicaid program at 42 C.F.R. § 435.911.
3305.3Eligibility shall begin on the first day of the month of application, which is consistent with the Medicaid requirement at 42 C.F.R. § 435.914(b).
3305.4Alliance program enrollees shall be required to recertify their enrollment in person every six (6) months and complete a face-to-face interview. Those enrollees that had previously received an annual recertification shall be required to comply with a reduced recertification period of no less than six (6) months upon receipt of a notice from DHS. Such notice shall contain the date by which the enrollee must complete all recertification requirements, including a face-to-face interview.
3305.5A notice of the requirement to recertify shall be mailed to an enrollee no less than thirty (30) days in advance of the scheduled recertification date. The recertification date shall be set by DHS based upon the eligibility date.
3305.6An Alliance program enrollee, or his or her authorized representative, who fails to complete and sign a recertification package and complete the required face-to-face interview shall be subject to termination in accordance with Section 555 of District of Columbia Public Assistance Act of 1982, effective April 6, 1982 (D.C. Law 4-101; D.C. Official Code § 4-205.55 (2008 Repl.)).
3305.7A recertification package shall include:
(a) A signed District of Columbia medical assistance recertification form;
(b) Acceptable proof of residence as provided in Subsection 3304.4;
(c) Acceptable proof of income as provided in Subsection 3304.5;
(d) Acceptable proof of countable resources as provided in Subsection 3304.6; and
(e) A valid and verifiable social security number if the enrollee declares himself or herself to be a U.S. citizen or qualified alien and has not previously provided a valid and verifiable social security number.
3305.8If an Alliance program enrollee fails to recertify within the prescribed time period, but completes the recertification package and face-to-face interview within the next calendar month after the termination date, the Alliance program enrollee shall not be required to complete a new application.
3305.9An applicant or recipient who is hospitalized, disabled or aged may request an exemption from the in-person requirements set forth in Subsections 3305.1 and 3305.4, if they are hospitalized, disabled, or aged during the application or recertification period, and therefore unable to complete the required face-to-face interview. To qualify for this exemption, the Alliance beneficiary or their authorized representative shall submit the following:
(a) Documentation from a hospital or medical professional attesting to the customer’s unavailability due to medical incapacity or disability, if the customer is unavailable due to medical incapacity or disability during the period of recertification; or
(b) A request for an exemption detailing the reason why the customer cannot complete the required face-to-face interview, which DHS may approve on a case-by-case basis, if the customer is sixty-five (65) years or older.
3305.10The Alliance program enrollee shall be required to submit a new application if he or she fails to recertify, as indicated in Subsection 3305.4.
3305.11DHS shall take no action to terminate, discontinue, or suspend eligibility without giving the Alliance program enrollee adequate and timely notice consistent with the Medicaid requirement, as set forth in Section 555 of District of Columbia Public Assistance Act of 1982, effective April 6, 1982, (D.C. Law 4-101; D.C. Official Code § 4-205.55).
3305.12To determine countable income, DHS shall aggregate earned income and disregard the first one hundred dollars ($100) in income. Further, DHS shall apply the exclusions detailed in Supplement 8a to Attachment 2.6-A of the District of Columbia State Plan for Medical Assistance (Medicaid State Plan).
3305.13To determine countable resources, DHS shall aggregate resources that are available to the applicant and apply the exclusions detailed in Supplement 8b to Attachment 2.6-A of the District's Medicaid State Plan.
3305.14All of an applicant’s resources shall be presumed available. An applicant may rebut this presumption by proving to the satisfaction of the District that a resource is not available to the applicant. An applicant shall be deemed to have rebutted the presumption if he or she establishes that there is a legal or other actual barrier to disposing of the asset that cannot be reasonably overcome. Resources that are not available are not included in the calculation of an applicant's countable resources.