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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-57. ENROLLMENT AND DISENROLLMENT REQUIREMENTS AND PROCEDURES FOR BENEFICIARIES ELIGIBLE FOR THE MEDICAID MANAGED CARE PROGRAM FOR DISABLED CHILDREN AND YOUTHS |
Section 29-5702. DISENROLLMENT
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5702.1Except as provided in §5702.3 and 5702.4, an enrolled child may voluntarily disenroll from any plan without cause.
5702.2A voluntary disenrollment shall be effective on the first day of the following month if the disenrollment request form is dated on or before the 15th of the month, but in no case shall the disenrollment be effective later than the first day of the second month after the month in which disenrollment is requested.
5702.3During the months two (2) through six (6) of membership, children enrolled in the managed care provider’s plan may disenroll only for good cause.
5702.4The managed care provider may disenroll any enrolled child who demonstrates a pattern of disruptive or abusive behavior or of missing scheduled appointments without notice, or whose utilization of service is fraudulent or deceptive.
5702.5The managed care provider shall submit a written request to the Department for written approval of each proposed involuntary disenrollment.
5702.6Except as provided in §5702.8, an involuntary disenrollment shall be effective not later than the first day of the second month following the approval of the involuntary disenrollment.
5702.7No eligible child shall be disenrolled solely because of an adverse change in health status.
5702.8The Department shall disenroll an enrolled child when the child becomes ineligible for Medicaid. The disenrollment shall be effective not later than the first day of the first full month following the effective date of the termination of Medicaid eligibility.