Section 29-2004. INCOME CRITERIA

 

2004.1The program of financial assistance described in this chapter shall be available to both uninsured individuals and to persons covered by health insurance plans (up to the amount of any insurance co-payment required for the purchase of an eligible drug under those plans).

 

2004.2If the applicant is eighteen (18) years of age or older, the applicant’s household, for purposes of this chapter, shall include the applicant, his or her spouse (if the spouse is residing in the same household), and any persons under age twenty-one (21) for whom the applicant is financially responsible.

 

2004.3If the applicant is an individual under the age of eighteen (18) years, the applicant’s household, for purposes of this chapter, shall include the applicant, his or her parent(s) residing in the home, and any other persons under age twenty-one (21) who resides in the home.

 

2004.4If the applicant is eighteen (18) years of age or older, “household income,” for purposes of this chapter, is defined as the total gross income, before taxes and other deductions, of the applicant and his or her spouse, if the spouse is residing in the same household.

 

2004.5If the applicant is younger than eighteen (18) years of age and living with his or her parent(s), “household income,” for purposes of this chapter, is defined as the total gross income, before taxes and other deductions, of the applicant and his or her parent(s) residing in the same household.

 

2004.6If the applicant is younger than eighteen (18) years of age and living alone or with a spouse and children, “household income,” for purposes of this chapter, is defined as the total gross income, before taxes and other deductions, of the applicant and his or her spouse, if the spouse is residing in the same household.

 

2004.7Income eligibility, for purposes of this chapter, shall be determined on the basis of gross income received in the calendar month of application.

 

2004.8Income eligibility for both uninsured and insured individuals shall be determined as follows:

 

(a)A monthly income eligibility level for each size household equal to five hundred percent (500%) of the federal poverty level shall be calculated by multiplying the current federal poverty income level by five (5) and then dividing the result by twelve (12); and

 

(b)The result shall be rounded up to the nearest dollar; and

 

(c)Persons whose household income is less than or equal to the monthly income eligibility level shall qualify for full payment of the cost of the eligible drugs.

 

2004.9Applicants shall have the right to an appeal regarding an eligibility determination made under this program.

 

2004.10Information on how to request an appeal shall be provided to the applicant along with the notice of eligibility determination.

 

source

Final Rulemaking published at 36 DCR 4935, 4937 (July 14, 1989).